The prevalence of hepatitis B and C markers among narcotic users

611 patients with acute parenteral virus hepatitis (VH) were studied with a view to find out markers indicating the presence of hepatitis B and hepatitis C virus infection (HB, HC, HB + C, HC + HBsAg). Of these, 166 patients (27.2%) systematically used narcotic drugs intravenously. Essential differences between drug users and VH patients without drug addiction were established regarding the distribution of patients by age and sex, the etiological structure and severity of the disease. Thus, in the group of drug users the prevalence of males, young people (15-29 years of age) and the mixed form of hepatitis B + C was noted. In VH patients using drug the disease took a more severe course than in such patients without drug addiction. The highest proportion of intravenously drug users with a severe and moderate course of the disease was found among patients with HB + C and HB.     

Problem drug use in a central London general practice.

OBJECTIVE--To describe the profile of problem drug users presenting in general practice and to determine whether they can be cared for in general practice. DESIGN--Study of consultations by problem drug users. SETTING--Central London general practice. SUBJECTS--150 problem drug users presenting over two years. MAIN OUTCOME MEASURES--Stopping drug use, alterations in lifestyle, obtaining paid work, and stopping drug related crime. RESULTS--Of the 150 patients, 111 were men and 39 women, and 106 were unemployed. 121 patients used heroin, 112 of whom injected. 145 patients accepted a methadone reduction programme and 81 completed it. A further 25 were stabilised on reducing doses of methadone, until places became available for them as inpatients at drug dependency units or rehabilitation projects. CONCLUSION--Withdrawal programmes for patients who misuse drugs can be successfully managed in general practice.     

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.     

Pharmacokinetics of mitomycin C in cancer patients during prolonged administration of the preparation

The mitomycin C levels in the blood of patients subjected to prolonged intravenous injection of the drug in 200-300 ml of isotonic sodium chloride solution for 15-50 minutes were determined in the microbiological test system consisting of E. coli and 1.5 per cent of agar in the meat-peptone broth with restricted contents of the nutrients. Such administration of the drug usually provided lower blood levels than intravenous injections of the drug in analogous doses. However, the drug renal excretion was also less intensive. It suggested that the drug administered for a prolonged period was more completely absorbed by the host tissues. This was confirmed by much lower blood levels of the drug, when the tumors were large, as compared to those in patients with insignificant residues of the tumor tissue after surgical resections. The curves of mitomycin C distribution in the blood indicate that the pharmacokinetics of the drug in patients with tumors is a multi-factorial function.     

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.     

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.     

泌尿生殖道非淋菌性感染的病原学以及耐药性分析

目的：探究泌尿生殖道非淋茵性感染的病原学以及耐药性,指导临床合理用药。方法：对我院2006年3月．2011年12月确诊的2136例非淋菌性泌尿生殖道感染患者进行标本采集,对病原体及其耐药性进行检测分析。结果：淋茵感染泌尿生殖道病原茵主要为CT及支原体,男性患者CT感染率高于女性患者,女性患者支原体感染率高于男性患者,此外,念珠茵、滴虫及其他难以检出细菌亦属于致病病原茵的一种;在12种抗生素中,多西环素、米诺环素及交沙霉素敏感率较高,均〉80％,罗红霉素、红霉素及环丙沙星敏感度较低,均〈20％。结论：非淋茵感染泌尿生殖道病原菌主要为CT及支原体,男性患者CT感染率高于女性患者,女性患者支原体感染率高于男性患者,病原茵对多西环素、米诺环素及交沙霉素耐药性较低,但不同地域病原茵耐药性亦存在差异,应按照实际情况进行耐药性检测,指导临床合理用药。     

Predisposing Factors in Adverse Reactions to Drugs

Predisposing factors were sought in 118 patients who developed adverse drug reactions in hospital. Significantly more patients of 60 years and over, and more women than men, developed adverse drug reactions. Patients with reactions had more drugs before the development of the reaction than patients who did not develop reactions. A previous adverse drug reaction and a history of allergic disease were significant factors, while a history of jaundice or the presence of diabetes mellitus and renal disease was not.     

