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Introducción: El término ''síndrome antifosfolipídico'' (SAF) describe la asociación de los anticuerpos antifosfolipídicos (AAF) con un cuadro clínico de hipercoagulabilidad caracterizado por trombosis a repetición y abortos recurrentes. Objetivo: Presentar un caso de celulitis severa de periné en paciente con SAF y tratamiento con hidroxicloroquina. Caso clínico: Paciente de 39 años con embarazo de término con SAF tratado con hidroxicloroquina y anticoagulación que desarrolló una infección severa de partes blandas del periné que fue tratado con interrupción del embarazo, drenaje agresivo del periné y tratamiento antibiótico extenso con buena evolución. Conclusión: La asociación del tratamiento con hidroxicloroquina, embarazo y una complicación séptica es incierta. El tratamiento con inmunosupresión no es estándar y podría haber favorecido el mal pronóstico del cuadro clínico. (AU)
Objetive: To present a case of severe perineal cellulitis in a pregnant patient with Antiphospholipid syndrome treated wiht hidroxicloroquine. Case report: A 39 years old female pregnant patient with AFS treated with hidroxicloroquine and heparin developed severe perineal infection with systemic impairment. Final treatment included aggressive perineal drainage in multiple sessions, pregnancy delivered and systemic treatment with wide spectrum antibiotics and general measures. Discusion and Conclusion: Treatment with hidroxicloroquine, pregnancy and septic complication is infrequent. This approach is not standard and it could favored worst prognostic of the general syndrome. (AU)
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Humans , Female , Pregnancy , Adult , Pregnancy Complications, Infectious , Cellulitis/surgery , Cellulitis/drug therapy , Antiphospholipid Syndrome/drug therapy , Fournier Gangrene/surgery , Fournier Gangrene/drug therapy , Perineum/surgery , Perineum/injuries , Clindamycin/therapeutic use , Vancomycin/therapeutic use , Meropenem/therapeutic use , Hydroxychloroquine/adverse effects , Hydroxychloroquine/therapeutic use , Anti-Bacterial Agents/therapeutic useABSTRACT
Introduction: Voriconazole (VRCZ) is a triazole antifungal agent for which therapeutic drug monitoring (TDM) is recommended. At Juntendo University Hospital, the VRCZ TDM implementation rate was 42% between January 2011 and October 2017. Here, we report that modifications to the hospital’s drug ordering system improved the implementation rate of VRCZ TDM.Method: In August 2018, the drug ordering system was modified so that a message appeared on the screen to notify clinicians of the need to monitor VRCZ blood concentrations and to recommend a date for sample collection. In addition, the laboratory orders for VRCZ levels were digitized. We compared two one-year periods before and after implementation of the modifications (August 2017 to July 2018 and August 2018 to July 2019) to verify the effect of the changes.Result: Results showed an increase in the TDM implementation rate: 12 patients (42.8%) received TDM before modification of the system, and 26 patients (92.9%) received TDM after modification of the system. Further, the rate of blood sampling at the recommended time point for estimating blood concentration (day 5-7 after the start of administration) improved after system modification, i.e., blood samples were collected from 18 patients (64.3%) at the steady state point. In contrast, blood samples were collected from only 6 patients (21.4%) before system modification. When blood concentrations deviated from the target range in patients who received TDM, clinicians took appropriate actions, such as reducing drug doses, prescribing drug holidays, or discontinuing medications.Conclusion: A system that provides information related to VRCZ blood concentration measurements can help clinicians provide patients with optimal pharmacotherapy.
