Drug resistance in patients with pulmonary tuberculosis.

A review of the records of 984 patients admitted to hospital from 1970 through 1973 with bacteriologically proven pulmonary tuberculosis showed bacterial resistance to one or more antituberculosis drugs in 103 (10.5%). Among the patients who had had previous drug treatment for tuberculosis the prevalence of drug resistance was 20% in the Canadian-born patients and 69.4% in the recent immigrants. Among the patients who had had no previous drug treatment the prevalence of drug resistance (primary resistance) was 2.7% in Canadian-born patients but 11.4% in recent immigrants. Because of the higher prevalence of drug resistance among recent immigrants and the finding in recent years that increasingly more tuberculosis patients in Ontario are recent immigrants, drug resistance in this group is likely to assume even more importance in the future.     

Benign familial tremor treated with primidone.

Primidone given to a patient for epilepsy produced an unexpected reduction in benign familial tremor. Over the next eight years the drug was therefore tried in a prospective study of 20 other patients with benign familial tremor alone. Of these, six could not tolerate the drug because of vertigo and nausea but 12 obtained a good response, which in some cases was dramatic. Investigations in two patients suggested that the effect was mediated predominantly by derived phenylethylmalonamide, though primidone had some effect, since tremor recurred slightly on withdrawing the drug despite a constant or rising blood phenylethylmalonamide concentration. Primidone is highly effective in benign familial tremor. More patients with the condition are intolerant of the drug than are usually found with epilepsy.     

Clinical experience with metiamide.

The new histamine H2-receptor antagonist, metiamide, was shown to inhibit acid and pepsin secretion in gastric secretion studies performed on patients suffering from peptic ulceration. The new drug was administered intravenously in these experiments, but effective plasma levels could also be produced by oral administration. When symptomatic patients were treated with the drug nearly all experienced marked symptomatic relief, and there was some evidence that ulcer healing occurred during treatment. When the drug was withdrawn symptoms tended to return. No toxic reactions were encountered in this trial. Double-blind studies are now being made in Britain to establish the place metiamide may have in the treatment of duodenal ulceration.     

Incidence of piperacillin-specific drug antibody in patients with and without piperacillin

The aim of this study was to investigate the incidence of piperacillin-specific drug antibody in patients with and without piperacillin. Piperacillin antibody was detected by piperacillin-induced hemolysis test kit. Three hundred samples were collected from patients who had been treated with piperacillin within 3 months; and 222 samples were from patients who were treated with other antibiotics; and a normal group of 120 samples was from healthy blood donors. The results showed that the positive rates in the piperacillin group, the other antibiotic group and the control group were 11.33%, 4.95% and 1.67%, respectively, which was statistically significant. The antibody titer was from 2 to 64. The antibody titer of the piperacillin group was significantly higher than that of the other two groups. The study suggests that piperacillin is able to induce piperacillin-specific drug antibody and drug antibody detection is useful for maintaining the safety of medication.     

Use of 5-Fluorocytosine in Patients with Impaired Renal Function

The plasma level and elimination of 5-fluorocytosine (5-FC) was measured in normal subjects and patients with impaired renal function. Prolongation of the half-life of the drug in renal failure has been confirmed. Renal clearance of 5-FC was about 75% of the creatinine clearance and a corresponding modification of drug dosage should be made in patients with renal insufficiency.     

Further Experience with Azathioprine in Rheumatoid Arthritis

Azathioprine has been shown to reduce the steroid requirements of patients with severe rheumatoid arthritis. Twenty-seven patients treated with azathioprine have now been followed up for 30 months. At the end of this period only 10 were still taking the drug. Maximum steroid reduction occurred within the first 12 months of treatment. Some steroid-sparing effect seemed to persist after the drug was stopped. There was no evidence that azathioprine prevented radiological deterioration. No deaths occurred and toxic effects always reversed on stopping the drug.     

