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  • Research Progress in Pharmacological Effects and Mechanisms of Berberine against Pancreatic Cancer
    ZHANG Ming-fa, SHEN Ya-qin
    2024, 21(7): 667-671. https://doi.org/10.13493/j.issn.1672-7878.2024.07-001
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    Berberine is a bioactive substance with a wide range of pharmacological effects. It has the effects against tumors in addition to anti-inflammatory, antibacterial, antiviral, antihypertensive, anti-hypoxic, hypoglycemic, and hypolipidemic effects. In recent years, domestic and foreign scientific research groups have conducted many in-depth studies on the roles of berberine in the field of anti-pancreatic cancer and achieved many important results. Therefore, the anti-pancreatic cancer effect and pharmacological mechanism of berberine are reviewed, and related studies are analyzed in this article.
  • Study on Determination of Plasma Concentration of Ceftazidime-Avibactam Sodium by LC-MS/MS*1
    WANG Yin-hui, ZHANG Xiao-li, FAN Wei-bin, YANG Li-ting, LIN Bin
    2024, 21(7): 672-676. https://doi.org/10.13493/j.issn.1672-7878.2024.07-002
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    Objective: To establish a method for determination of plasma concentration of ceftazidime-avibactam sodium by liquid chromatography-tandem mass spectrometry (LC-MS/MS), and provide a reference for the safe and rational use of ceftazidime-avibactam sodium in clinical practice. Methods: A method for determination of plasma concentration of ceftazidime-avibactam sodium by LC-MS/MS was established by using an ACQUITY UPLC BEH C18 column (2.1 mm×50 mm, 1.7 μm), 10 mmol/L ammonium acetate (A)-100% acetonitrile (B) as a mobile phase, a flow rate of 0.3 mL/min, and a positive/negative ionization switching multiple reaction monitoring (MRM) mode, etc., and the specificity, precision, accuracy, recovery, stability of the method were tested. Results: The retention times of ceftazidime and avibactam were 0.89 min and 0.46 min, respectively. Endogenous substances in plasma had no interference with the detection of ceftazidime and avibactam. The linear equation of ceftazidime was y=537.989x+56.449 6 (r=0.995 3), with good linear performance within the concentration range of 0.5-200μg/mL; the linear equation of avibactam was y=1 788.74x+25.226 9 (r=0.998 0), with good linear performance within the concentration range of 0.05-25μg/mL. The intra-batch and inter-batch precisions of high-, medium- and low-concentration ceftazidime and avibactam samples were all within 15.00%, and their accuracy was within ±15.00%. The recoveries of ceftazidime and avibactam in this method were above 80.00%. In addition, when the samples were stored at room temperature for 6 h, stored in the sample injection tray for 24 h, stored at 4 ℃ for 24 h and repeatedly frozen and thawed (-80 ℃→25 ℃) for 3 cycles, the measurement deviations of high-, medium- and low-concentration ceftazidime and avibactam samples were all within ±15.00%. Conclusion: This method has good specificity and a large linear range, and has good precision, accuracy and stability, which can provide a basis for the individualized medication of ceftazidime-avibactam sodium in clinical patients.
  • Pharmaceutical Care for Anti-infection Treatment in One Patient with Neck Multi-space Infection and Chest Wall Abscess Induced by Pediococcus Pentosaceus
    LONG Jiang-mei, LIU Lei, NI Mao-mei, YE Hui-ping, QIAN Xin
    2024, 21(7): 677-681. https://doi.org/10.13493/j.issn.1672-7878.2024.07-003
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    Objective: To analyze the pharmaceutical care process of anti-infection treatment in patients with neck multi-space infection and chest wall abscess induced by Pediococcus pentosaceus, and provide a reference for the diagnosis and treatment of patients with Pediococcus pentosaceus infection in clinical practice. Methods and Results: A patient went to the hospital's emergency department due to "sore throat for 6 days, accompanied by expectoration, fever, dysphagia, and restriction of mouth opening". After examination, the doctor considered it to be neck multi-space infection with chest wall abscess, then the patient was admitted to the otolaryngology department; on the first day of admission, abscess incision and drainage was performed and a drainage tube was placed to drain the pus. The pus was used for microbial culture, and cefoperazone-sulbactam sodium + ornidazole were given empirically. On the fifth day, Pediococcus pentosaceus was cultured in the pus. After referring to related data, the clinical pharmacist suggested adjusting the anti-infection treatment regimen to ampicillin; on the eighth day, the patient's left chest wall was still swollen, so a second operation was performed and a drainage tube was placed to drain the pus; in the following 3 weeks, the patient's abscess gradually disappeared, the wound surface gradually recovered, and no bleeding, redness and swelling were observed, and the patient was basically cured. Conclusion: The infection with Pediococcus pentosaceus is relatively rare in clinical practice; in addition, a serious abscess was formed for the patient. Therefore, doctors and pharmacists should attach importance to it and take internal medicine and surgical methods to ensure the treatment effect.
