Allergic reactions associated with airborne fish particles in IgE-mediated hypersensitive patients
《新英格兰杂志》综述全文(中文版)：大量失血的预防与治疗
《新英格兰杂志》综述全文（中文版）：大量失血的预防与治疗Prevention and Treatment of Major Blood Loss大量失血的预防与治疗Pier Mannuccio Mannucci, M.D., and Marcel Levi, M.D., Ph.D.NEJM,Volume 356:2301-2311 May 31, 2007 Number 22第一部分In a medical setting, surgery is the most common cause of major blood loss, defined as a loss of 20% of total blood volume or more. In particular, cardiovascular procedures, liver transplantation and hepatic resections, and major orthopedic procedures including hip and knee replacement and spine surgery, are associated with severe bleeding. Excessive blood loss may also occur for other reasons, such as trauma. Indeed, bleeding contributes to approximately 30% of trauma-related deaths.1 Bleeding in critical locations, such as an intracerebral hemorrhage, may also pose a major clinical challenge.Severe bleeding often requires blood transfusion. Even when the benefits of transfusion outweigh the risks (e.g., mismatched transfusion, allergic reactions, transmission of infections, and acute lung injury),2 strategies to minimize the use of limited resources such as blood products are essential. The most obvious and probably the most effective strategy is to improve surgical and anesthetic techniques. For example, liver transplantation, a procedure that once required transfusion of large amounts of blood products, now has relatively small transfusion requirements in most instances.Ruling out abnormalities of hemostasis in a patient with bleeding is also essential, because such problems can often be corrected by replacing the defective components of the hemostatic system. However, cases of excessive blood loss in which no surgical cause or abnormalities in hemostasis can be identified require pharmacologic strategies, which can be broadly divided into preoperative prophylaxis for operations that confer a high risk of bleeding and interventions for massive, refractory bleeding. The medications that have been most extensively evaluated as hemostatic agents include the antifibrinolytic lysine analogues aminocaproic acid and tranexamic acid; aprotinin, a bovine-derived protease inhibitor; and desmopressin, a synthetic analogue of the antidiuretic hormone that raises the plasma levels of factor VIII and von Willebrand factor.3 In addition, recombinant activated factor VII appears to be efficacious in an array of clinical situations associated with severe hemorrhage.4 The safety of aprotinin, the most widely used of these agents, has been questioned because of concerns about renal and cardiovascular adverse events.5Most trials of hemostatic agents have been designed to assess therapeutic efficacy, but they were not optimally designed to assess potential toxic effects, so definitive safety data are lacking for all hemostatic agents. Many trials of these agents have used perioperative blood loss and othermeasures that are not the most clinically relevant end points, and many published trials were not powered to assess more clinically relevant outcomes such as mortality or the need for reoperation. We review the therapeutic benefits of hemostatic drugs and consider the risk of adverse events. In particular, we consider thrombotic complications, which constitute a major concern when agents that potentiate hemostasis are administered.第二部分Antifibrinolytic AgentsApproximately 5% of patients undergoing cardiac surgery require reexploration because of excessive blood loss; indeed, bleeding during and after cardiac surgery is an established marker of increased morbidity and mortality.6,7,8 Pharmacologic strategies are therefore often used to minimize blood loss during cardiac surgery. Aprotinin (a direct inhibitor of the fibrinolytic enzyme plasmin) is the only drug reported to minimize transfusion requirements in coronary-artery bypass grafting and approved by the Food and Drug Administration (FDA). Aminocaproic acid and tranexamic acid are also used, but they have not been approved by the FDA for this indication. The mechanism of action of these agents is illustrated in Figure 1. Table 1 lists the most frequently used dosages of antifibrinolytic agents.Figure 1. Mode of Action of Lysine Analogues (Aminocaproic Acid and Tranexamic Acid).Activation of plasminogen by endogenous plasminogen activators results in plasmin, which causes degradation of fibrin. Binding of plasminogen to fibrin makes this process more efficient and occurs through lysine residues in fibrin that bind to lysine-binding sites on plasminogen (Panel A). In the presence of lysine analogues, these lysine-binding