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A child with respiratory distress and chocolate brown arterial blood 一个有呼吸困难和巧克力棕色动脉血的孩子
Pub Date : 2023-01-01 DOI: 10.4103/jcrsm.jcrsm_87_22
Fanny Amalraj, P. Jose, S. Ponnarmeni, Peter Prasanth Kumar Kommu
Methemoglobinemia is a hemoglobinopathy that occurs when the heme is oxidated. Ferric iron in oxidized heme cannot bind and transport oxygen. Hence, when the concentration exceeds 15%, symptoms start with cyanosis, distress, and tachypnea, and may progress to seizure, unconsciousness, and even death as the concentration increases. Congenital methemoglobinemia is rare and often clinically missed but responds well with medications. Here, the case of a 12-year-old girl with respiratory distress and no cyanosis is being reported. The diagnosis was made based on a chocolate brown-colored arterial blood sample taken for analysis. The importance of considering this condition as a differential diagnosis in a case of respiratory distress of unknown etiology is being discussed here.
高铁血红蛋白血症是当血红素被氧化时发生的一种血红蛋白病。氧化血红素中的铁不能结合和运输氧。因此,当浓度超过15%时,症状开始为发绀、窘迫和呼吸急促,随着浓度的增加,可能发展为癫痫发作、意识不清甚至死亡。先天性高铁血红蛋白血症是罕见的,临床上经常被遗漏,但药物治疗效果良好。在此,我们报告一名十二岁女孩,呼吸窘迫而无紫绀。诊断是基于巧克力棕色的动脉血液样本进行分析。在病因不明的呼吸窘迫病例中,考虑这种情况作为鉴别诊断的重要性正在这里讨论。
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引用次数: 0
Revisiting the use of antenatal corticosteroids for late preterm and early term infants: An observational analytical study 重新审视晚期早产儿和早期足月婴儿使用产前皮质类固醇:一项观察性分析研究
Pub Date : 2023-01-01 DOI: 10.4103/jcrsm.jcrsm_75_22
Shiny Rugmini, Femitha Pournami, A. Prithvi, Anand Nandakumar, Jyothi Prabhakar, Naveen Jain
Background: Guidelines from prominent policymakers on the use of antenatal steroids (ANS) in “late preterm deliveries and early term casearian deliveries” (LET) are nonuniform. This descriptive study compared LET infants born during two-time epochs: Retrospective: ANS exposed (ANSE) (when institute practice was to administer ANS to all LET mothers), and prospective – ANS unexposed (ANSU) (after the policy was revised in May 2021). Methodology: All antenatal mothers of anticipated late-preterm and early-term cesarean deliveries were being administered ANS before May 2021. Following the revision of hospital policy, this practice was discontinued. Comparative analysis for respiratory morbidity (RM) and other clinically relevant outcomes were conducted in infants born during two-time epochs (ANSE vs. ANSU). Results: Among 379 included infants, those with RMs were comparable between groups: 33 (17.5%) in ANSE; 31 (16.4%) in ANSU – Odds ratio (OR) 1.08; 95% confidence interval (CI) (0.61–1.92), P = 0.78. No difference was noted in hypoglycemia events: 23 (12.2%) in ANSE; 22 (11.6%) in ANSU, OR = 1.05 95% CI (0.56–1.96), P = 0.87. Conclusion: ANS in LET did not seem to reduce the risk of RM. It may be appropriate to audit individual unit practices and relevant outcomes before blanket recommendations are made.