  • Analysis of Diagnosis and Treatment of Pulmonary Infection with Pneumocystis Jirovecii and Cryptococcus Neoformans in One Patient after Renal Transplantation
    WU Xi-ya, YIN Fei-fei
    2024, 21(7): 682-685. https://doi.org/10.13493/j.issn.1672-7878.2024.07-004
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    Objective: To analyze the diagnosis and treatment process of pulmonary infection with Pneumocystis jirovecii and Cryptococcus neoformans in patients after renal transplantation, and provide a reference for the diagnosis and treatment of fungal infections in such immunosuppressed patients in the clinical practice. Methods and Results: One patient who had been taking immunosuppressants for a long time after renal transplantation visited the hospital due to "chest tightness, shortness of breath, and poor appetite for more than 20 days". According to the chest CT result, the patient was considered to have community-acquired pneumonia. After admission, the patient's routine blood test, routine biochemical test, and arterial blood gas analysis showed no obvious abnormalities except for a high creatinine level. However, 2 days later, the cryptococcal capsular polysaccharide antigen test reported positive result, the (1,3)-β-D-glucan test reported positive result. Cryptococcal fungal spores and a small amount of Pneumocystis jirovecii were found in the smear and methenamine silver staining of the alveolar lavage fluid. The next-generation sequencing (NGS) on alveolar lavage fluid showed positive fungi (Cryptococcus neoformans and Pneumocystis jirovecii). Therefore, the patient was diagnosed with fungal pneumonia caused by Cryptococcus neoformans and Pneumocystis jirovecii, and fluconazole and compound sulfamethoxazole were given immediately. After about one week, the patient's creatinine level continued to rise. In order to reduce the impact on the patient's renal function, the dosage of fluconazole and the dosing frequency of compound sulfamethoxazole were reduced; then after 18 days, the patient's symptoms of chest tightness and shortness of breath had been relieved obviously, and the creatinine level was significantly decreased, so the patient was allowed to be discharged. After more than 3 months, the patient's chest CT showed that the lesions were significantly absorbed or improved. Conclusion: Mixed pulmonary fungal infection is relatively rare in clinical practice, and it is extremely dangerous for immunocompromised patients if it is not well managed. Therefore, it is extremely important to complete the examinations and make an early definite diagnosis for the treatment and prognosis of patients.