sites are occupied, resulting in an inhibition of fibrin binding to plasminogen and impairment of endogenous fibrinolysis (Panel .Table 1. Mechanism of Action and Intravenous Doses of Antifibrinolytic Agents Used in Cardiac Surgery to Minimize Blood Loss and Transfusion Requirements.Efficacy of Antifibrinolytic AgentsAfter the first study in 1987,9 more than 70 randomized, controlled trials that included from 20 to 796 patients (median, 75) confirmed and established the efficacy of aprotinin for limiting the requirements for transfusion of red cells, platelets, and fresh-frozen plasma in patients undergoing cardiac surgery. We examine in depth four trials chosen for their size and design.In a study of 796 patients who were randomly assigned to receive aprotinin or placebo during primary coronary-artery bypass grafting, aprotinin was associated with reduced blood loss (mean [±SD], 664±1009 ml, vs. 1168±1022 ml in the placebo group). Aprotinin also was associated with a decreased rate of use of any blood product (40%, vs. 58% in the placebo group).10 In a randomized, placebo-controlled trial involving 704 patients, treatment with aprotinin was associated with a decrease in mean perioperative blood loss (832±50 ml, vs. 1286±52 ml in the placebo group) and a reduction in the proportion of patients requiring any transfusion (35% vs.55%).11 Two trials recruited patients who were at increased risk for bleeding because they were undergoing repeat cardiac surgery.12,13 On average, patients who received aprotinin needed between 1.6 and 2 units of blood products, whereas patients who received placebo needed between 10 and 12 units.12,13 Similar findings with aprotinin have been reported in many other placebo-controlled trials, with a reduction in perioperative blood loss ranging from 50 to 1350 ml (median reduction, 400 ml) and a reduction by a factor of 1.5 to 3 in the proportion of patients requiring any transfusion.14,15,16,17,18,19,20,21,22,23,24,25第三部分Randomized trials of tranexamic acid or aminocaproic acid are much less numerous than trials of aprotinin.26,27,28,29,30,31 In the largest trial of tranexamic acid, 210 patients were randomly assigned to receive tranexamic acid (at a dose of 10 g) or placebo. Administration of tranexamic acid resulted in a 69% reduction in red-cell transfusions, and the proportion of patients requiring any blood product was 12.5% in the tranexamic acid group as compared with 31.1% in the control group.31There have also been meta-analyses and systematic reviews of the efficacy of antifibrinolytic agents.32,33,34,35,36 Table 2 summarizes the results of a Cochrane review. As compared with placebo, the use of aprotinin or tranexamic acid, but not of aminocaproic acid, reduced the need for blood transfusion by 30% and saved approximately 1 unit of blood per operation.36 There was no difference in efficacy between low-dose and high-dose regimens of aprotinin (Table 1), whereas the large variations in dosages of tranexamic acid and aminocaproic acid precluded the evaluation of the relationship between dosage and efficacy. In terms of more clinically relevant events, the relative risk of reoperation for excessive bleeding was significantly reduced among patients who received aprotinin, as compared with those who received placebo, although mortality was not affected. There was a significant reduction in these events with either tranexamic acid or aminocaproic acid.36Table 2. Results of the Cochrane Review of the Effect of Antifibrinolytic Agents on Clinical Events among Patients Undergoing Major Surgical ProceduresThus, the results of controlled trials and reviews indicate that antifibrinolytic drugs are effective hemostatic agents in cardiac surgery. Reductions in both transfusion requirements and reoperation for bleeding appear to be confirmed by the narrow confidence intervals of the odds ratios that are indicators of the relative risks (Table 2). There are not enough efficacy data to draw definitive conclusions regarding the use of antifibrinolytic agents in other situations.Safety of Antifibrinolytic AgentsThere have been criticisms that many trials of the efficacy of aprotinin in cardiac surgery were unnecessarily carried out (and reported) after the transfusion-sparing efficacy was unequivocally established and that such studies should have focused instead on the more cogent and unsettled issue of safety.37,38 Adverse events, particularly thrombotic complications, are expected when a major regulatory system such as the fibrinolytic system is pharmacologically inhibited; this isespecially true in patients undergoing cardiac surgery, because they often have underlying atherothrombotic disease.Table 3, which summarizes the risks of complications when antifibrinolytic agents are administered, shows that none of the adverse events examined was significantly increased.36 However, a few early studies indicated that the use of aprotinin could lead to an increase in cases of postoperative renal dysfunction, possibly through the inhibition of kallikrein and other endogenous vasodilators, with a resultant reduction of renal blood flow.24,39,40Table 3. Results of the Cochrane Review of the Effect of Antifibrinolytic Agents on Adverse Events among Patients Undergoing Major Surgical Procedures.