背景:著名政策制定者关于在“晚期早产和早期剖宫产”(LET)中使用产前类固醇(ANS)的指导方针并不统一。本描述性研究比较了在两个时期出生的LET婴儿:回顾性:ANS暴露(ANSE)(研究所的做法是对所有LET母亲进行ANS治疗)和前瞻性- ANS未暴露(ANSU)(在2021年5月政策修订后)。方法:所有预期晚期早产和早期剖宫产的产前母亲在2021年5月之前接受了ANS。在医院政策修订后,这种做法停止了。比较分析两期出生婴儿的呼吸系统发病率(RM)和其他临床相关结局(ANSE与ANSU)。结果:在379例纳入的婴儿中,RMs组间具有可比性:ANSE组33例(17.5%);anu 31例(16.4%)-优势比(OR) 1.08;95%置信区间(CI) (0.61-1.92), P = 0.78。在低血糖事件方面没有差异:ANSE患者23例(12.2%);22例(11.6%),OR = 1.05 95% CI (0.56 ~ 1.96), P = 0.87。结论:LET中的ANS似乎并没有降低RM的风险。在提出全面建议之前,审计个别单位的做法和相关结果可能是适当的。
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引用次数: 0
Journal of Current Research in Scientific Medicine: Past, present and future 当代科学医学研究杂志:过去、现在和未来
Pub Date : 2023-01-01 DOI: 10.4103/jcrsm.jcrsm_29_23
Parthasarathy Ramamurthy, R. Kanungo
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引用次数: 0
Comparison of I-gel™ versus Baska mask® on oropharyngeal sealing pressure in patients receiving general anesthesia under spontaneous ventilation: A randomized controlled trial I-gel™与Baska mask®对自主通气全麻患者口咽密封压力的比较:一项随机对照试验
Pub Date : 2023-01-01 DOI: 10.4103/jcrsm.jcrsm_84_22
Bhimala Ramya, S. Dav, S. Segaran, D. Sivaramakrishnan, M. Zachariah, R. Ranjan
Background: Baska mask® is a newer third-generation supraglottic airway device (SAD) having a self-sealing membranous cuff that does not require inflation. Oropharyngeal sealing pressure (OSP) is used to quantify the efficacy of airway sealing in SAD. Our primary objective was to compare OSP between Baska mask® and I-gel™ in patients receiving general anesthesia on spontaneous ventilation. The secondary objectives were to determine the ease, duration, number of attempts during insertion, hemodynamic responses, and perioperative complications. Methodology: Fifty patients scheduled for a variety of surgical procedures lasting up to 90 min under general anesthesia were randomly allocated to one of the two groups, Group B (Baska mask®) and Group I (I-gel™). Data were collected and entered into an Excel sheet. Statistical analysis was performed using SPSS. Statistical tests used were Student's unpaired t-test, Mann–Whitney U-test, and Fisher's exact test. P < 0.05 was considered statistically significant. Results: The OSP was significantly higher in Group B than in Group I (29.4 ± 6.01 vs. 26.32 ± 4.26 cmH2O, respectively) (P = 0.042). The number of attempts, mean duration, and grade of ease of insertion in both groups had no statistical difference. Hemodynamic parameters were not significantly different between both groups. No postoperative complications were noticed in either group. Conclusion: Baska mask® offers a superior airway sealing pressure compared to I-gel™ without significant hemodynamic changes, with equal first-pass success rate and postoperative complications.
背景:Baska口罩®是一种较新的第三代声门上气道装置(SAD),具有自密封膜袖,不需要充气。口咽密封压力(OSP)用于量化SAD气道密封效果。我们的主要目的是比较Baska mask®和I-gel™在接受全身麻醉的自发通气患者中的OSP。次要目的是确定是否容易、持续时间、插入次数、血流动力学反应和围手术期并发症。方法:50例患者计划在全身麻醉下进行长达90分钟的各种手术,随机分为两组,B组(Baska mask®)和I组(I-gel™)。收集数据并输入到Excel表格中。采用SPSS进行统计分析。使用的统计检验有Student’s unpaired t检验、Mann-Whitney u检验和Fisher’s exact检验。P < 0.05为差异有统计学意义。结果:B组OSP显著高于I组(分别为29.4±6.01∶26.32±4.26 cmH2O) (P = 0.042)。两组的尝试次数、平均持续时间、易插入程度均无统计学差异。两组间血流动力学参数无显著差异。两组均无术后并发症发生。结论:与I-gel™相比,Baska mask®提供了更好的气道密封压力,没有明显的血流动力学变化,具有相同的首次通过成功率和术后并发症。
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引用次数: 0
Spontaneous rupture of pyogenic splenic abscess in infective endocarditis 感染性心内膜炎并发化脓性脾脓肿自发性破裂
Pub Date : 2023-01-01 DOI: 10.4103/jcrsm.jcrsm_19_23
Prashant Ahlawat, Gautam Jesrani, S. Mukherjee, Monica Gupta
Infective endocarditis (IE) has various cardiac and extracardiac complications, which include metastatic abscesses of the solid organs such as the liver, kidney, brain, and spleen. Splenic abscess in IE is an uncommon entity, and spontaneous rupture of a large abscess in a newly diagnosed patient with IE is infrequently described in the literature. A 42-year-old male presented to us with a fever and worsening pain in his left upper quadrant. A detailed evaluation led to the diagnosis of IE and a large pyogenic splenic abscess. The blood culture had a growth of Escherichia coli. He was managed initially with intravenous antibiotics, but an urgent laparotomy and splenectomy were undertaken as he deteriorated and developed shock. Unfortunately, despite a prompt surgical intervention, he succumbed to the illness due to persistent postoperative shock. The case describes the catastrophic complications of IE and broadens the understanding of its complication spectrum.
