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Effect of semaglutide on major cardiovascular events. 塞马鲁肽对主要心血管事件的影响
Q4 Medicine Pub Date : 2024-02-28 DOI: 10.1136/dtb.2024.000007

Overview of: Lincoff AM, Brown-Frandsen K, Colhoun HM, et al. Semaglutide and cardiovascular outcomes in obesity without diabetes. N Engl J Med 2023;389:2221-32.

概述:Lincoff AM, Brown-Frandsen K, Colhoun HM, et al. 塞马鲁肽与无糖尿病肥胖症患者的心血管后果。N Engl J Med 2023;389:2221-32.
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引用次数: 0
Do COX-inhibitors improve emergency contraception efficacy? COX 抑制剂能提高紧急避孕药的疗效吗?
Q4 Medicine Pub Date : 2024-02-28 DOI: 10.1136/dtb.2024.000011

Overview of: Li RHW, Lo SST, Gemzell-Danielsson K, et al. Oral emergency contraception with levonorgestrel plus piroxicam: a randomised double-blind placebo-controlled trial [correction appears in Lancet 2023;402:850]. Lancet 2023;402:851-8.

概述:Li RHW, Lo SST, Gemzell-Danielsson K, et al. 左炔诺孕酮加吡罗昔康口服紧急避孕药:随机双盲安慰剂对照试验[更正见《柳叶刀》2023;402:850]。柳叶刀 2023;402:851-8。
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引用次数: 0
Very low calorie diets and total diet replacement in type 2 diabetes: where are we now? 2 型糖尿病患者的超低卡路里饮食和完全饮食替代:我们现在在哪里?
Q4 Medicine Pub Date : 2024-02-28 DOI: 10.1136/dtb.2022.000055
Roy Taylor

Management of type 2 diabetes has now been simplified by the understanding that the condition is caused by excess fat in the liver together with suppression of beta cell function by the associated excess liver export of fat. These factors can be reversed by substantial weight loss leading to remission in the early years after diagnosis, or at least major decrease in cardiovascular risks and improvement in glucose control for all. Weight loss by any means is successful, but it is most easily achieved by rapid action using a low or very low calorie diet of around 800 kcal/day followed by sustained modest restraint of dietary habits. Oral hypoglycaemic agents and one antihypertensive drug can be withdrawn on day 1 of the weight loss diet, raising the importance of appropriate deprescribing.

2 型糖尿病的病因是肝脏中脂肪过多,以及肝脏输出过多脂肪抑制了 beta 细胞的功能,这一认识简化了对 2 型糖尿病的管理。这些因素都可以通过大幅减肥来扭转,从而在确诊后的最初几年使病情得到缓解,或至少大大降低心血管风险,并改善所有人的血糖控制。通过任何方式减轻体重都是成功的,但最容易实现的方法是迅速采取行动,采用低热量或极低热量饮食,每天约 800 千卡,然后持续适度控制饮食习惯。口服降糖药和一种降压药可在减肥饮食的第一天停用,因此适当停药非常重要。
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引用次数: 0
Drug-induced haemolysis: another reason to be cautious with nitrofurantoin 药物引起的溶血:谨慎使用硝基呋喃妥因的另一个原因
Q4 Medicine Pub Date : 2024-02-01 DOI: 10.1136/dtb.2024.251119rep
Chaitanya Bhatt, Zainab Doleeb, Priya Bapat, Christian Pagnoux