第四部分The risk of serious adverse events associated with aprotinin was recently highlighted by the results of a nonrandomized, observational study involving 4374 patients who underwent elective coronary-artery bypass surgery.5 That study, which compared aprotinin, aminocaproic acid, and tranexamic acid with no treatment, used the propensity-score adjustment method to balance the covariates and thus reduce bias that could arise if sicker patients selectively received one agent over another. The results indicated that, as compared with no treatment, aprotinin (but neither aminocaproic acid nor tranexamic acid) doubled the risk of severe renal failure, increased the risk of myocardial infarction or heart failure by 55%, and was associated with a nearly doubled increase in the risk of stroke or other cerebrovascular events. That study confirmed that the three antifibrinolytic agents reduced blood loss to a similar degree, but adverse events were much more frequent with aprotinin than with the other agents. Much debate followed the publication of the study,41,42,43,44 which was criticized on the grounds that it was observational, was carried out in many different countries and institutions, and was poorly controlled with respect to known determinants of outcome such as the use or nonuse of antithrombotic and inotropic drugs, the duration of cardiopulmonary bypass, and the amounts of blood transfused.However, other recent studies have also reported adverse renal effects of aprotinin. A review of randomized trials conducted from 1991 to 2005 reported that patients who received aprotinin had a 9% rate of renal failure (defined as the need for dialysis or a postoperative increase in the serum creatinine level of at least 2.0 mg per deciliter [176.8 µmol per liter]) and that renal dysfunction (defined as an increase in creatinine of 0.5 to 1.9 mg per deciliter [44.2 to 168.0 µmol per liter]) occurred in 12.9% of patients receiving aprotinin as compared with 8.4% of controls (relative risk, 1.47; 95% confidence interval [CI], 1.12 to 1.94; P<0.001).41 An observational survey commissioned by the manufacturer showed similar rates of renal dysfunction and renal failure among 67,000 patients who received aprotinin.45Although Mangano et al.5 and the authors of previous systematic reviews report that aminocaproic acid and tranexamic acid appear to be relatively safe,32,33,34,35,36 the numbers of trials and study participants were much smaller for these drugs than for aprotinin. Thus, confidence with regard to safety issues is not solid, especially with respect to thrombosis. Most important, trials comparing aprotinin with lysine analogues have been too few and toosmall.46,47,48,49 An independently funded, randomized clinical trial with three study groups is being conducted in Canada. The Blood Conservation using Antifibrinolytics: A Randomized Trial in a Cardiac Surgery Population (BART) study, which is still enrolling patients, plans to enroll 2970 patients undergoing high-risk cardiac surgery to determine whether aprotinin is superior to aminocaproic acid or tranexamic acid in reducing the risk of massive postoperative bleeding.50 Secondary end points are mortality from all causes and adverse events such as cardiovascular disease and renal failure.50第五部分On the basis of all the data reported thus far, there is abundant, solid evidence that aprotinin reduces perioperative and early postoperative blood loss and transfusion requirements in patients undergoing cardiac surgery. However, despite the large number of clinical trials involving this agent, its effectiveness in decreasing the need for reoperation has been reported only in reviews,36 and evidence of its effect on mortality is lacking. It is regrettable that the inexpensive lysine analogues have been less thoroughly investigated as of this writing, because it appears likely that these agents are at least as efficacious as aprotinin. The uncertainty about aprotinin's safety remains a substantial concern. Until