心血管病患者住院治疗期间潜在的药物相互作用研究

目的:明确住院治疗的心脏病患者中潜在的药物-药物相互作用(drug-drug interaction,DDI),并对DDI相关危险因素进行评估。方法:选择2013年5月至2013年12月入院治疗的至少服用2种药物且入院不少于24小时的心脏病患者为研究对象,应用"标准药物相互作用数据库Micromedex-2(Thomson Reuters)×2.0"对这些患者可能发生的药物相互作用进行分析。结果:共入选150例患者,其中32例患者被确认出现了至少一种药物组合的DDI,发生率为21.3%;明确了48个有潜在危险因素的药物相互作用。阿托伐他汀/阿奇霉素(10.4%)、依那普利/二甲双胍(10.4%)、依那普利/氯化钾(10.4%)、阿托伐他汀/克拉霉素(8.3%)、呋塞米/庆大霉素(6.3%)是最常见的存在相互作用的药物组合,阿托伐他汀、依那普利、地高辛、呋塞米、氯吡格雷、华法林等药物经常参与药物相互作用。大多数药物的相互作用比较温和,但"用药种类增多、住院时间延长、存在合并症"等危险因素与潜在药物-药物相互作用(potential drug-drug interaction,p DDI)密切相关。结论:住院治疗的心脏病患者潜在DDI发生率较高,用药种类增多、住院时间延长、存在合并症均为其发生的危险因素。对那些存在明确危险因素的住院治疗的心脏病患者密切监测是十分必要的,医务人员要尽早发现和预防这些潜在的药物相互作用对人体健康造成的伤害。     

女性阴道感染的常见病原菌分布情况 及与乳杆菌密度的关系

目的研究女性阴道感染常见病原菌分布情况及与乳杆菌密度的关系。方法选取2016年12月至2018年12月在我院就诊的120例女性生殖系统感染患者作为观察组,另选我院进行健康体检的女性120例作为对照组。分析观察组患者生殖系统感染念珠菌的构成以及耐药情况,探讨两组患者乳杆菌密度差异以及念珠菌、耐药情况与Nugent评分的相关性。结果观察组患者感染主要为白色念球菌,其次为克柔念珠菌、光滑念珠菌、近平滑念珠菌、热带念珠菌、平滑念珠菌和其他念珠菌。观察组患者耐药最高的为咪康唑,其次为酮康唑、伊曲霉素、克霉素、氟康唑、制菌霉素和两性霉素B;观察组患者的Nugent评分显著高于对照组,耐药患者的Nugent评分显著高于非耐药患者;患者念珠菌感染以及耐药情况分别与Nugent评分呈正相关,差异存在统计学意义(均P0.05)。结论患者生殖道乳杆菌密度、白色念珠菌感染情况以及耐药情况分别与Nugent评分呈正相关,在患者的治疗过程当中,可以将乳杆菌数量的恢复情况作为评价其治疗效果的指标之一。     

A Comparison of Nitrogen Mustard and Vinblastine Sulfate in the Treatment of Patients with Hodgkin's Disease

In a crossover study the effectiveness of intermittent maintenance doses of nitrogen mustard was compared to that of vinblastine sulfate in the treatment of 61 patients with advanced Hodgkin''s disease. Forty-five of the patients had had previous radiation therapy. Nine of 29 patients who received nitrogen mustard as the first drug had a complete response and five had a partial response. The comparative results in 32 patients receiving vinblastine sulfate first were nine complete responses and 13 partial responses. The median duration of the complete responses to each drug was 43 weeks. The partial responses were of shorter duration. When the second drug was given in adequate doses, almost as many patients responded with a similar median duration of response.It is concluded that nitrogen mustard and vinblastine sulfate are equally effective single agents in the treatment of patients with advanced Hodgkin''s disease and that patient preference would favour vinblastine sulfate because of its negligible side effects.     

Treatment of idiopathic hypercalciuria with indapamide.