汉族和维吾尔族乙型肝炎病毒耐药基因的相关临床研究

目的:利用基因芯片技术研究伊犁地区汉、维两个民族乙型肝炎病毒(HBV)耐药基因的差异性。方法:收集2014年1月-2015年12月我院收治的汉族及维吾尔族(以下简称"维族")慢性HBV感染患者各50例,患者均经基因芯片技术筛选确诊存在天然HBV耐药基因(耐核苷酸类药物),观察HBV耐药基因分型特点及对核苷酸类药物的耐药突变位点的情况。结果:汉族HBV感染患者的耐药基因型集中于B、C型,且以C型为主,而维族以D型为主,两组各基因型比较,差异均有统计学意义(P0.05)。汉族患者在rt204位点变异明显,而维族在rtn236t、rta181v/t+rtn236t位点变异明显,差异均有统计学意义(P0.05)。结论:在新疆伊犁地区天然HBV病毒耐药基因患者中,汉族及维族耐药基因分型及耐药基因突变位点均存在显著差异,临床可通过基因芯片技术筛选变异靶点,选择合适的敏感药物。     

Anti-Tuberculosis Drug Resistance among New and Previously Treated Sputum Smear-Positive Tuberculosis Patients in Uganda: Results of the First National Survey

Background

Multidrug resistant and extensively drug resistant tuberculosis (TB) have become major threats to control of tuberculosis globally. The rates of anti-TB drug resistance in Uganda are not known. We conducted a national drug resistance survey to investigate the levels and patterns of resistance to first and second line anti-TB drugs among new and previously treated sputum smear-positive TB cases.

Methods

Sputum samples were collected from a nationally representative sample of new and previously treated sputum smear-positive TB patients registered at TB diagnostic centers during December 2009 to February 2011 using a weighted cluster sampling method. Culture and drug susceptibility testing was performed at the national TB reference laboratory.

Results

A total of 1537 patients (1397 new and 140 previously treated) were enrolled in the survey from 44 health facilities. HIV test result and complete drug susceptibility testing (DST) results were available for 1524 (96.8%) and 1325 (85.9%) patients, respectively. Of the 1209 isolates from new cases, resistance to any anti-TB drug was 10.3%, 5% were resistant to isoniazid, 1.9% to rifampicin, and 1.4% were multi drug resistant. Among the 116 isolates from previously treated cases, the prevalence of resistance was 25.9%, 23.3%, 12.1% and 12.1% respectively. Of the 1524 patients who had HIV testing 469 (30.7%) tested positive. There was no association between anti-TB drug resistance (including MDR) and HIV infection.

Conclusion

The prevalence of anti-TB drug resistance among new patients in Uganda is low relative to WHO estimates. The higher levels of MDR-TB (12.1%) and resistance to any drug (25.3%) among previously treated patients raises concerns about the quality of directly observed therapy (DOT) and adherence to treatment. This calls for strengthening existing TB control measures, especially DOT, routine DST among the previously treated TB patients or periodic drug resistance surveys, to prevent and monitor development and transmission of drug resistant TB.     

Evaluation of biological availability and anti-arrhythmic effect of a new drug Phenytoinum "Polfa"]

Studies were performed in 15 patients with ventricular arrhythmia. During the first day, the patients received 1000 mg of a new micronised form of Phenytoinum "Polfa" or adequate dose of a foreign drug in 3 doses every 3 hours and subsequently during 10 days alternatively native or foreign drug in a daily dose 300 mg. Twenty-four EKG Holter monitoring and determination of serum drug level were carried out after a 10-day treatment; area under the curve (AUC) in one 8 h dose interval was determined. Studies have shown usefulness of a new form of Phenytoinum (Polfa). Blood serum drug levels near to the therapeutic ones were observed. Steady-state Phenytoinum concentration was 11.1 +/- 5.9 micrograms/ml and after foreign drug it was 11.7 +/- 6.1 micrograms/ml, AUC0-8 was 90.4 and 105.3 micrograms/ml/h respectively. In 9/15 patients (60%) Phenytoinum (Polfa) produced substantial improvement in the cardiac arrhythmia.     

Psychophysiological and Psychosocial Profile of Patients Attending Drug Addiction Centers

Drug treatment centres provide the highest level of rehab services for patients diagnosed with drug addictions. Most inpatient drug rehab programs focus on medical detox and mental health interventions. However, how to optimize the later remains a challenge. The aim of this study was to examine the psychophysiological and psychosocial profile of patients attending drug addiction centres in comparation with the general population. A total of 105 inpatient drug rehab patients and 50 participants from the general population were compared based on standardized psychophysiological and psychosocial measures. Results of this study suggest that patients attending drug addiction centers differ from general population in several different psychophysiological and psychosocial factors. Patients reported significantly lower levels of physical activity and increased sympathetic responsiveness, and significantly higher levels in loneliness, psychologically inflexibility and neuroticism. The results of this study highlight the importance of address healthy lifestyle behaviors such as sport practice and psychological variables such as loneliness, psychological (in)flexibility and neuroticism to improve current programs aim to prevent or reduce problematic drug consumptions.