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Fufang Niuhuang Xiaoyan capsule was a classical compound prescription with the efficacy of heat-clearing, detoxification, sedation and anti-inflammation, with cinnabaris as one of its active ingredients. The study focuses on the pharmacokinetics of mercury in rats after oral administration of cinnabaris and Fufang Niuhuang Xiaoyan capsule, in order to explore the effect of combined traditional Chinese medicines on mercury metabolism. In this study, the method of nitric-perchloric acid digestion system coupled with cold atomic-atomic fluorescence spectroscopy (CV-AFS) was adopted to accurately determine mercury in whole blood of rats. Fufang Niuhueng Xiaoyan capsule had three dose schemes of oral administration, namely equivalent clinical dose, 3 times of equivalent clinical dose and 10 times of equivalent clinical dose; And the doses of oral administration of cinnabaris was calculated according to that of Fufang Niuhuang Xiaoyan capsule. SPF grade healthy SD rats were fasted overnight before the oral administration with cinnabaris suspension (or Fufang Niuhuang Xiaoyan capsule suspension). After oral administration of different doses of cinnabaris, no obvious changes in tmax and MRT were observed, while Cmax/dose, AUC0-48 h/dose and AUC0-∞/dose decreased with the increase in dose, indicating that total mercury absorption in body was declining. As the dose increased, Ke, CL/F decreased, and t1/2 increased, indicating that the elimination slowed down, and mercury metabolism showed non-linear dynamic characteristics within a certain range of dose (22-220 mg•kg⁻¹). The total mercury metabolism in the whole blood of rats after oral administration with different doses of Fufang Niuhuang Xiaoyan capsule also showed non-linear dynamic characteristics. The results were correlated with the low solubility of cinnabaris in the body. Compared with cinnabaris, Fufang Niuhuang Xiaoyan capsule showed no obvious changes in V/F and MRT, while Ke, CL/F, tmax decreased, and t1/2, Cmax/dose, AUC0-48 h/dose, AUC0-∞/dose increased significantly. The results showed that Fufang Niuhuang Xiaoyan capsule accelerated absorption, slowed down elimination and improved the total absorption of mercury in the whole blood, indicating that Fufang Niuhuang Xiaoyan capsule may contain components for promoting absorption and alleviating elimination of mercury. Fufang Niuhuang Xiaoyan capsule had an impact on the pharmacokinetics of cinnabaris, and long-term administration of cinnabaris (Fufang Niuhuang Xiaoyan capsule) was possible to cause accumulation of mercury in the body. This study could explain changes in efficacy of Fufang Niuhuang Xiaoyan capsule, evaluate the rationality of compound medicines containing toxic elements and provide scientific basis for the rational and safe use of Fufang Niuhuang Xiaoyan capsule.
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Objective To determine the content of heavy metals and harmful elements in commercially available Yuanhu Zhitong Capsule. Methods The determination of lead, cadmium, arsenic, mercury, copper and chromium by atomic absorption spectrometry and atomic fluorescence spectrometry was established.Results The recovery rate of the method was between 91.2% and 111.2%, and the precision of the experiment was less than 5%, and the range of each element was good.The stability and reproducibility of the method were good.Lead and cadmium and copper of Yuanhu zhitong capsule in different degree exceeded the standard, while the content of arsenic, mercury and chromium was in accordance with the requirements. Conclusion The method is simple and easy to operate, convenient and quick.The content of the current limit of Yuanhu zhitong capsule still need to establish the quality standard of lead and cadmium, arsenic, mercury, copper and chromium.In this paper, the establishment of the heavy metals and harmful elements determination method of Yuanhu zhitong capsule provide quality control and safety evaluation of reference.
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Objective:To analyze the content of Pb, Cd, Cu, As and Hg in freeze-dried Rehmannia from different habitats by FAAS and double channels AFS. Methods:The contents of Pb,Cd and Cu in Rehmannia from different habitats were directly deter-mined by FAAS, while the contents of As and Hg were determined by double channels AFS after pretreated with HNO3-HClO4 . Re-sults:It was shown that each element had good linear relationship with the correlation coefficient above 0. 997 4. The average recovery was 97. 88%-100. 90% with RSD of 0. 019% -4. 20% (n=6). Meanwhile, the concentrations of 5 harmful elements and heavy met-als in 4 batches of 10 samples were higher than the limits described in Chinese pharmacopoeia. Conclusion:The results measured by the method are considered to be accurate, quick and easy to be operated. It can be used to determine heavy metals and harmful ele-ments in freeze-dried Rehmannia from different habitats.
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The safety of traditional Chinese medicine (TCM) is a major strategic issue that involves human health. With the continuous improvement in disease prevention and treatment, the export of TCM and its related products has increased dramatically in China. However, the frequent safety issues of Chinese medicine have become the 'bottleneck' impeding the modernization of TCM. It was proved that mycotoxins seriously affect TCM safety; the pesticide residues of TCM are a key problem in TCM international trade; adulterants have also been detected, which is related to market circulation. These three factors have greatly affected TCM safety. In this study, fast, highly effective, economically-feasible and accurate detection methods concerning TCM safety issues were reviewed, especially on the authenticity, mycotoxins and pesticide residues of medicinal materials.