  • Clinical Analysis of Acute Kidney Injury Caused by Combined Use of Vancomycin and Flurbiprofen Axetil*1
    HUANG Li
    2024, 21(7): 686-690. https://doi.org/10.13493/j.issn.1672-7878.2024.07-005
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    Objective: To analyze the occurrence, treatment measures and possible causes of acute kidney injury caused by combined use of vancomycin and flurbiprofen axetil, and provide a reference for the safe and rational use of vancomycin and flurbiprofen axetil in clinical practice. Methods and Results: The patient 1 underwent cardiothoracic surgery during hospitalization and was given flurbiprofen axetil for pain relieving after surgery. During this period, the patient's renal function indicators were normal. Later, due to wound infection, vancomycin was given. On the second day, the patient developed oliguria, and the levels of creatinine, urea nitrogen and urea increased significantly, which was considered to be acute kidney injury. These clinical manifestations progressively worsened in the next 2 days, so vancomycin and flurbiprofen axetil were discontinued clinically and symptomatic treatment was given. Later, the patient's urine volume and renal function indicators gradually improved to normal. The Naranjo's Assessment Scale showed that the patient's acute kidney injury was "probably" associated with vancomycin, and "possibly" associated with flurbiprofen axetil. The patient 2 underwent total knee arthroplasty; one and a half years later, the redness, swelling and pain symptoms occurred in the knee joint and calf, which was clinically considered to be caused by infection. So vancomycin was given for anti-infection and flurbiprofen axetil was given for relieving pain. From the 6th day, the patient's creatinine level increased progressively, and then the urea nitrogen level also became abnormal, which was considered acute kidney injury. On the 17th day, vancomycin and flurbiprofen axetil were discontinued clinically and symptomatic treatment was given. Later, the patient's creatinine level gradually decreased. The Naranjo's Assessment Scale showed that the patient's acute kidney injury was "possibly" associated with vancomycin and flurbiprofen axetil. Conclusion: Both vancomycin and flurbiprofen axetil may cause acute kidney injury. The combined use of them or even the superposition of other risk factors may increase the possibility of risk. Therefore, necessary risk assessment should be performed when nephrotoxic drugs are clinically used or used in combination to reduce the risk of related adverse drug reactions.
  • Analysis of Epidemiological Characteristics of Adverse Drug Reactions Caused by Anti-tuberculosis Drugs in a Hospital
    TU Shang-qing, ZHANG Liu, ZHANG Song, TANG Bo-wen, FU Pin-xiang
    2024, 21(7): 691-694. https://doi.org/10.13493/j.issn.1672-7878.2024.07-006
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    Objective: To analyze the epidemiological characteristics of adverse drug reactions (ADRs) caused by anti-tuberculosis drugs in the hospital and provide a reference for the safe medication of anti-tuberculosis drugs in clinical practice. Methods: A total of 897 patients with tuberculosis admitted to the hospital for anti-tuberculosis treatment from January 2020 to December 2023 were selected as research objects, the occurrence of ADRs caused by anti-tuberculosis drugs was summarized, and the information of patients such as age, occurrence time, clinical manifestations and severity of ADRs was collected to analyze the clinical characteristics of ADRs caused by anti-tuberculosis drugs. Results: Among 897 tuberculosis patients, anti-tuberculosis drug-related ADRs occurred in 378 patients, with an ADR incidence of 42.14%, and the ages of the 378 patients with ADRs were mainly elder than 60 years old (192 cases, 50.79%), followed by 40-60 years old (90 cases, 23.81%) and 18-40 years old (81 cases, 21.43%). The ADRs caused by anti-tuberculosis drugs mostly occurred in 15-30 days after medication (123 cases, 32.54%), followed by less than and equal to 15 days after medication (78 cases, 20.63%), and 45-60 days after medication (76 cases, 20.11%). ADRs caused by anti-tuberculosis drugs were mainly manifested as liver damage (141 cases, 37.30%), gastrointestinal reactions (90 cases, 23.81%) and urinary system abnormalities (69 cases, 18.25%). For the severity of ADRs caused by anti-tuberculosis drugs, most of them were mild (287 cases, 75.93%) and only 6 cases (1.59%) were severe. Conclusion: The anti-tuberculosis drug-related ADRs have a high incidence in hospitals, and the target populations are mainly middle-aged and elderly people, and their symptoms are mostly mild. Clinically, it is necessary to attach importance to them, monitor their medications to ensure the safe medication of patients.
