右美托咪啶与咪达唑仑在重症破伤风患者镇静中效果比较

目的:比较右美托咪啶与咪达唑仑用于重症破伤风患者镇静中效果。方法:选取2012年1月~2015年12月间在我院治疗的重症破伤风患者72例,通过随机数表法分为右美托咪啶组与咪达唑仑组,各36例,给予右美托咪啶组静脉泵入右美托咪啶1μg/kg持续时间为10 min,之后以0.3~0.6μg/kg进行维持,咪达唑仑组静脉泵入咪达唑仑0.05 mg/kg,持续时间为1 min,之后以0.02~0.1/kg·h进行维持。监测两组患者用药前及用药12 h后平均动脉压(MAP)、呼吸频率(RR)、血氧饱和度(SpO_2)和心率(HR)深用Ramasy评分法评估镇静程度。结果:两组患者治疗后HR、RR、MAP水平明显降低而SpO_2明显上升且右美托咪啶组HR、RR、及SpO_2改善更显著差异均有统计学意义(P0.05);两组用药后4 h、8 h、12 h时Ramasy评分在组间、组内比较差异均无统计学意义(P0.05);右美托咪啶组不良反应发生率为5.56%,低于咪达唑仑组的16.67%,差异有统计学意义(P0.05)。结论右美托咪啶有助于维持患者血流动力学的稳定减少重症破伤风患者心动过速、心率增快、呼吸抑制等不良反应情况的发生。     

Internal Medicine: Ventilator Management of Severe Asthma

The Scientific Board of the California Medical Association presents the following inventory of items of progress in internal medicine. Each item, in the judgment of a panel of knowledgeable physicians, has recently become reasonably firmly established, both as to scientific fact and important clinical significance. The items are presented in simple epitome, and an authoritative reference, both to the item itself and to the subject as a whole, is generally given for those who may be unfamiliar with a particular item. The purpose is to assist busy practitioners, students, researchers, or scholars to stay abreast of these items of progress in internal medicine that have recently achieved a substantial degree of authoritative acceptance, whether in their own field of special interest or another.The items of progress listed below were selected by the Advisory Panel to the Section on Internal Medicine of the California Medical Association, and the summaries were prepared under its direction.     

Papaya Ring Spot Virus: An Understanding of a Severe Positive-Sense Single Stranded RNA Viral Disease and Its Management

Viral diseases have been studied in-depth for reducing quality, yield, health and longevity of the fruit, to highlight the economic losses. Positive-sense single-stranded RNA viruses are more devastating among all viruses that infect fruit trees. One of the best examples is papaya ringspot virus (PRSV). It belongs to the genus Potyvirus and it is limited to cause diseases on the family Chenopodiaceae, Cucurbitaceae and Caricaceae. This virus has a serious threat to the production of papaya, which is famous for its high nutritional and pharmaceutical values. The plant parts such as leaves, latex, seeds, fruits, bark, peel and roots may contain the biological compound that can be isolated and used in pharmaceutical industries as a disease control. Viral disease symptoms consist of vein clearing and yellowing of young leaves. Distinctive ring spot patterns with concentric rings and spots on fruit reduce its quality and taste. The virus has two major strains P and W. The former cause disease in papaya while the later one in papaya. Virion comprises 94.4% protein, including a 36 kDa coat protein which is a component responsible for a non-persistent transmission through aphids, and 5.5% nucleic acid. Cross protection, development of transgenic crops, exploring the resistant sources and induction of pathogen derived resistance have been recorded as effective management of PRSV. Along with these practices reduced aphid population through insecticides and plant extracts have been found ecofriendly approaches to minimize the disease incidence. Adoption of transgenic crops is a big challenge for the success of disease resistant papaya crops. The aim of this review is to understand the genomic nature of PRSV, detection methods and the different advanced control methods. This review article will be helpful in developing the best management strategies for controlling PRSV.     

Risk of Severe Upper Gastrointestinal Complications among Oral Bisphosphonate Users

Background

Oral bisphosphonates (BPs) are the primary agents for the treatment of osteoporosis. Although BPs are generally well tolerated, serious gastrointestinal adverse events have been observed.

Aim

To assess the risk of severe upper gastrointestinal complications (UGIC) among BP users by means of a large study based on a network of Italian healthcare utilization databases.

Methods

A nested case-control study was carried out by including 110,220 patients aged 45 years or older who, from 2003 until 2005, were treated with oral BPs. Cases were the 862 patients who experienced the outcome (hospitalization for UGIC) until 2007. Up to 20 controls were randomly selected for each case. Conditional logistic regression model was used to estimate odds ratio (OR) associated with current use of BPs after adjusting for several covariates. A set of sensitivity analyses was performed in order to account for sources of systematic uncertainty.

Results

The adjusted OR for current use of BPs with respect to past use was 0.94 (95% CI 0.81 to 1.08). There was no evidence that this risk changed either with BP type and regimen, or concurrent use of other drugs or previous hospitalizations.

Conclusions

No evidence was found that current use of BPs increases the risk of severe upper gastrointestinal complications compared to past use.