In conjunction with BMJ Case Reports, DTB will feature occasional drug-related cases that are likely to be of interest to readers. These will include cases that involve recently marketed drugs for which there is limited knowledge of adverse effects and cases that highlight unusual reactions to drugs that have been marketed for several years. We report the case of a previously healthy woman in her 60s who presented to the emergency department with acute confusion, vomiting and fever. She was recently diagnosed with a urinary tract infection as an outpatient and had completed the fifth day of a 7-day course of treatment with nitrofurantoin. We maintained a wide differential diagnosis including infectious, metabolic, autoimmune and medication-related causes. She developed an acute normocytic anaemia in hospital with a haemoglobin drop from 121 g/L to 89 g/L. Further investigation revealed evidence of haemolysis with an elevated bilirubin, lactate dehydrogenase, reticulocyte count and decreased haptoglobin. She was worked up for both inherited and acquired causes of haemolysis and found to have glucose-6-phosphate dehydrogenase deficiency. Her presentation was thought to be secondary to nitrofurantoin-induced haemolysis and she recovered completely with conservative management through intravenous fluids and discontinuation of nitrofurantoin. Nitrofurantoin is recommended by both the Canadian and American Urological Association as a first-line antibiotic for uncomplicated urinary tract infections (UTIs),1 even though it only exerts bactericidal effects in the urine when reacting with susceptible bacteria at therapeutic doses.2 As a commonly prescribed antibiotic, clinicians should be aware of its broad side effect profile. Nitrofurantoin is frequently associated with nausea, vomiting, diarrhoea and loss of appetite.2 It has also been associated with severe adverse events such as pulmonary toxicity, hepatotoxicity and peripheral neuropathy. Haemolytic anaemia in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency is another possible side effect, which may be easily overlooked, …
DTB 将与 BMJ 病例报告合作,不定期刊登读者可能感兴趣的药物相关病例。这些病例包括近期上市但不良反应知识有限的药物,以及上市多年但反应异常的药物。我们报告了这样一个病例:一名 60 多岁的健康妇女因急性精神错乱、呕吐和发烧到急诊科就诊。她最近在门诊被诊断为尿路感染,并且已经完成了硝基呋喃妥因 7 天疗程的第五天。我们进行了广泛的鉴别诊断,包括感染、代谢、自身免疫和药物相关原因。她在住院期间出现急性正常红细胞性贫血,血红蛋白从 121 克/升降至 89 克/升。进一步检查发现她有溶血症状,胆红素、乳酸脱氢酶、网状细胞计数升高,血红蛋白下降。对她进行了遗传性和获得性溶血病因检查,发现她患有葡萄糖-6-磷酸脱氢酶缺乏症。她的病症被认为是继发于硝基呋喃妥因引起的溶血,通过静脉输液和停用硝基呋喃妥因的保守治疗,她完全康复了。加拿大和美国泌尿外科协会均建议将硝基呋喃妥因作为治疗无并发症尿路感染(UTI)的一线抗生素1,尽管该药只有在治疗剂量下与易感细菌发生反应时才会在尿液中产生杀菌作用2。2 硝基呋喃妥因作为一种常用的处方抗生素,临床医生应注意其广泛的副作用。2 硝基呋喃妥因常伴有恶心、呕吐、腹泻和食欲不振。葡萄糖-6-磷酸脱氢酶(G6PD)缺乏症患者的溶血性贫血是另一种可能出现的副作用,这种副作用可能很容易被忽视, ...
