Methylene blue treatment for moderate-to-severe cases of acute respiratory syndrome due to COVID-19 infection: clinical outcomes—a prospective study

Background: We studied the real-life experience with Methylene blue administration among the moderate and severe cases of acute respiratory distress syndrome due to Covid-19 infection with the standard of care. Materials and Methods: This study is a prospective, single-center study including 103 hospitalized patients conducted in a tertiary healthcare center from June 2020 to July 2021. The route of administration of Methylene blue was through nebulization (0.5 mL 0.5% solution of Methylene blue + 2.5 mL of distilled water) three times a day as long as the patient was admitted. An ampoule of 10 mL of Methylene blue with 90 mL of potable water through oxygen port was administered as long as they needed oxygen. About 2 mg/kg body weight of Methylene blue in 300 mL of N.S. over 3 h was given once a day for 5 days. Results: Approximately 103 patients were seen with a mean age of 56.49 years. The most prevalent comorbid condition was diabetes. The SpO2 improved by 7.827%. On post-Methylene blue administration, the serum ferritin, C-reactive protein, lactate dehydrogenase, and D-dimer were reduced in comparison to pre-Methylene blue administration. Also, the average total length of stay was 14 ± 4.20, 13 ± 5.66, and 14 ± 3.50 days in 26.78% of patients in intensive care unit, 17.51% of patients in high dependency unit, and 58.71% of patients in Covid general ward, respectively. About 86.4% of the patients recovered and got discharged post-Methylene blue administration. The all-cause mortality was 13.59%, which could be due to underlying comorbidities and complications of Covid-19 infections. Conclusion: Methylene blue administration accelerated recovery in our patients with moderate and severe Covid-19 disease by controlling the hyperimmune response. The clinical improvement was seen by decreased levels of inflammatory markers, improved oxygen saturation, reduced length of hospital stay, and clinical improvements. Methylene blue administered in nebulization form, through oxygen port, and through intravenous infusion in the dose of 2 mg/kg body weight for 5 days and improved patients’ recovery, so it can be considered as a therapeutic option in moderate and severe Covid-19 disease.

Impacto del decúbito prono en el síndrome de insuficiencia respiratoria aguda en pacientes con COVID-19 bajo ventilación mecánica invasiva / Impact of prone position on acute respiratory distress syndrome in patients with COVID-19 under invasive mechanical ventilation / Impacto de la posição prona na síndrome da insuficiência respiratória aguda em pacientes com COVID-19 sob ventilação mecânica invasiva

Resumen: A finales del año 2019 surgió una nueva especie de coronavirus con la capacidad de producir enfermedad en humanos, conocida como SARS-CoV-2 y definiéndose la enfermedad como COVID-19. A partir de marzo del 2020 se comenzaron a presentar casos de neumonía por SARS-CoV-2 en el Hospital Español de México, algunos de estos pacientes desarrollaron la enfermedad grave requiriendo ventilación mecánica invasiva. Se realizó el estudio de una serie de casos, de tipo descriptivo, transversal, retrolectivo y analítico, desde mayo de 2020 hasta agosto de 2020, en pacientes ingresados en el área de terapia intensiva COVID en dicho hospital. Se obtuvo una muestra de 42 pacientes, 32 (76%) hombres y 10 (24%) mujeres, con neumonía severa por SARS-CoV-2 e hipoxemia refractaria con un cuadro de síndrome de insuficiencia respiratoria aguda (SIRA) moderado (PaO2/FiO2 < 200) a severo (PaO2/FiO2 < 100), los cuales necesitaron ventilación mecánica invasiva y por hipoxemia refractaria al menos un evento de decúbito prono. La duración mínima de cada episodio de prono fue al menos de 24 horas, teniendo como mínimo un evento de decúbito prono y como máximo siete eventos, con un promedio global de 2.7 eventos de decúbito prono. El tiempo máximo prono por evento fue de 36 horas continuas, teniendo un promedio de 30.1 horas en decúbito prono. Se logró establecer que los pacientes en decúbito prono presentaron una mejoría respecto al índice de oxigenación (PaO2/FiO2) con una p < 0.01, a diferencia de otros indicadores de oxigenación tales como PaO2 y PaCO2, donde no se encontró suficiente evidencia respecto a ser predictor sobre mortalidad y gravedad.