the results of the Canadian trial are available,50 aprotinin remains the hemostatic agent of choice. However, it should be used only when excessive perioperative and early postoperative blood loss is predicted (e.g., in the case of a complex operation or special clinical circumstances such as the use of antiplatelet agents).Evidence of the efficacy of lysine analogues is not as solid as that for aprotinin, so these agents should be used only as a second choice in high-risk cardiac surgery. There is definitely no role for either aprotinin or other hemostatic agents in noncomplex coronary-artery bypass surgery, even though in many cases an off-pump procedure is used, which reduces blood loss and transfusion requirements.51,52 The FDA has warned that it is important to monitor patients receiving aprotinin for renal, cardiac, and brain toxic effects and that aprotinin should be used only when the clinical benefit of reducing blood loss is essential to medical management and outweighs any risk.53Recombinant Activated Factor VIIRecombinant activated factor VII (rFVIIa) is thought to act locally at the site of tissue injury and vascular-wall disruption by binding to exposed tissue factor, generating small amounts of thrombin that are sufficient to activate platelets4 (Figure 2). The activated platelet surface can then form a template on which rFVIIa directly or indirectly mediates further activation of coagulation, ultimately generating much more thrombin and leading to the conversion of fibrinogen to fibrin.54,55 Clot formation is stabilized by the inhibition of fibrinolysis due to rFVIIa-mediated activation of thrombin-activatable fibrinolysis inhibitor.56Figure 2. Mechanism of Action of Recombinant Factor VIIa.When the vessel wall is disrupted, subendothelial tissue factor becomes exposed to circulating blood and may bind factor VIIa (Panel A). This binding activates factor X, and activated factor X(factor Xa) generates small amounts of thrombin. The thrombin (factor IIa) in turn activates platelets and factors V and VIII. Activated platelets bind circulating factor VIIa (Panel , resulting in further factor Xa generation as well as activation of factor IX. Activated factor IX (factor IXa) (with its cofactor VIIIa) yields additional factor Xa. The complex of factor Xa and its cofactor Va then converts prothrombin (factor II) into thrombin (factor IIa) in amounts that are sufficient to induce the conversion of fibrinogen to fibrin.第六部分Efficacy of rFVIIaInitially, rFVIIa was licensed for the treatment of bleeding in patients with hemophilia who had antibodies inactivating factor VIII or IX.4 More recently, this agent has been used extensively in patients with major hemorrhage from surgery, trauma, or other causes.57 A small, controlled clinical trial showed that rFVIIa could minimize perioperative blood loss and transfusion requirements in patients undergoing transabdominal prostatectomy, an operation that is often associated with major blood loss.58 In that trial, 36 patients were randomly assigned to receive a single preoperative injection of rFVIIa (20 or 40 µg per kilogram of body weight) or placebo. Administration of the active drug resulted in a significant reduction of blood loss (50%) and eliminated the need for transfusion, which was required in approximately 60% of patients who received placebo.58Additional studies have focused on patients undergoing orthotopic liver transplantation. An open-label pilot study involving six patients showed a marked reduction in transfusion requirements among those who received a single dose of rFVIIa (80 µg per kilogram) as compared with matched historical controls.59 However, a subsequent randomized, placebo-controlled trial evaluating two different doses of rFVIIa (60 and 120 µg per kilogram) showed no reduction in transfusion requirements among 182 liver-transplant recipients, although red-cell transfusion was averted in 8.4% of patients who received rFVIIa but in none of the patients in the placebo group.60 Two randomized, controlled trials of rFVIIa (up to 100 µg per kilogram at every second hour of surgery) in patients with cirrhosis or normal liver function who were undergoing major liver resection did not show a significant effect of rFVIIa on either the volume of blood products administered or the percentage of patients requiring transfusion.61,62In addition, rFVIIa was evaluated in a randomized, controlled study involving 20 patients undergoing noncoronary cardiac surgery requiring cardiopulmonary bypass.63 Administration of rFVIIa at a dose of 90 µg per kilogram after discontinuation of bypass significantly reduced the