  • Analysis of Clinical Characteristics of Elderly Patients Receiving Anti-infective Pharmaceutical Consultation in a Hospital*1
    LI Wei-wei, HU Han-shuai
    2024, 21(7): 699-703. https://doi.org/10.13493/j.issn.1672-7878.2024.07-008
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    Objective: To analyze the clinical characteristics of elderly patients who received anti-infective pharmaceutical consultation in the hospital and provide a reference for the continuous improvement of pharmaceutical services for elderly patients in the clinical practice. Methods: A total of 3 328 patients who received anti-infective pharmaceutical consultation in the Second Affiliated Hospital of Guizhou Medical University from December 2021 to December 2023 were selected as the research objects through the hospital's information system. The information such as patients' age, underlying diseases, liver and kidney functions, infection sites, department distribution, reasons for consultation, consultation opinions of clinical pharmacists and their adoption, disease outcome, patient satisfaction was collected, and the relevant clinical characteristics of the elderly patients were analyzed. Results: Among the 3 328 patients who received anti-infective pharmaceutical consultation, 1 433 cases were elderly patients (43.06%). Among the 1 433 elderly patients, their ages were mainly in the range of 60 to 80 years old (1 217 cases, 84.93%); the vast majority of patients (1 350 cases, 94.21%) had more than three underlying diseases, and most patients (1 008 cases, 70.34%) had infections in multiple sites. In addition, most patients (964 cases, 67.27%) underwent microbiological examinations before pharmaceutical consultation. The 1 433 elderly patients were distributed in 28 clinical departments, among which the top five were critical care medicine (434 cases, 30.29%), oncology (155 cases, 10.82%), nephrology and rheumatology (100 cases, 6.98%), orthopedics (76 cases, 5.30%) and hematology (72 cases, 5.02%). The main reason for consultation for elderly patients was "poor effect of anti-infection regimen" (1 123 cases, 78.37%); after the consultation, the vast majority of patients fully followed the consultation opinions (1 405 cases, 98.05%), and the conditions of most patients improved (1 210 cases, 86.12%). The sampling survey showed that the doctors' overall satisfaction with clinical pharmacists' pharmaceutical consultation was as high as 99.33%. Conclusion: Clinical pharmacists conduct anti-infective pharmaceutical consultation for elderly patients, which not only effectively helps patients to achieve good therapeutic effect, but also gains the recognition and affirmation from clinicians and demonstrates the professional ability and value of clinical pharmacists.
  • Analysis of Comments on Rational Drug Use for Outpatient and Emergency Prescriptions in a Grade A Tertiary General Hospital in 2023
    QIN Nan, ZHANG Mei, ZHENG Shuang, SHEN Hai-juan, LI Yi
    2024, 21(7): 703-707. https://doi.org/10.13493/j.issn.1672-7878.2024.07-009
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    Objective: To analyze the comments on rational drug use for outpatient and emergency prescriptions in the hospital in 2023, and provide a reference for promoting rational drug use in clinical practice. Methods: A total of 15 060 outpatient and emergency prescriptions from the First Affiliated Hospital of Soochow University from January to December 2023 were selected as research data. The information such as patients' ages, sex and diagnosis, and type, dosage form, usage and dosage of drugs in the prescriptions was collected, and comments on rational drug use for the prescriptions were made based on relevant guidelines, consensus, package inserts of drugs and other relevant data, and the main reasons for irrational drug use and department distribution were analyzed. Results: The results of comments on prescriptions showed that among 15 060 prescriptions, there were 146 irrational prescriptions, with an irrational incidence of 0.97%. In addition, the use rate of antibacterial drugs in the outpatient clinics throughout the year was 7.00%, while the use rate of national essential drugs was 65.73%. Among the 146 irrational prescriptions, the main reasons for irrational drug use were "inappropriate usage and dosage" (62 prescriptions, 42.47%) and "inappropriate indications" (37 prescriptions, 25.34%), and the secondary reason was "irregular signature and seal of physicians" (20 prescriptions, 13.70%). The 146 irrational prescriptions basically involved all outpatient and emergency departments of the hospital, and the top three departments with the highest irrational rates were general surgery, gastroenterology and radiotherapy departments, with irrational incidences of 1.75%, 1.60% and 1.60%, respectively. Conclusion: The overall drug use in the outpatient and emergency departments of the hospital in 2023 is relatively rational, but there are still some problems. The inspection and training should be strengthened to promote clinical rational drug use and ensure the medication safety.