     

Pharmacotherapy of schizophrenic patients: preponderance of off-label drug use

Multiple drug class combinations are often prescribed for the treatment of schizophrenia, although antipsychotic monotherapy reflects FDA labeling and scientific justification for combinations is highly variable. This study was performed to gain current data regarding drug treatment of schizophrenia as practiced in the community and to assess the frequencies of off-label drug class combinations. 200 DSM IV-diagnosed schizophrenic patients recruited from community treatment sources participated in this cross-sectional study of community based schizophrenic patients. Drug class categories include First and Second Generation Antipsychotic drugs (FGA and SGA, respectively), mood stabilizers, antidepressants and anti-anxiety drugs. 25.5% of patients received antipsychotic monotherapy; 70% of patients received an antipsychotic and another drug class. A total of 42.5% of patients received more than one antipsychotic drug. The most common drug class combination was antipsychotic and a mood stabilizer. Stepwise linear discriminant function analysis identified the diagnosis of schizoaffective schizophrenia, history of having physically hurt someone and high scores on the General Portion of the PANSS rating scale predicted the combined use of an antipsychotic drug and a mood stabilizer. "Real world" pharmacotherapy of schizophrenia has developed its own established practice that is predominantly off-label and may have outstripped current data support. The economic implications for public sector payers are substantial as well as for the revenue of the pharmaceutical industry, whose promotion of off-label drug use is an increasingly problematic. These data are consistent with the recognition of the therapeutic limitations of both first and second generation antipsychotic drugs.     

The Effects of Thiethylperazine Dimaleate (Torecan) on Nausea and Vomiting

A double-blind study of thiethylperazine dimaleate (Torecan) and a placebo, given intramuscularly, was carried out on 40 patients with nausea and/or vomiting due to a variety of causes. No effect on these symptoms was noted in five patients who received the drug and in six who received the placebo. Thiethylperazine dimaleate was judged to have a good effect in 14 patients and the placebo in five patients. The placebo had a slight effect in nine patients and the drug in one.     

Clinical evaluation and use of urine screening for drug abuse.

Urine drug screening is indicated to evaluate patients who show mental status or behavioral changes and to monitor the abstinence of drug abusers. The appropriate timing for collecting urine specimens may vary depending on the suspected drug of abuse and on laboratory factors. Laboratories use a variety of techniques to do urine screens, and these must be understood by clinicians ordering the screens to interpret results correctly. In treating drug-abusing patients, clinicians must apply structured reinforcement in conjunction with urine screen results to aid patients in achieving abstinence.     

Use of Computer-assisted Model in Diagnosis of Drug Hypersensitivity Jaundice

Of 374 patients with jaundice seen in the liver unit over a four-year period 21 were finally thought to be hypersensitive to one of seven different drugs. The clinical, laboratory, and histological features were often difficult to distinguish from those of viral hepatitis, tumour of the extrahepatic biliary tree, or primary biliary cirrhosis. A computer-assisted diagnostic model made use of minor differences, and made a correct diagnosis in all patients. Even when information about drug ingestion was left out it was still correct in 81% of patients. Sixty-four other patients gave a history of ingestion of potentially hepatotoxic drugs of whom 62 were correctly diagnosed by the computer. In the complete series of 374 patients only two were incorrectly computed to have drug jaundice when there was no history of drug ingestion.Two additional patients became jaundiced after exposure to drugs, but were found to have primary biliary cirrhosis.     

Drug Defaulting in a General Practice

Different groups of patients in a general practice have been under close observation by defined methods to assess the extent of their adherence to drug schedules. Patients taking antibiotics, admitted to a short drug trial and prescribed long-term treatments, proved in most cases to be compliant. Antenatal patients taking a once-daily dosage of prophylactic iron were more co-operative than those taking divided dosages. Socially isolated patients and those of low social class were particularly likely to neglect their drugs.It is suggested that the significance and extent of the problem have been largely ignored and that all drug trials undertaken on outpatients should incorporate methods of detecting defaulters.     

Treatment Effect and Drug-Resistant Mutations in Chinese AIDS Patients Switching to Second-Line Antiretroviral Therapy

This study aimed to investigate treatment effect, drug resistance changes, and their influencing factors in Chinese AIDS patients after switching to second-line antiretroviral therapy, and thus provide important information for the scale-up of second-line antiretroviral treatment in China. In Weishi county of Henan province, where second-line antiretroviral therapy was introduced early in China, 195 AIDS patients were enrolled, of which 127 patients met the switching criterion and 68 patients volunteered to switch drugs without meeting the switching criterion. CD4 cell count, viral load and in-house PCR genotyping for drug resistance were measured for all 195 subjects before drug switch, as well as 6 and 12 months after drug switch. Extensive secondary mutations to the protease inhibitor were observed, which suggested that long-term drug resistance surveillance is necessary for patients switching to second-line antiretroviral therapy. Multidrug resistance and cross-resistance were extensive in Chinese patients that experienced first-line treatment failure. Patients need timely CD4 count, viral load, and drug resistance monitoring in order to switch to second-line therapy under conditions of relatively good immunity and low viral duplication levels.