need for blood transfusion (relative risk of any transfusion, 0.26; 95% CI, 0.07 to 0.90). In addition, a propensity score?matched, case?control study involving 51 patients with massive blood loss after cardiac surgery showed a significant decrease in blood loss and requirements for blood products after the administration of rFVIIa (at a dose of 35 to 70 µg per kilogram).64 In this study, however, the incidence of acute renal dysfunction among patients receiving rFVIIa was 2.4 times that in the control group, although there were no significant differences between the two groups with regard to other adverse events.64Several case reports and case series suggest that rFVIIa is also useful in reducing major blood loss in patients with trauma.65 A placebo-controlled trial involving 143 patients with severe blunt trauma showed that three successive doses of rFVIIa (200, 100, and 100 µg per kilogram) significantly reduced red-cell transfusion (mean reduction, 2.6 units) and reduced the proportion of patients in whom massive transfusion, defined as more than 20 units of red cells, was required (14% of treated patients vs. 33% of controls).66 However, a parallel trial involving 134 patients with penetrating trauma showed no significant effects.66第七部分Studies have also evaluated rFVIIa for the treatment of spontaneous intracranial hemorrhage, a condition for which there is a paucity of effective therapeutic options.67 A dose-finding trial involving 400 patients showed that as compared with placebo, rFVIIa was associated with a slower increase in the size of intracerebral hematoma. More important, there was a 35% reduction in mortality and an improved disability score at 90 days in patients who received rFVIIa.67 Unfortunately, these promising early results were not confirmed in a subsequent phase 3, randomized, controlled trial involving 821 patients.68 A preliminary report indicated that there was a significant reduction in the size of the intracerebral hematoma but with no effect on mortality and severe disability on day 90, the primary end point of the study.68 The manufacturer has not sought regulatory approval for rFVIIa for the treatment of intracerebral hemorrhage.This agent has also been studied in patients with bleeding esophageal varices and portal hypertension, a combination that constitutes another major clinical challenge. In a randomized, controlled trial involving 245 patients with cirrhosis and upper gastrointestinal bleeding (66% of whom had bleeding varices) who were being treated with standard endoscopic and pharmacologic interventions, the administration of rFVIIa (eight consecutive doses of 100 µg per kilogram within 30 hours after the initiation of treatment) was not more effective than placebo with respect to the primary composite end point (failure to control bleeding within 24 hours and failure to prevent rebleeding or death within the first 5 days).69 However, in a subgroup of patients with more severe cirrhosis (classified as Child class B or C), rFVIIa was associated with a decrease in the proportion of patients reaching the composite end point (8%, vs. 23% in the control group; P=0.03). Furthermore, none of the patients treated with rFVIIa had rebleeding within 24 hours, whereas rebleeding occurred in 11% of patients in the control group (P=0.01).69Many case reports and case series have examined the use of rFVIIa in patients with excessive or life-threatening blood loss occurring in an array of clinical settings.57 However, no randomized, controlled clinical trials have been completed, which is not surprising, given the difficulty of performing meaningful studies in such heterogeneous situations. Many reports claim that the use of rFVIIa resulted in rapid reduction of blood loss or a decrease in transfusion requirements after other therapeutic measures had failed. Although many of these reports appear to be compelling, it is difficult to assess the usefulness of rFVIIa properly, since publication bias in case reports and series is likely.