Abstract: At the end of 2019, a new species of coronavirus identified as SARS-CoV-2 emerged, with the ability to cause disease in humans, defined as COVID-19. As of March 2020, cases of SARS-CoV-2 pneumonia began to appear at the Hospital Español de México, some of these patients developed severe disease requiring invasive mechanical ventilation. A descriptive, cross-sectional, retrolective and analytical study of cases was conducted from May to August 2020, in patients admitted to the COVID intensive care area at said hospital. A sample of 42 patients was obtained, 32 (76%) men and 10 (24%) women, with severe pneumonia due to SARS-CoV-2 and refractory hypoxemia with a picture of acute respiratory insufficiency syndrome (SIRA) from moderate (PaO2/FiO2 < 200) to severe (PaO2/FiO2 < 100), which required invasive mechanical ventilation and for refractory hypoxemia at least one event in the prone position. The minimum duration of each prone episode was at least 24 hours, with a minimum of one decubitus and prone events and a maximum of seven events, with a global average of 2.7 prone events. The maximum prone time per event was 36 continuous hours, with an average of 30.1 hours in the prone position. It was possible to establish that patients in the prone position presented an improvement regarding the oxygenation index (PaO2/FiO2) with a p < 0.01, unlike other characteristics such as PaO2 and PaCO2, where not enough evidence was found with regard to being a predictor of mortality and gravity.

Resumo: No final de 2019, surgiu uma nova espécie de Coronavírus com capacidade de causar doença em humanos, identificando-se como COVID-19 e definindo a doença como SARS-CoV-2. Em março de 2020, casos de pneumonia por SARS-CoV-2 começaram a aparecer no Hospital Español de México, alguns desses pacientes desenvolveram doença grave que requereram ventilação mecânica invasiva. Uma série de casos descritivos, transversais, retroletivos e analíticos foi realizada de maio de 2020 a agosto de 2020 em pacientes internados na área de terapia intensiva COVID do Hospital Español de México. Uma amostra de 42 pacientes, 32 (76%) homens e 10 (24%) mulheres, com pneumonia grave por SARS-CoV-2 e hipoxemia refratária com síndrome de insuficiência respiratória aguda (SIRA) moderada (PaO2/FiO2 < 200) a grave (PaO2/FiO2 < 100), que exigiu ventilação mecânica invasiva e devido à hipoxemia refratária pelo menos um evento em decúbito prono. A duração mínima de cada episódio na posição prona foi menor a 24 horas, tendo como mínimo de 1 evento decúbito e prona e como máximo de 7 eventos, com uma média global de 2.7 eventos em decúbito prona. O tempo máximo em prona por evento foi de 36 horas contínuas, com média de 30.1 horas na posição prona. Foi possível estabelecer que os pacientes em decúbito prona apresentaram melhora em relação ao índice de oxigenação (PaO2/FiO2) com p < 0.01, ao contrário de outros indicadores de oxigenação como PaO2 e PaCO2, não foram encontradas evidências suficientes de ser um preditor de mortalidade e gravidade.

Clinico-Etiological Profile of Electrolyte Imbalance among Patients in a Government Hospital in Dakshina Kannada

Introduction: Hyponatremia is a state of electrolyteimbalance with a high prevalence rate, it is one of the leadingcause of morbidity and mortality in our settings. The aim ofthis study was to evaluate the clinical features and etiology ofhyponatremia in patients admitted in our government hospital.Material and methods: A 1-year prospective cross-sectionalobservational study was conducted on adult patients withmoderate-to-severe hyponatremia admitted to the hospital.Patients demographics were recorded and investigations weredocumented. Data were analyzed using independent samplet-test.Results: Vomiting (28) followed by confusion (26) was themost common complaint. Confusion was significantly highin patients with severe hyponatremia as compared to patientswith moderate. Increased urine sodium levels were observedin these patientsConclusion: Patients with hyponatremia secondary to aninfectious cause should be meticulously screened and timelyand effective treatment of hyponatremia is determined by theeffective understanding of pathophysiology and associatedrisk factors of hyponatremia.