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引用次数: 0
Tramadol-warfarin interaction 曲马多-华法林相互作用
Q4 Medicine Pub Date : 2024-02-01 DOI: 10.1136/dtb.2024.000008
BMJ Publishing Group Ltd
Key learning points A UK coroner who concluded that the death of a patient was caused by a generally unknown interaction between warfarin and tramadol has asked NHS England to take action to prevent future deaths from such an interaction.1 A patient who had been prescribed warfarin for several years had her international normalised ratio (INR) monitored by …
学习要点 英国一名验尸官得出结论,一名患者的死亡是由华法林和曲马多之间普遍未知的相互作用造成的,该验尸官要求英格兰国家医疗服务系统(NHS)采取行动,防止今后再发生此类相互作用导致死亡的事件。
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引用次数: 0
Severe azathioprine-induced liver injury 22 months after initiation of treatment 开始治疗 22 个月后,硫唑嘌呤诱发严重肝损伤
Q4 Medicine Pub Date : 2024-02-01 DOI: 10.1136/dtb.2024.253505rep
Giovanni Cataletti, Fabrizio Santagata, Luca Pastorelli, Pier Maria Battezzati
Drug-induced liver injury (DILI) is the leading cause of acute liver failure in high-income countries. Acute cholestasis is one of the most common forms of hepatotoxicity induced by azathioprine. It usually begins during the first year of treatment, with most cases reported during the first month. We describe an uncommon case of DILI that occurred after 22 months of drug administration. A woman in her 50s was hospitalised because of jaundice and asthenia. She had been treated with azathioprine for myasthenia gravis during the last 2 years. Acute cholestatic injury was diagnosed. After ruling out most common causes of cholestasis, azathioprine was withdrawn and subsequent histological findings in liver biopsy were consistent with drug-induced cholestatic liver damage. After discontinuation of azathioprine, biochemical parameters progressively normalised and remarkable clinical improvement was achieved. With this report, we suggest that azathioprine should be considered among the causes of liver injury, despite long treatment duration. Drug-induced liver injury (DILI) is the most common cause of acute liver failure in high-income countries.1 Most cases are idiosyncratic and involve immune-mediated mechanisms which are independent of the dose used. In population-based studies, the incidence of DILI ranges between 13.9 and 19.1 cases per 100.000 people per year,1 a figure likely flawed by systematic under-reporting. Identification of the liable drug and its prompt discontinuation are critical to achieve patient recovery. Azathioprine is an immunosuppressive drug that works by inhibiting lymphocyte proliferation, thus limiting inflammatory and autoimmune responses. Azathioprine is a well-known cause of DILI, with an incidence of 1 case per 1103 users.2 Most cases of azathioprine-induced liver injury have been reported between the first month3 4 and the first year5–12 of treatment, while only a few cases of DILI have been described in long-term users of azathioprine.13 14 In the present …
在高收入国家,药物性肝损伤(DILI)是导致急性肝功能衰竭的主要原因。急性胆汁淤积是硫唑嘌呤诱发的最常见肝毒性形式之一。急性胆汁淤积症通常发生在治疗的第一年,大多数病例发生在治疗的第一个月。我们描述了一例不常见的 DILI 病例,该病例是在用药 22 个月后发生的。一名 50 多岁的妇女因黄疸和气喘住院。在过去两年中,她一直在使用硫唑嘌呤治疗肌无力。诊断结果为急性胆汁淤积性损伤。在排除了最常见的胆汁淤积原因后,她停用了硫唑嘌呤,随后的肝活检组织学结果与药物引起的胆汁淤积性肝损伤一致。停用硫唑嘌呤后,生化指标逐渐恢复正常,临床症状也得到显著改善。通过本报告,我们认为,尽管硫唑嘌呤的治疗时间较长,但仍应将其视为肝损伤的原因之一。在高收入国家,药物性肝损伤(DILI)是急性肝功能衰竭最常见的原因。1 大多数病例具有特异性,涉及免疫介导机制,与用药剂量无关。在基于人口的研究中,DILI 的发病率介于每年每 10 万人 13.9 例至 19.1 例之间,1 这一数字很可能因系统性漏报而存在缺陷。确定致病药物并及时停药对患者的康复至关重要。硫唑嘌呤是一种免疫抑制剂,通过抑制淋巴细胞增殖发挥作用,从而限制炎症和自身免疫反应。硫唑嘌呤是众所周知的导致 DILI 的原因,每 1103 例使用者中就有 1 例发病。2 大多数硫唑嘌呤诱发肝损伤的病例都是在治疗的第一个月3 4 到第一年5-12 之间报告的,而长期使用硫唑嘌呤的患者中仅有少数病例被描述为 DILI。