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Background: Endometriosis is one of the common gynaecological problems mostly affecting the women in reproductive age, associated with non menstrual pelvic pain and other symptoms and recurrence of endometriosis is common after medical or even surgical treatment. Objectives: This review is done to assess, whether conservative surgery and adjunctive hor- mone suppression therapy is more beneficiary than surgery alone in the treatment of sympto- matic endometriosis in term of pelvic pain and disease recurrence. Data sources and search method: Searched had been performed on Cochrane Central Register of Controlled trials, MEDLINE, PsycINFO. Journals and reference lists had been also searched. Review methods: Only Randomized controlled trials were included if they compared the effec- tiveness of hormone therapy following conservative surgery with surgery alone or surgery plus placebo in the treatment of symptomatic endometriosis. Outcome data had been analysed by using a Mantel-Haenzel Fixed-effect model to perform meta-analysis and results had been pre- sented as Risk ratio for binary data and Standardised Mean difference for continuous data with 95% confidence intervals. Results: Out of 8 trails pelvic pain was reported in 7 trials. No significant benefit was observed both in pelvic pain recurrence (RR= 0.75, 95% Cl- 0.54 to1.04) and disease recurrence (RR 0.89, 95% Cl 0.53 to 1.49) among 5 trials (481& 447 participants) in favour of surgery and adjunctive hormone therapy. On the other hand another 2 trials (280 participants) showed sig- nificant benefit in pelvic pain score (Std. Mean difference-0.80, 95%Cl -1.05 to -0.55) but con- siderable heterogeneity (I²= 96%) was observed. Conclusion: Women who received Post-surgical hormone therapy in the treatment of sympto- matic endometriosis had no advantages in respect of endometriosis and pelvic pain recurrence in compared with surgery alone.
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OBJECTIVE: To establish an HPLC-MS method for the determination of ecabet and a HG-AFS method for the determination of bismuth, and to investigate their urinary excretion profiles after oral administration of ecabet bismuth suspension in healthy volunteers. METHODS: Urine samples were precipitated, acidized, and separated on an Hanbon ODS-2 column with methanol-20 mmol·L-1 ammonium (55:45) as a mobile phase. Electrospray ionization source and negative ion mode for MS were used. A sensitive hydride generation atomic fluorescence spectrophotometry (HG-AFS) method for the determination of bismuth was also developed and validated. Urine samples were digested using wet digestion method. Ten healthy volunteers were given single oral dose of 800 mg ecabet bismuth suspension. RESULTS: The calibration curve in urine was linear in the range of 20.44-30660 ng·mL-1 for ecabet and 0.3-40 ng·mL-1 for bismuth, respectively. The average recoveries were more than 92.8% and 92.0%, respectively. After the volunteers took the suspensions, the average urinary excretion rates of ecabet and bismuth were highest at 0-2 h and the average cumulative excretion percentages of ecabet and bismuth in urine within 72 h were (0.9±0.6)% and (0.02±0.01)%, respectively. CONCLUSION: The methods are suitable for the determination of ecabet and bismuth in human urine and for the investigation on their urinary excretion profiles. Copyright 2012 by the Chinese Pharmaceutical Association.
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Humans , Male , Ameloblasts , Fibrosarcoma , Gingiva , Jaw , Mandible , Mouth Floor , Neck , Neoplasm Metastasis , Odontogenic Tumors , Recurrence , UlcerABSTRACT
The objective of this paper is to discuss the current guidelines for treatment of endometriosis, emphasis on the role of laparoscopic surgery and medical treatment. The accuracy of diagnosis of endometriosis without laparoscopy is very low, as a false negative rate of 19 % and a false positive rate of 44%, when a diagnosis was made pre laparoscopy, 81% had the diagnosis can confirmed on laparoscopy, while 19% did not have endometriosis. It is concluded that laparoscopy is required for evaluation and treatment of endometriosis. Medical therapy is effective in reducing progression of endometriosis score.
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EndometriosisABSTRACT
OBJECTIVE:To establish a determination method for trace elements of Plumbago zeylanica. METHODS:Induct- ively coupled plasma emission spectrum (ICP-AES) was used to determine seven trace elements of P. zeylanica, i.e. Cu, Zn,Fe,Ca,Mg,Mn and Sr simultaneously. Se was determined by atomic fluorescence (AFS) method. RESULTS: The RSD ranged from 0.78% to 3.01%(n=5),while the recovery was within 91.9%～105.8%. The result obtained was satisfactory. Se took a large proportion in P. zeylanica, followed by Cu,Zn,Fe,Ca,Mg,Mn,Sr.CONCLUSION: The method is brief, rapid and accurate for the determination of P. zeylanica. The study provide reference for future pharmacological study of P. zeylanica.
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0.05) both in AFS assay and MTT assay to detect the apoptosis of the cell lines. However, there was significant difference ( P
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Three methods C2, 3-diaminonaphathalene molecular fluorimetry, hydride generation atomic fluorescence spectrometry (HG-AFS) and hydride generation atomic absorption spectrometry (HG-AAS)] for the determination of selenium in food samples were compared with one another. The absolute detection limits of HG-AFS and HG-AAS are 1.2 and 0.9ng respectively, lower than that of molecular fluorimetry(3.9ng). The precisions and accuracies of HG-AFS and HG-AAS are similar to molecular fluorimetry. When these methods were used to determine selenium in 6 standard reference materials, there was no significant difference among the mean values from each of the methods.