Twenty-six patients with idiopathic hypercalciuria (urine calcium level greater than 300 mg/24 h [7.5 mmol/d]) were treated with indapamide (a nonthiazide diuretic), 2.5 mg/d for 3 consecutive months. A mean decrease in urine calcium levels of 52% was noted (p less than 0.05). When therapy with indapamide was stopped, the calcium levels returned to pretherapy values. The effect of indapamide on urine calcium levels was similar to that of hydrochlorothiazide in 10 patients who were receiving the latter drug before therapy with indapamide. The results show that indapamide is an efficient drug for the treatment of idiopathic hypercalciuria.     

Impaired oxidation of debrisoquine in patients with perhexiline neuropathy.

The use of perhexiline maleate as an antianginal agent is occasionally associated with side effects, particularly neuropathy and liver damage. The reason why some individuals develop these toxic reactions is not clear, though some evidence suggests that they may result from impaired oxidative metabolism, due to genetic or hepatic factors, and consequential accumulation of the drug in toxic concentrations. Drug oxidation was measured with an oxidation phenotyping procedure in 34 patients treated with perhexiline, 20 of whom had developed neuropathy and 14 of whom had not. Most of the 20 patients with neuropathy, but not the unaffected patients, showed an impaired ability to effect metabolic drug oxidation. This impairment was independent of hepatic function, concurrent drug therapy, or tobacco or alcohol consumption. The fact that the ability to oxidise several drugs is genetically controlled points to a genetic susceptibility to developing neuropathy in response to perhexiline. Routine determination of the drug oxidation phenotype might lead to safer use of perhexiline by predicting patients who may be more at risk of developing a neuropathic reaction associated with its long-term use.     

High Prevalence of Illicit Drug Use in Men Who Have Sex with Men with HIV-1 Infection in Japan

Objective

To examine the prevalence of illicit drug use among men who have sex with men (MSM) with HIV-1 infection in Japan, where the life-time prevalence of illicit drug use in the general population is only 2.9%.

Design

A single-center cross-sectional study at a large HIV clinic in Tokyo, which treats approximately 15% of HIV-1 infected patients in Japan.

Methods

The prevalence of illicit drug use and the assciation of characteristics and social demographics of the patients with illicit drug use were examined. Patients who visited the clinic for the first time from 2005 to 2010 were enrolled. Relevant variables were collected using a structured interview and from the medical records. Multivariate logistic regression analyses were applied to estimate the odds of association of MSM over non-MSM HIV-infected patients with illicit drug use.

Results

1,196 patients were enrolled. They were mostly Japanese men of relatively young age. Illicit drug use (including injection drugs) was reported by 35% of the patients (by 40% of MSM), and 4% were IDU while 5% were on methamphetamine. 2% of the population was arrested due to illicit drugs. MSM was significantly associated with illicit drug use (adjusted OR = 4.60; 95% CI, 2.88–7.36; p<0.01). Subgroup analysis of the patients stratified by three age groups (≤30, 31 to 40, and >40) showed that the odds of association of MSM with illicit drug use was the strongest in the youngest age group (≤30 years: adjusted OR = 7.56; 95% CI, 2.86–20.0; p<0.01), followed by the oldest (>40 years: adjusted OR = 6.15; 95% CI, 2.40–15.8; p<0.01), and the weakest in the group aged 31 to 40 (adjusted OR = 3.39; 95% CI, 1.73–6.63; p<0.01).

Conclusions

The prevalence of illicit drug use is high among MSM patients with HIV-1 infection in Japan. Effective intervention for illicit drug use in this population is warranted.     