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引用次数: 0
Delirium secondary to anticholinergics 继发于抗胆碱能药物的谵妄
Q4 Medicine Pub Date : 2024-01-31 DOI: 10.1136/dtb.2024.253547rep
Annalise Bellizzi, Elyse Mercieca, Catherine Dimech
In conjunction with BMJ Case Reports , DTB will feature occasional drug-related cases that are likely to be of interest to readers. These will include cases that involve recently marketed drugs for which there is limited knowledge of adverse effects and cases that highlight unusual reactions to drugs that have been marketed for several years. We present a case of a young man who developed sudden deterioration in his physical and mental state whilst being treated as an inpatient for substance-induced psychosis. This deterioration was manifested by sudden disorientation, change in behaviour and visual hallucinations. It was only after excluding other potential causes that this presentation was attributed to the regular administration of procyclidine that was being used to counteract the extrapyramidal side effects from antipsychotics. The patient showed a dramatic improvement on stopping procyclidine. This case highlights the importance of awareness of rare adverse drug reactions and the resultant distressing effect for the patient himself. Antipsychotics are the mainstay of treatment of psychosis. They are well known for their extrapyramidal side effects (EPSEs) that greatly impact a patient’s well-being, including stiffness, tremor, difficulty eating and writing. Procyclidine is commonly prescribed to alleviate EPSEs. It does so by inhibiting the action of acetylcholine at the muscarinic receptor, hence minimising its excitatory effects.1 Reported side effects of procyclidine include most commonly drowsiness, dizziness, constipation, flushing, nausea, nervousness, blurred vision and dry mouth. Rarely, it is reported to cause abdominal pain, difficulty swallowing, urinary retention, weakness, chest pain, fainting, fever, tachycardia, arrhythmias, change in mental state (such as confusion, hallucinations, memory problems), mydriasis and visual changes.1 2 Being an anticholinergic, anticholinergic delirium is a possible, although rare, adverse effect of procyclidine. Following the use of Adverse Drug Reaction Probability Scale,3 this case report illustrates a probable procyclidine-induced delirium in …
DTB 将与 BMJ 病例报告合作,不定期刊登读者可能感兴趣的药物相关病例。这些病例包括近期上市的药物(对其不良反应了解有限),以及已上市数年的药物的异常反应。我们介绍了一个年轻男子的病例,他在接受药物诱发的精神病住院治疗期间,身体和精神状态突然恶化。这种恶化表现为突然迷失方向、行为改变和视觉幻觉。在排除了其他可能的原因后,这一症状才被归因于定期服用普罗环利定来对抗抗精神病药物的锥体外系副作用。停用丙环利定后,患者的病情有了明显好转。这个病例突出了认识罕见药物不良反应的重要性,以及由此给患者本人带来的痛苦。抗精神病药物是治疗精神病的主要药物。众所周知,抗精神病药物的锥体外系副作用(EPSE)会严重影响患者的健康,包括僵硬、震颤、进食和书写困难。普罗环利定是缓解 EPSE 的常用处方药。它通过抑制乙酰胆碱在毒蕈碱受体上的作用,从而将其兴奋作用降至最低。1 据报道,普罗环利定的副作用通常包括嗜睡、头晕、便秘、脸红、恶心、紧张、视力模糊和口干。1 据报道,普罗环利定最常见的副作用包括嗜睡、眩晕、便秘、脸红、恶心、紧张、视力模糊和口干,罕见的副作用包括腹痛、吞咽困难、尿潴留、虚弱、胸痛、昏厥、发热、心动过速、心律失常、精神状态改变(如精神错乱、幻觉、记忆问题)、眼花和视力改变。根据药物不良反应概率表3 ,本病例报告说明了普罗环利定可能诱发的谵妄。
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引用次数: 0