Meta-analysis of Efficacy and Safety of Tapentadol Immediate-release Preparation for Relie ving Moderate and Severe Acute Pain after Brachiocephalic Arteritis / 中国药房

OBJECTIVE： To systematically evaluate the efficacy and safety of Tapentadol immediate-release preparation （Tap IR） for relieving severe acute pain after brachiocephalic arteritis， and to provide evidence-based reference for rational drug use. METHODS： Retrieved from PubMed， Medline， Cochrane library， CNKI， VIP， Wanfang database and American clinical trial database， randomized controlled trials （RCTs） about Tap IR （trial group） versus Oxycodone immediate-release preparation or placebo for relieving severe acute pain after brachiocephalic arteritis were collected. After literature screening， data extraction and literature quality evaluation with modified Jadad scale， Meta-analysis was conducted by using RevMan 5.3 software. RESULTS： A total of 6 RCTs were included， involving 2 378 patients. Results of Meta-analysis showed that 48 h total pain relief value （TOTPAR48） of trial group was significantly higher than control group [MD＝35.60，95％CI（27.31， 43.88）， P＜0.000 01]. Results of sub-group analysis showed that TOTPAR48 of trial group using Tap IR 50 mg [MD＝28.68， 95％CI （18.18， 39.17），P＜0.00 001]， 75 mg [MD＝39.97， 95％CI （34.21， 45.73）， P＜0.000 01] and 100 mg[MD＝38.50， 95％CI（1.46， 75.54），P＝0.04] were significantly higher than control group； TOTPAR48 of patients who received Tap IR 75 mg were significantly higher than patients who received Tap IR 50 mg [MD＝9.04，95％ CI（4.31， 13.77），P＝0.000 2]. There was no statistical significance in the utilization rate of rescue medicine （URM） between 2 groups [RR＝1.23，95％ CI（0.84， 1.80），P＝0.29]. Subgroup analysis showed that URM in patients who received Tap IR 75 mg was significantly lower than those receiving Tap IR 50 mg [RR＝0.62，95％CI（0.41， 0.94），P＝0.02]. The total difference of 48 h pain intensity （SPID48） in trial group was significantly lower than control group [MD＝－18.96，95％CI（－37.28，－0.64），P＝0.04]. Subgroup analysis showed that SPID48 in patients who received Tap IR 75 mg was significantly higher than those receiving Tap IR 50 mg [MD＝21.66，95％CI（8.93， 34.39），P＝0.000 9]. There was no statistical significance in the total change of pain impression （PGIC） between 2 groups [RR＝0.95，95％CI（0.88， 1.03），P＝0.23]. Subgroup analysis showed that PGIC in patients who received Tap IR 75 mg was significantly higher than those receiving Tap IR 50 mg [RR＝1.07，95％CI（1.01， 1.13），P＝0.02] but significantly lower than those receiving Tap IR 100 mg [RR＝0.86，95％CI（0.77， 0.97），P＝0.01]. The incidence of nausea， vomiting， constipation， dizziness and headache in trial group were significantly lower than control group （P＜0.05）. CONCLUSIONS： Tap IR shows good therapeutic efficacy and safety for severe acute pain after brachiocephalic arteritis， and the efficacy of Tap IR might be better when the dose of Tap IR is 75 mg.

Short-term efficacy of pranoprofen combined with sodium hyaluronate in the treatment of moderate to severe dry eye / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate the short-term clinical efficacy of pranoprofen eye drops combined with sodium hyaluronate eye drops in the treatment of moderate to severe dry eye and its influence on the psychological status of patients.<p>METHODS: From January to December 2018, 318 patients with moderate to severe dry eye were selected and treated in ophthalmology department of our hospital. The patients were divided into experimental group(238 patients)and control group(80 patients)by random number table method, and the control group was treated with sodium hyaluronate eye drops, while the test group was treated with pranoprofen eye drops combined with sodium hyaluronate eye drops. The general data of the patients were statistically analyzed. Before treatment, 7d, 14d, 28d after treatment, the patients' scores of conscious symptoms and signs were investigated by questionnaire, the degree of conjunctival congestion, tear breakup time, corneal fluorescein staining and tear secretion were examined, and the degree of anxiety and depression were evaluated.<p>RESULTS: There was no significant difference in general data between the two groups(<i>P</i>>0.05). In terms of patients' scores of conscious symptoms and signs, degree of conjunctival congestion, tear breakup time, corneal fluorescein staining and tear secretion, the experimental group was significantly improved 7d after treatment, and the effect was more significant with the prolonged treatment, while the control group was gradually improved 14 or 28d after treatment. At the same treatment time point, the efficacy of the experimental group was significantly better than that of the control group, and the difference was statistically significant(<i>P</i><0.05). With the improvement of the condition after treatment, the anxiety or depression symptoms of the patients were improved. The experimental group was significantly improved 7d after treatment, while the control group was gradually improved 14d or 28d after treatment. At the same treatment time point, compared with the control group,the anxiety and depression degree of the patients in the experimental group were significantly reduced(<i>P</i><0.05).<p>CONCLUSION: Pranoprofen eye drops combined with sodium hyaluronate eye drops for treatment of dry eye syndrome had fast and significant effect, patients' self-consciousness symptoms and signs are significantly improved, conjunctival congestion and corneal fluorescein staining are reduced, tear breakup time is prolonged, tear secretion is increased, and anxiety or depression are significantly improved.