Comparison of salicylazosulfapyridine bioavailability following oral and rectal administration in patients with ulcerative colitis]

Salicylazosulfapyridine--a drug commonly used in the ulcerative colitis--is effective following both oral and rectal administration. Pharmacokinetics of the drug given per rectum (in the form of suppositories) has not been investigated so far. The present study aims at comparing bioavailability of salicylazosulfapyridine following oral and rectal administration to patients with the ulcerative colitis and healthy volunteers. It was found, that following rectal administration the drug is not so readily absorbed as in oral dosage form. No sulfapyridine and 5-aminosalicylic acid have been detected in blood serum, when the drug was given in the form of rectal suppositories. Clinical stage of the disease did not affect absorption of both unchanged drug and its metabolites. Due to the fact, that the drug is active locally, rectal suppositories seem a therapeutical alternative in patients only with lesions localized in the rectum.     

Eye pain with nifedipine and disturbance of taste with captopril: a mutually controlled study showing a method of postmarketing surveillance

Several notifications of eye pain and blurred vision associated with treatment with nifedipine were received by New Zealand''s Intensive Medicines Monitoring Programme. A questionnaire survey of patients taking nifedipine was undertaken to test the importance of these associations, with disturbance of taste associated with captopril taken as a methodological control. Altogether 961 patients taking nifedipine and 368 taking captopril were sent a questionnaire that asked whether any eye problems and changes in the sense of taste had occurred while they were taking the drug and whether these had resolved after treatment was stopped. Compliance was high: of 922 and 343 questionnaires that were assumed to have been delivered to patients taking nifedipine and captopril, respectively, 770 (84%) and 295 (86%) were returned satisfactorily completed. The distribution of sex was comparable in the two groups; patients taking captopril were slightly younger. Eye symptoms were reported in both groups, but eye pain was significantly more common in patients taking nifedipine (107 (14%) compared with 26 (9%) patients taking captopril). This is a new finding and may be related to ocular vasodilatation. Theoretically, glaucoma is a possible adverse reaction. Loss of taste was significantly associated with captopril, but no other disturbances of taste showed significant associations. Loss of taste persisted in 27 out of 35 patients who continued to take captopril and in three out of eight patients when the drug was withdrawn.This study showed a method of assessing early signs of adverse drug reactions, which has been used once before and identified previously unrecognised reactions.     

Mechanisms of action of clofibrate on cholesterol metabolism in patients with hyperlipidemia

The influence of clofibrate on cholesterol metabolism in patients with hyperlipidemia was studied by means of sterol balance and isotope kinetic techniques and by measurements of flow rates of cholesterol through the biliary tract. Long-term balance studies were carried out on a metabolic ward in 24 patients with all currently recognized types of hyperlipidemia; in five other patients with hypercholesterolemia, pool sizes and turnover rates of cholesterol were defined by compartmental analysis before and after three years' daily administration of the drug. Except in fat-induced hypertriglyceridemia (two patients), clofibrate caused reduced plasma levels of triglycerides and cholesterol in all categories of hyperlipidemia. As a general rule, excretion of cholesterol into bile and feces was significantly increased and fecal bile acid excretion was decreased, regardless of the type of lipoprotein abnormality. Despite a net increase in steroid excretion in most patients with hyperlipidemia, cholesterol synthesis was not increased; indeed, in many patients synthesis appeared to be decreased. While the data obtained in 29 patients were not always consistent, the bulk of the evidence suggests that, in all forms of hyperlipidemia except fat-induced hyperglyceridemia, the drug causes an increased output of cholesterol while simultaneously inhibiting any compensatory increase in cholesterol synthesis. Therefore, it appeared that the increased excretion of steroids was most likely derived from cholesterol stored in tissues. This conclusion was strengthened by finding that long-term administration of the drug can cause marked reduction in body pools of cholesterol. These findings are reflected clinically by resolution of skin and tendon xanthomatosis. However, it is not yet known whether the accumulation of cholesterol in arterial walls that is part of the process of atherogenesis can be inhibited or reversed by the drug.     