感染性心内膜炎(IE)有各种心脏和心外并发症,包括肝、肾、脑和脾等实体器官的转移性脓肿。脾脓肿在IE中是一种罕见的实体,在新诊断的IE患者中自发破裂的大脓肿在文献中很少被描述。一名42岁男性向我们报告发烧左上腹疼痛加剧。详细的评估导致诊断IE和一个大的化脓性脾脓肿。血培养有大肠杆菌生长。他最初接受静脉注射抗生素治疗,但在病情恶化并出现休克后,进行了紧急剖腹手术和脾切除术。不幸的是,尽管进行了及时的手术干预,但由于持续的术后休克,他死于疾病。该病例描述了IE的灾难性并发症,拓宽了对其并发症谱的理解。
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引用次数: 0
Loss to follow-up of cervical cancer screening program beneficiaries at Rural Health Training Center in South India – An explanatory mixed method study 印度南部农村卫生培训中心宫颈癌筛查项目受益人的随访损失——一项解释性混合方法研究
Pub Date : 2023-01-01 DOI: 10.4103/jcrsm.jcrsm_97_22
Subalakshmi Subramaniyan, R. Sindhuri, Reena Mohan, K. Ganapathy, Jayasree Manivasakan
Background: In India, routine Pap smear screening is an ongoing process for the detection of cervical cancer, but the follow-up component remains unaddressed. The objectives of the present study were to find out the proportion of abnormal Pap smear results among women aged 30 years screened through the cervical cancer screening program at RHTC, their follow-up status, and explore the reasons and solutions for loss to follow-up (LTFU). Methodology: An explanatory mixed-method study (quantitative: A record-based cohort study followed by qualitative: Five in-depth interviews with loss to follow-up patients and 14 key informant interviews with stakeholders who were purposively selected to identify barriers and possible solutions for LTFU using an interview guide) was conducted in RHTC over 3 months. Ethical principles were adhered to. Results: The results showed that 307 of the 1328 women screened had abnormal Pap smear results. Of the 31 women with precancerous lesions, 26 (83.9%) were on regular follow-ups, and 5 (16.1%) were on irregular follow-ups. Manual content analysis showed five broad categories as barriers to LTFU, namely: (1) general awareness and practical issues; (2) family-related issues; (3) economic issues; (4) cultural issues; and (5) healthcare-associated issues. Community-level awareness generation for capacity building through health education constantly; displaying creative health information models (information, education, and communication); a positive deviance approach; a family and partner-centered approach; the formation of support groups; proactive intervention; and an incentive-based follow-up approach were possible solutions to mitigate the rate of LTFU. Conclusion: Improper knowledge, socio-cultural myths, and a lack of support from partners and family members were the main barriers identified for LTFU. Hence, to strengthen the follow-up component after the initial screening test, periodical sensitization and initiating an incentive-based follow-up approach should be recommended.