Herbal-partitioned moxibustion for moderate to severe persistent allergic rhinitis with spleen-deficiency syndrome / 中国针灸

<p><b>OBJECTIVE</b>To explore the clinical efficacy of herbal-partitioned moxibustion on moderate and severe persistent allergic rhinitis (AR) with spleen-deficiency syndrome.</p><p><b>METHODS</b>With prospective case series study method, forty-seven patients of moderate and severe persistent AR with spleen-deficiency syndrome were treated with herbal-partitioned moxibustion at Yintang (GV 29), Shenque (CV 8), Hegu (LI 4) and Zusanli (ST 36), once every two days, three treatments a week, continuously for 8 weeks. The visual analogue scale (VAS), rhinoconjunctivitis quality of life questionnaire (RQLQ) and scores of spleen-deficiency syndrome were recorded before treatment, 2 weeks, 4 weeks and 8 weeks into treatment as well as 4 weeks after treatment; in addition, the improvement rate of each index was compared before and after treatment.</p><p><b>RESULTS</b>Compared before treatment, the VAS, RQLQ and scores of spleen-deficiency syndrome were significantly reduced 2 weeks, 4 weeks and 8 weeks into treatment as well as 4 weeks after treatment (<0.05,<0.01). The efficacy was gradually increased 2 weeks, 4 weeks and 8 weeks into treatment (all<0.01). On the 8 weeks into treatment, the improved and markedly effective rate was 59.6% (28/47) for VAS, 19.1% (9/47) for RQLQ and 14.9% (7/47) for scores of spleen-deficiency syndrome; the total effective rate was all 85.1% (40/47). Compared with 4 weeks after treatment, there was no significant difference (all>0.05).</p><p><b>CONCLUSIONS</b>The herbal-partitioned moxibustion has superior efficacy for moderate and severe persistent allergic rhinitis with spleen-deficiency syndrome.</p>

Preventive effect of low molecular weight heparin calcium on venous thrombosis in patients with moderate to severe burn and analysis of nursing satisfaction / 中国生化药物杂志

Objective To explore the preventive effect of low molecular weight heparin calcium in severe burn patients with venous thrombosis. Methods 64 patients of lower extremity burns complicated by systemic inflammatory response in Taizhou Enze medical center (Group) Enze hospital from March 2016 to 2017 March as the research object, were received once daily subcutaneous injection of 2850 U (0.3 mL) low molecular weight heparin calcium treatment, continuous injection of 10 d. The control group was given the routine nursing on the basis treatment, the observation group was given nursing intervention, the incidence rate of deep venous thrombosis and nursing satisfaction rate were compared between two groups. Methods FIB and blood D-dimer in the seventh day after treatment were improved (P<0.05) , PT and APTT in the seventh day after treatment were increased (P<0.05) , the level of FIB in the seventeenth day after treatment was significantly lower than the first day and the seventh day. The incidence of deep vein thrombosis in the observation group was significantly lower than the control group, nursing satisfaction rate in the observation group was higher than the control group, the difference was statistically significant (P<0.05). Conclusion Subcutaneous injection of low molecular weight heparin calcium in patients who are in high blood coagulation state after moderately severe burns SIRS can effectively prevent deep venous thrombosis, auxiliary nursing intervention is helpful to promote the rehabilitation of patients and improve nursing satisfaction.