女性糖尿病患者合并尿路感染大肠埃希菌耐药性分析

目的 回顾性分析女性糖尿病(DM)合并尿路感染( UTI)大肠埃希菌的耐药情况及产超广谱β-内酰胺酶(ESBLs)的发生率,以指导临床合理选择抗菌药物.方法 对近4年在浙江大学医学院附属第二医院确诊DM合并UTI女性患者的中段尿标本中分离出的95株大肠埃希菌进行耐药性分析,用纸片扩散法表型确证试验检测ESBLs,以女性非糖尿病患者为对照组,并以年份进行分组分析.结果 95株大肠埃希菌ESBLs阳性率为40.0％,明显高于对照组,糖尿病组对氨苄西林、环丙沙星、左氧氟沙星耐药率较高,均＞60.0％,对环丙沙星、左氧氟沙星、头孢曲松、头孢唑林、头孢吡肟、头孢呋辛耐药率明显高于对照组,早期组与近期组的产ESBLs率及耐药率差异无统计学意义.结论 女性糖尿病伴尿路感染大肠埃希菌对多种抗菌药物的耐药率较高,临床应根据药敏试验结果合理使用抗菌药物.     

Efficacy of the M-2 protocol in previously untreated patients with advanced multiple myeloma

37 consecutive, previously untreated patients with advanced multiple myeloma (16 patients Stage II, 21 patients Stage III) were treated with a five drug regimen consisting of carmustine, melphalan, vincristine, cyclophosphamide and prednisolone (M-2-protocol) in a prospective manner. Remission was achieved in 24 patients (65%). The median time to remission was 10 weeks, the median duration of remission 15,3 months. Median survival time from the onset of treatment was 24 months for all patients. Responding patients have a projected 65% three year survival. Median survival in non-responders was 10 months. 8 patients died during the first year of treatment. These results do not confirm the favourable results with this drug combination obtained in a previous trial. The discrepancy may be explained by a higher proportion of poor risk patients in the present study.     

Persistence with anti-tumour necrosis factor therapies in patients with psoriatic arthritis: observational study from the British Society of Rheumatology Biologics Register

Introduction  

Anti-TNF therapies represent a breakthrough in the treatment of severe psoriatic arthritis. However, little is known about long-term drug persistence with these treatments in patients with psoriatic arthritis in routine clinical practice. The aim of this study was to assess persistence with first-course and second-course treatment with anti-TNF agents in a prospective cohort of psoriatic arthritis patients and to identify factors associated with and reasons for drug discontinuation.     

Allergic alteration of leukocytes in patients with drug intolerance

Increased sensitivity to benzylpenicillin, ampicillin, claforan, cefzol, novocain and lidocaine was determined by means of the leukocyte allergic alteration (LAA) test in 599 patients with intolerance reactions to these preparations in their medical history. In most of these patients the test results exceeded 30% and reached 98%, their average values exceeding those in the control group no subjects with no drug intolerance. The LAA test ensured a high level (83%) of the detection of drug intolerance.     

The Role of Patients’ Age on Their Preferences for Choosing Additional Blood Pressure-Lowering Drugs: A Discrete Choice Experiment in Patients with Diabetes

ObjectivesTo assess whether patients’ willingness to add a blood pressure-lowering drug and the importance they attach to specific treatment characteristics differ among age groups in patients with type 2 diabetes.ResultsOf the 161 patients who completed the questionnaire, 151 (72%) could be included in the analyses (mean age 68 years; 42% female). Aged patients were less willing to add a drug than non-aged patients (67% versus 84% respectively; P = 0.017). In both age groups, the effect on blood pressure was most important for choosing a drug, followed by the risk of adverse drug events and the risk of death. The effect on limitations due to stroke was only significant in the non-aged group. The effect on blood pressure was slightly more important in the non-aged than the aged group (P = 0.043).ConclusionsAged patients appear less willing to add a preventive drug than non-aged patients. The importance attached to various treatment characteristics does not seem to differ much among age groups.