背景:在印度,常规子宫颈抹片检查是检测宫颈癌的一个持续过程,但后续部分仍未得到解决。本研究的目的是了解RHTC宫颈癌筛查项目筛查的30岁女性子宫颈抹片检查结果异常的比例及其随访情况,并探讨失访(LTFU)的原因及解决方法。方法学:在RHTC进行了为期3个月的解释性混合方法研究(定量:基于记录的队列研究,随后是定性研究:对随访患者进行了5次深入访谈,并与有目的选择的利益相关者进行了14次关键信息提供者访谈,以确定LTFU的障碍和可能的解决方案,使用访谈指南)。道德原则得到遵守。结果:1328名接受筛查的妇女中,有307人子宫颈抹片检查结果异常。31例癌前病变妇女中,26例(83.9%)定期随访,5例(16.1%)不定期随访。手册内容分析显示了LTFU的五大障碍,即:(1)一般意识和实际问题;(二)家庭事务;(3)经济问题;(4)文化问题;(5)医疗保健相关问题。通过不断进行健康教育,提高社区一级的认识,促进能力建设;展示创新的健康信息模式(信息、教育和传播);积极偏差方法;以家庭和伙伴为中心的方针;成立支援小组;积极的干预;和以激励为基础的随访方法是降低LTFU发生率的可能解决方案。结论:不正确的知识、社会文化神话、缺乏伴侣和家庭成员的支持是LTFU的主要障碍。因此,为了加强初步筛选试验后的随访内容,应建议定期增敏和启动基于奖励的随访方法。
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引用次数: 0
Clinicomicrobiological profile of mycotic keratitis patients presenting at a tertiary care hospital of rural North India 在印度北部农村三级保健医院出现的真菌性角膜炎患者的临床微生物学概况
Pub Date : 2023-01-01 DOI: 10.4103/jcrsm.jcrsm_64_22
Jyoti Sangwan, K. Lohan, Manpreet Kaur, Y. Kumar, Nishtha Saini, Prof. Vanita Mane, P. Singla, Sameena Khan
Background: Mycotic keratitis (MK) or keratomycosis is an infection of corneal stroma caused by a variety of fungal species. It is a condition resulting in blindness if untreated seen, especially in tropical and subtropical countries. The identification of causative fungus is key to starting appropriate treatment. This study aimed to describe clinicomicrobiological profile along with associated demographic factors of MK patients presenting at a tertiary care hospital situated in rural North West India. Methodology: A cross-sectional study was conducted for 3 years from June 2018 to June 2021 at a tertiary care hospital situated in rural North India after obtaining ethics committee approval. After obtaining informed consent, a detailed history was taken from suspected MK patients. Then, corneal scrapings were taken under the slit lamp and processed in the microbiology laboratory for isolation and identification of causative agents. The results obtained were analyzed. Results: A total of 114 nonrepetitive samples were collected from patients suspected of keratomycosis during the study period. Eighty-one (71.1%) samples were found to be positive for fungal growth. Males were affected more than females (1.53:1). Individuals belonging to the age group of 21–40 years were involved the most. Farmers (48.1%) were affected most of all. The predominant fungal species isolated was Candida followed by Aspergillus and Fusarium. Conclusion: The present study highlights the different etiology of MK across different geographical regions. Candida spp. was the most common etiological agent observed in the study followed by Aspergillus and Fusarium spp. Its prevalence, risk factors, and causative agents involved vary with geographic variation, occupation, and local prevailing practices. Timely diagnosis can get an individual the right treatment and can save the vision.