Preventive effect of low molecular weight heparin calcium on venous thrombosis in patients with moderate to severe burn and analysis of nursing satisfaction / 中国生化药物杂志

Objective To explore the preventive effect of low molecular weight heparin calcium in severe burn patients with venous thrombosis. Methods 64 patients of lower extremity burns complicated by systemic inflammatory response in Taizhou Enze medical center (Group) Enze hospital from March 2016 to 2017 March as the research object, were received once daily subcutaneous injection of 2850 U (0.3 mL) low molecular weight heparin calcium treatment, continuous injection of 10 d. The control group was given the routine nursing on the basis treatment, the observation group was given nursing intervention, the incidence rate of deep venous thrombosis and nursing satisfaction rate were compared between two groups. Methods FIB and blood D-dimer in the seventh day after treatment were improved (P<0.05) , PT and APTT in the seventh day after treatment were increased (P<0.05) , the level of FIB in the seventeenth day after treatment was significantly lower than the first day and the seventh day. The incidence of deep vein thrombosis in the observation group was significantly lower than the control group, nursing satisfaction rate in the observation group was higher than the control group, the difference was statistically significant (P<0.05). Conclusion Subcutaneous injection of low molecular weight heparin calcium in patients who are in high blood coagulation state after moderately severe burns SIRS can effectively prevent deep venous thrombosis, auxiliary nursing intervention is helpful to promote the rehabilitation of patients and improve nursing satisfaction.

Clinical Observation of Xuebijing Injection in the Treatment of Moderate and Severe Infection of Stage Ⅲ-Ⅳ Pressure Ulcer / 中国药房

OBJECTIVE:To observe the clinical effect and safety of Xuebijing injection in the treatment of moderate and se-vere infection of stage Ⅲ-Ⅳ pressure ulcer. METHODS:A total of 130 cases of moderate and severe infection of stage Ⅲ-Ⅳ pres-sure ulcer admitted to our hospital from Jul. 2011 and Jun. 2016 were randomly divided into observation group and control group, with 65 cases in each group. Control group was treated with 0.5%Iodophor disinfectant to disinfect the sore surface,given wet ster-ile gauze soaked with 0.5% Iodophor disinfectant to compress sore surface for 30 min,and then given Aikangfu absorptive silver ion antibacterial healing dressing to fill wound,changed dressing after 2/3 was soaked. Observation group was additionally given Xuebijing injection 50 mL added into normal saline 100 mL intravenously for 30-40 min,2-3 times a day,for consecutive 7 days,on the basis of control group. Treatment course of both groups lasted for 4 weeks. The clinical efficacy,the score of pres-sure ulcer scale for healing(PUSH),debridement time,the time of local symptom and SIRS disappearance as well as the occur-rence of ADR were compared between 2 groups. RESULTS:The total response rate of observation group(93.85%)was signifi-cantly higher than that of control group (80.00%),and debridement time,the time of local symptom and SIRS disappearance were all significantly shorter than control group,with statistical significance(P0.05). After 1-4 weeks of treatment,PUSH score of 2 groups was de-creased significantly compared to before treatment,and the score of observation group was significantly lower than that of con-trol group,with statistical significance(P<0.05). No obvious ADR was found in 2 groups. CONCLUSIONS:For moderate and severe infection of stage Ⅲ-Ⅳ pressure ulcer,Xuebijing injection effectively reduces inflammatory exudation,improves the ab-sorption of necrotic tissue,relieves local symptom and systematic inflammatory reaction,promotes the healing of pressure ulcers and has good clinical effect and safety.