Intravenous acetaminophen associated with acute liver failure 静脉注射对乙酰氨基酚导致急性肝衰竭
Q4 Medicine Pub Date : 2024-01-31 DOI: 10.1136/dtb.2024.251305rep
Maunoo Lee, Joshua McCarron, Aaron Balinski, Richard Bower
In conjunction with BMJ Case Reports, DTB will feature occasional drug-related cases that are likely to be of interest to readers. These will include cases that involve recently marketed drugs for which there is limited knowledge of adverse effects and cases that highlight unusual reactions to drugs that have been marketed for several years. A woman in her mid-60s, without known liver disease, was admitted to the hospital with a partial malignant colonic obstruction. Over a 6-day course, she received a total of 13 g of intravenous acetaminophen not exceeding 4 g over a 24-hour period. She developed encephalopathy and an international normalised ratio of 6.1 meeting criteria for acute liver failure (ALF). She was treated with intravenous N-acetyl cysteine and other causes of liver failure were excluded. The patient was discharged with subsequent resolution of encephalopathy and improvement of her liver chemistries. Though ALF is rare, in countries where acetaminophen is readily available, almost 50% of ALF cases are acetaminophen-induced hepatotoxicity and most have been documented as oral ingestion of acetaminophen. We present a rare case of intravenous acetaminophen-induced ALF. Acute liver failure (ALF) is defined as new onset coagulopathy with international normalised ratio (INR) ≥1.5 and encephalopathy without pre-existing cirrhosis.1 Drug-induced liver injury (DILI) is the most common cause of ALF in the USA occurring at a rate of 20 cases per 100 000 persons.2 3 Of all DILI cases, acetaminophen-induced hepatotoxicity accounts for up to 46% of ALF cases.2 The two main aetiologies of acetaminophen overdoses are either intentional, often in context of suicide attempts, and unintentional overdoses, also known as therapeutic misadventures.3 4 Bower et al conducted a population-based surveillance for ALF that noted 55% of all acetaminophen-related ALF cases to be therapeutic misadventures.5 Current US Food and Drug Administration packaging …
DTB 将与 BMJ 病例报告合作,不定期刊登读者可能感兴趣的药物相关病例。这些病例包括近期上市的药物(对其不良反应了解有限),以及已上市数年的药物的异常反应。一位 60 多岁的妇女因部分恶性结肠梗阻入院,她没有已知的肝病。在为期 6 天的治疗过程中,她总共静脉注射了 13 克对乙酰氨基酚,24 小时内用药量不超过 4 克。她出现了脑病,国际正常化比率为 6.1,符合急性肝衰竭 (ALF) 的标准。她接受了 N-乙酰半胱氨酸静脉注射治疗,并排除了导致肝衰竭的其他原因。患者出院后,脑病得到缓解,肝脏化学指标也有所改善。虽然ALF很罕见,但在对乙酰氨基酚很容易买到的国家,几乎50%的ALF病例都是对乙酰氨基酚引起的肝中毒,而且大多数病例都有口服对乙酰氨基酚的记录。我们介绍了一例罕见的静脉注射对乙酰氨基酚诱发的 ALF 病例。急性肝衰竭(ALF)是指国际正常化比值(INR)≥1.5 的新发凝血病和无肝硬化的脑病。对乙酰氨基酚过量的两种主要病因是故意过量(通常是企图自杀)和非故意过量(也称为治疗失误)。3 4 Bower 等人对 ALF 进行了一项基于人群的监测,结果发现在所有与对乙酰氨基酚相关的 ALF 病例中,55% 属于治疗失误。
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引用次数: 0
Dupilumab-induced ocular surface disease: a primer. 杜比鲁单抗诱发的眼表疾病:入门指南。
Q4 Medicine Pub Date : 2024-01-30 DOI: 10.1136/dtb.2023.249019rep
Merin Anna Reji, Aaisha Haque, Supriya Goyal, Guha Krishnaswamy
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引用次数: 0
Limiting drugs prescribed in primary care. 限制初级保健处方药。
Q4 Medicine Pub Date : 2024-01-30 DOI: 10.1136/dtb.2023.000030
Michael Wilcock
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引用次数: 0
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