背景:真菌性角膜炎(Mycotic keratitis, MK)是由多种真菌引起的角膜基质感染。如果不及时治疗,这种疾病会导致失明,特别是在热带和亚热带国家。病原真菌的鉴定是开始适当治疗的关键。本研究旨在描述在印度西北部农村一家三级保健医院就诊的MK患者的临床微生物学概况以及相关的人口统计学因素。方法:在获得伦理委员会批准后,于2018年6月至2021年6月在印度北部农村的一家三级保健医院进行了为期3年的横断面研究。在获得知情同意后,对疑似MK患者进行详细的病史记录。然后在裂隙灯下取角膜屑,在微生物实验室进行病原分离和鉴定。对所得结果进行了分析。结果:在研究期间,共收集了114例疑似角孢菌病患者的非重复样本。81份(71.1%)样品真菌生长呈阳性。男性多于女性(1.53:1)。21 ~ 40岁的个体发病最多。农民(48.1%)受影响最大。分离到的真菌种类以念珠菌为主,其次是曲霉和镰刀菌。结论:本研究强调了不同地理区域MK的不同病因。念珠菌是研究中最常见的病原,其次是曲霉和镰刀菌,其流行率、危险因素和病原体因地理差异、职业和当地流行做法而异。及时的诊断可以使患者得到正确的治疗,并可以挽救视力。
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引用次数: 0
A cross-sectional study to assess the post-traumatic stress disorder among discharged coronavirus disease-19-infected individuals in Karnataka, Southern India 一项评估印度南部卡纳塔克邦冠状病毒病-19感染者出院后创伤后应激障碍的横断面研究
Pub Date : 2023-01-01 DOI: 10.4103/jcrsm.jcrsm_77_22
Kishore S. Gudegowda, Riya George, Iswarya Partheeban, Ranganath T Sobagaiah
Background: Posttraumatic stress disorder (PTSD) is a mental disorder that may develop after exposure to a horrifying or traumatic event. India reported a high number of cases worldwide during the waves of the coronavirus disease-19 (COVID-19) pandemic. Even though a high prevalence of PTSD is expected among hospitalized COVID-19 patients, only a very few studies have addressed the issue till now. The objectives of the study were to assess the prevalence and risk factors associated with PTSD among discharged COVID-19-infected individuals from a designated COVID-19 hospital in Karnataka. Methodology: A cross-sectional study was conducted among a total of 120 patients who were discharged after recovery from a designated COVID-19 hospital in Karnataka. Multistage random sampling was done, and equal representation was ensured from all the zones as per the hospital protocol from April 2021 to June 2021. Telephonic interviews with the subjects were conducted; participants were evaluated for PTSD using a semi-structured, prevalidated questionnaire (impact of events scale-revised) after 1 month of discharge from the hospital. Results: The prevalence of PTSD was found to be 29.16%. PTSD was more commonly associated among the middle age group, presence of comorbidities, and with an increased number of days of hospitalization stay especially in ICU with the ventilator. Conclusions: Studying PTSD and its associated factors is necessary to inform about the COVID-19 prognosis. Physicians treating the patient and caretakers of patients should be aware of PTSD risk and should consider PTSD Screening.
背景:创伤后应激障碍(PTSD)是一种可能在暴露于恐怖或创伤性事件后发展的精神障碍。在冠状病毒病-19 (COVID-19)大流行期间,印度报告了全球大量病例。尽管在住院的COVID-19患者中,创伤后应激障碍的患病率预计会很高,但到目前为止,只有很少的研究解决了这个问题。该研究的目的是评估卡纳塔克邦一家指定的COVID-19医院出院的COVID-19感染者中PTSD的患病率和相关风险因素。方法:在卡纳塔克邦一家COVID-19指定医院康复出院的120名患者中进行横断面研究。根据2021年4月至2021年6月的医院协议,进行了多阶段随机抽样,确保了所有区域的平等代表性。对受试者进行电话访谈;出院1个月后,使用半结构化、预先验证的问卷(事件影响量表-修订)对参与者进行PTSD评估。结果:PTSD患病率为29.16%。PTSD更常见于中年人、合并症的存在以及住院天数的增加,特别是在ICU中使用呼吸机。结论:研究创伤后应激障碍及其相关因素对了解COVID-19预后有必要。治疗病人的医生和病人的看护人应该意识到PTSD的风险,应该考虑PTSD筛查。
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引用次数: 0
Enhancing the interpretational skills of complete blood count reports by second year medical students using competency based learning method 运用能力为基础的学习方法,提高医二学生对全血细胞计数报告的解释能力
Pub Date : 2023-01-01 DOI: 10.4103/jcrsm.jcrsm_21_23
R. Varghese, Niraimathi Manickam, A. Mohanraj
Background: Competency-based learning can help improve the skills of medical students to interpret lab reports like complete blood counts (CBCs). The objectives of this study were to assess whether “hands-on training” on interpreting the CBC reports is useful and to evaluate the students' and faculty's feedback on their experience based on the Kirkpatrick four-level training model. Methodology: Second-year MBBS students were initially assessed on the knowledge they already had regarding the interpretation of CBC reports, which they had learned in Physiology (T1). They were then divided into two groups as study (S) and control (C) groups. Study group students alone were given “hands-on training” to interpret CBC reports. Then, both the groups were assessed using objectively structured practical examination (OSPE) (T2). The control group was given the same training on another day. Then, both the groups were assessed using OSPE 1 month later (T3). Both the pretraining and posttraining scores were analyzed using repeated measures analysis of variance. Results: The mean scores differed significantly over time points. In the study group (Group A), the scores from pretraining (T1) to posttraining (T2) (P = 0.001), pretraining (T1) to 1 month later (T3) (P = 0.001), pretraining (T1) to 1 month later (T3) (P = 0.001), and posttraining (T2) to 1 month later (T3) (P = 0.001) were significant. However, in the control group (Group B), the scores from pretraining (T1) to 1 month later (T3) (P = 0.001) and posttraining (T2) to 1 month later (T3) (P = 0.001) were significant, but not from pretraining (T1) to posttraining (T2). Between the study and control groups, the difference in scores at pretraining (P = 0.001) and posttraining (P = 0.001) was significant, but not for the test 1 month later (35.5 ± 11.6 vs. 37.2 ± 10.7). Conclusion: Competency-based learning enhanced the student's interpreting skills of CBC reports, which will be useful in their career as doctors.