Effect of midazolam on inflammatory mediators in patients with moderate and severe brain injury / 中国中西医结合急救杂志

Objective To investigate the effect of midazolam on inflammatory response in patients with moderate and severe craniocerebral injury and its protective effect on the brain and mechanism.Methods A prospective study was conducted.One hundred and twenty patients with moderate and severe craniocerebral injury admitted to the Intensive Care Unit (ICU) of Jiangsu Subei Peoples' Hospital from April 2013 to July 2016 were enrolled,and they were divided into a conventional treatment group (58 cases) and a midazolam group (62 cases) according to the random number table method.Both groups were given conventional western medicine treatment,and in cases with surgical indications,operations were performed;in midazolam group,additionally intravenous injection of midazolam 2-3 mg was given firstly,and then continuous intravenous infusion of the drug 0.05-0.10 mg· kg-1· h-1 was applied by a pump,and in operative patients,the above management was given 3 hours after operation.The mean arterial pressure (MAP),heart rate (HR),Riker sedation agitation score (SAS) and electroencephalogram bispectral index (BIS) were measured before and after treatment for 24,48 and 72 hours,respectively.The levels of interleukin-6 (IL-6) and soluble nerve chemotactic protein (sFkn) in plasm and cerebrospinal fluid (CSF) were measured by double antibody sandwich enzyme linked immunosorbent assay (ELISA) at each time point;the incidence of epilepsy and 28-day mortality were recorded.Results Before and after treatment,the MAP and HR in the two groups of patients were stable,the difference being not statistically significant (both P ＞ 0.05).Compared with those before treatment,after treatment the SAS score and BIS in two groups of patients were gradually decreased,and at 72 hours reached the lowest levels (SAS score:conventional treatment group was 3.8 ± 1.0 vs.5.7 ± 2.0,midazolam group was 3.6 ± 0.9 vs.5.8 ± 1.7;BIS:conventional treatment group was 69± 12 vs.82± 12,midazolam group was 72± 15 vs.82± 12,all P ＜ 0.05),but there were no significant differences between the two groups (all P ＞ 0.05),suggesting that the two groups had achieved the desired goal of sedation.ELISA results showed:compared with those before treatment,after treatment for 24 hours,the CSF IL-6,sFkn and plasm sFkn levels were temporarily increased in short term,and then showed a tendency of gradually decreasing,and the plasm IL-6 presented persistently descending in the conventional treatment group,while in the midazolam group,since 24 hours after treatment,each index showed a trend of decrease and continued to 72 hours.After treatment at each time point,the CSF and plasm levels of IL-6 and sFkn were significantly lower in midazolam group than those of the conventional treatment group,and reached to the minimal levels at 72 hours [CSF:IL-6 (ng/L) was 251.6 ± 145.7 vs.347.3 ± 146.4,sFkn (ng/L):289.7 ± 79.3 vs.423.6 ± 132.8;plasm:IL-6 (ng/L) was 54.4± 27.3 vs.85.6 ± 41.8,SFkn (ng/L):919.9±426.3 vs.1 199.4 ± 414.8,all P ＜ 0.05].The incidence of epilepsy in the midazolam group was obviously lower than that in the conventional treatment group [1.61％ (1/62) vs.10.34％ (6/58),P ＜ 0.05],but there was no significant difference between midazolam group and the conventional treatment group in the 28-day mortality [11.29％ (7/62) vs.10.34％ (6/58),P ＞ 0.05].Conclusion Midazolam can reduce the incidence of epilepsy in patients with moderate and severe traumatic brain injury,and its brain protective effect may be related to the decrease of CSF and plasm IL-6 and sFkn levels.

Clinical Observation of Salmeterol and Fluticasone Propionate in the Treatment of Moderate and Severe Bronchial Asthma / 中国药房

OBJECTIVE:To observe clinical efficacy and safety of salmeterol and fluticasone propionate in the treatment of mod-erate and severe bronchial asthma. METHODS:98 patients with moderate and severe bronchial asthma were selected from our hospi-tal were included in the study and were randomly divided into control group(49 cases,3 cases withdrew from the test and 46 cases completed the test)and observation group(49 cases,2 cases withdrew from the test and 47 cases completed the test). Control group was given Budesonide aerosol preparation,1 dose,bid;observation group was given Salmeterol and fluticasone propionate inhala-tion,1 dose,bid. The treatment course lasted for 2 months. Clinical efficacy,lung function indexes,the time of clinical symptom disappearance,FEV1,PD20,ACT score,asthma attack times within half an year,EO%and ECP in serum and sputum,and the oc-currence of ADR were compared between 2 groups. RESULTS:After treatment,total effective rate of observation group was signifi-cantly higher than that of control group(95.73% vs. 76.09%);FVC,FEV1 and PEF and other indexes of 2 groups were increased significantly,and the observation group was significantly higher than the control group;the disappearance time of pulmonary rales, wheezing,dyspnea and cough in observation group were significantly shorter than in control group;PD20 and ACT score of 2 groups were significantly increased,ACT score of observation group was significantly higher than that of control group;EO% and ECP in serum and sputum of observation group were significantly lower than those of control group,there was statistical significance (P0.05). All ADRs disappeared after drug withdrawal. CONCLUSIONS:Therapeutic efficacy of salmeterol and fluticasone propio-nate is better than budesonide in the treatment of moderate and severe bronchial asthma,and can effectively improve lung function, shorten the time of clinical symptoms disapperance and reduce the level of inflammatory factor with and good safety.