背景:基于能力的学习有助于提高医学生对全血细胞计数(CBCs)等实验室报告的理解能力。本研究的目的是基于Kirkpatrick四级培训模型,评估CBC报告的“实践培训”是否有用,并评估学生和教师对他们的经验反馈。方法:对MBBS二年级学生进行初步评估,评估内容是他们已经掌握的关于CBC报告解释的知识,这些知识是他们在生理学(T1)中所学到的。然后将他们分为两组:研究组(S)和对照组(C)。学习小组的学生单独接受了解读CBC报告的“动手训练”。然后,采用客观结构化实践考试(OSPE) (T2)对两组进行评估。对照组在另一天进行同样的训练。1个月后(T3)对两组患者进行评分。采用重复测量方差分析对训练前和训练后得分进行分析。结果:各时间点平均得分差异显著。在研究组(A组)中,训练前(T1)至训练后(T2) (P = 0.001)、训练前(T1)至训练后1个月(T3) (P = 0.001)、训练前(T1)至训练后1个月(T3) (P = 0.001)、训练后(T2)至训练后1个月(T3) (P = 0.001)得分均有统计学意义。而在对照组(B组)中,训练前(T1)至训练后1个月(T3) (P = 0.001)和训练后(T2)至训练后1个月(T3) (P = 0.001)的得分有统计学意义,而训练前(T1)至训练后(T2)的得分无统计学意义。在实验组和对照组之间,训练前(P = 0.001)和训练后(P = 0.001)的得分差异有统计学意义,但在1个月后的测试中差异无统计学意义(35.5±11.6比37.2±10.7)。结论:基于能力的学习提高了学生对全血细胞计数报告的口译能力,对其今后的医生职业生涯有一定的帮助。
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引用次数: 0
A One-Pot Synthesis of Sulfonyl Amidinesvia Three-Component Reaction Under Mild and Solvent-Free Conditions 温和无溶剂条件下三组分反应一锅法合成磺酰脒
Pub Date : 2022-12-17 DOI: 10.14302/issn.2766-8681.jcsr-21-3805
Chiaa Adiche, D. El Abed
A convenient one-pot synthetic protocol for the preparation of sulfonyl amidines has been developed. The procedure combines three-component reaction of sulfonyl azide, methyl propiolate and secondary cyclic amine coupling in one sequence without any solvent or catalyst and at room temperature. The reaction proceeds smoothly and a variety of desired sulfonyl amidines were obtained in moderate to good yields. This protocol has synthetic advantages in terms of low environmental impact and very short reaction time.
提出了一种简便的一锅法合成磺胺基化合物的方法。该方法是在室温下,在无溶剂或催化剂的情况下,将磺酰叠氮、丙酸甲酯和仲环胺偶联在一个序列中进行的三组分反应。反应进行顺利,以中高收率得到了多种所需的磺酰脒。该工艺具有对环境影响小、反应时间短的综合优势。
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引用次数: 0
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Journal of Current Research in Scientific Medicine
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