Clinical Observation of Pranoprofen Combined with Sodium Hyaluronate in the Treatment of Moderate and Severe Dry Eyes / 中国药房

OBJECTIVE:To explore the effectiveness and safety of pranoprofen combined with sodium hyaluronate in the treat-ment of moderate and severe dry eyes. METHODS:180 patients with moderate and severe dry eyes were divided into observation group and control group by random number table method,with 90 cases in each group. Control group was given Sodium hyaluro-nate eye drops,one drop each time,tid,and received physical therapy as cleaning eyelid,hot compress and glandulae tarsales mas-sage. Observation group was additionally given Pranoprofen eye drops,one drop each time,tid. A treatment course lasted for 2 weeks. The monocular corneal fluorescence staining score,break-up time of tear film(BUT),dry eye symptom scores,ShirmerⅠtest (SIT) before and after treatment,clinical efficacy and ADR were compared between 2 groups. RESULTS:2,4 weeks after treatment,monocular corneal fluorescence staining scores and dry eye symptom scores of 2 groups were significantly lower than be-fore treatment;BUT and SIT were significantly longer than before;those indexes after 4 weeks of treatment were significantly bet-ter than after 2 weeks of treatment;those indexes of observation group after 2,4 weeks of treatment were significantly better than those of control group at the same time,with statistical significance (P0.05). CONCLUSIONS:For moderate and severe dry eyes,prano-profen combined with sodium hyaluronate can effectively control ocular inflammation and improve tear film stability. It shows defi-nite therapeutic efficacy and good safety.

Psoriasis Vulgar moderada y severa: opciones terapéuticas (tratamientos convencionales) / Moderate and Severe Psoriasis Vulgaris: therapy options(conventional therapies)

La psoriasis es una enfermedad de filiación inmunológica, frecuente a nivel mundial. En población europea y en EE.UU. reporta una prevalencia del 0,6 al 4%. No hay reportes en Uruguay. La forma clásica de presentación es la vulgar en placas. Si bien en la mayoría de los casos es paucisintomática y las terapias tópicas permiten su control (psoriasis leve), en una proporción importante de casos es capaz de afectar severamente la calidad de vida al generalizarse o asociar afectación de otros órganos, o en casos extremos inclusive llevar a la muerte. El objetivo principal de este artículo es brindar recomendaciones unificadas sobre el tratamiento de la psoriasis vulgar en placas moderada y severa. En esta parte se discuten tratamientos sistémicos ‘convencionales’, priorizando la fototerapia, metotrexato, ciclosporina A y retinoides. Aquí no se incluirán las terapias dirigidas contra blancos moleculares (llamadas ‘terapias biológicas’) que ya constituyen alternativas convencionales en los países desarrollados.

Psoriasis is a common worldwide disease and is considered of immune affiliation. In Europe and the U.S. population reported a prevalence of 0.6 to 4%. There are no reports of Uruguay prevalence. The classic presentation is vulgar plates. Although in most cases the disease is paucisymptomatic and topical therapies allows control (mild psoriasis), in a significant proportion can severely affect quality of life associated with generalized psoriasis or involvement of other organs. Even lead to death. The main objective of this article is to provide unified guidelines on the treatment of chronic plaque psoriasis with moderate to severe presentation. This part discusses systemic ‘conventional’ treatments, giving priority to phototherapy, methotrexate, cyclosporin A and retinoids. The so called ‘Biologic Therapies’ wich are already conventional alternatives in developed countries, will be the subject of Part II of these recommendations.