第八部分Safety of rFVIIaControlled clinical trials have shown that the incidence of thrombotic complications among patients who received rFVIIa was relatively low and similar to that among patients who received placebo.70 However, most studies of rFVIIa involved patients who had impaired coagulation or who were at low risk for thrombosis. In one trial involving patients with conditions such as intracerebral hemorrhage and a much higher risk of thrombosis, 7% of patients receiving rFVIIa had serious thromboembolic events ? mainly myocardial infarction or ischemic stroke ? as compared with 2% of those receiving placebo.67 Midway through this trial, an exclusion criterion changed. Initially, only patients with thrombotic disease within 30 days before enrollment were excluded, but at the midpoint, all patients with any history of thrombotic disease were excluded, which may have obscured safety concerns associated with the use of rFVIIa. A review based on the FDA MedWatch database indicated that thromboembolic events have occurred in both the arterial and venous systems, particularly in patients with diseases other than hemophilia in whom rFVIIa was used on an off-label basis.71 A total of 54% of the thromboembolic events were arterial thrombosis (in most cases, stroke or acute myocardial infarction); venous thromboembolism (in most cases, venous thrombosis or pulmonary embolism) occurred in 56% of patients. In 72% of the 50 reported deaths, thromboembolism was considered the probable cause. It is not clear to what extent the clinical conditions requiring the use of rFVIIa may have contributed to the risk of thrombosis.71 These findings provide evidence of an increased risk of thrombotic complications that may offset the potential benefit of rFVIIa in patients with severe blood loss.The availability of rFVIIa has expanded the treatment options for acute hemorrhage in patients with conditions other than hemophilia. This agent is not a panacea, but it has efficacy in patients with trauma and excessive bleeding that is resistant to other treatments. However, the promising results obtained so far must be substantiated by confirmatory trials, and studies of the cost-effectiveness of this expensive agent are also warranted. The many published cases of dramatic success in patients with various types of acute hemorrhages, albeit convincing and rewarding for the involved clinicians, should be viewed with caution in terms of constituting clinically directive evidence. Attempts are being made to improve the potency and efficacy of rFVIIa further by engineering the molecule through DNA technology, but clinical trials designed to establish increased efficacy and safety remain to be performed.72,73第九部分Other InterventionsDesmopressin was originally developed and licensed for the treatment of inherited defects of hemostasis.74,75,76 This drug, given by slow intravenous infusion at a dose of 0.3 µg per kilogram, acts by releasing ultralarge von Willebrand factor multimers from endothelial cells, leading to an increase in plasma levels of von Willebrand factor and associated factor VIII and anenhancement of primary hemostasis.77,78 The strongest evidence of efficacy is in the prevention and treatment of bleeding in patients with mild hemophilia A and von Willebrand's disease.75,76 In 1986, Salzman et al.79 showed that as compared with placebo, desmopressin reduced blood loss and transfusion requirements by approximately 30% during complex cardiac surgery. Subsequent attempts to reproduce these findings were variable; most did not confirm the marked benefit originally reported.80,81,82 Overall, there have been 18 trials of desmopressin in a total of 1295 patients undergoing cardiac surgery. These trials show a small effect on perioperative blood loss (median reduction, 115 ml). Several reviews suggest that although desmopressin helps to reduce perioperative blood loss, its effect is too small to influence other, more clinically relevant outcomes such as the need for transfusion and reoperation.33,83,84,85 In addition, desmopressin does not reduce blood loss or transfusion requirements during elective partial hepatectomy, another operation often associated with major blood loss.86 A report that desmopressin reduced blood loss associated with posterior spinal surgery for idiopathic scoliosis87 was not confirmed.88,89,90Although desmopressin can shorten the skin-bleeding time in patients with uremia,91 the current widespread use of recombinant erythropoietin has made this abnormality of hemostasis much less frequent than it was previously.92 The beneficial effect of erythropoietin on hemostasis is based on the increase in red-cell mass, which affects the blood?fluid dynamics, leading to a more intense interaction between circulating platelets and the vessel wall.Thus, there is little evidence that desmopressin is efficacious in conditions other than mild hemophilia A and von Willebrand's disease. The use of desmopressin in some patients who have bleeding as a consequence of inherited and acquired defects of platelet function may be considered. This drug has been shown to shorten the skin-bleeding time in patients with cirrhosis of the liver and in those with some types of inherited platelet disorders.93 However, the use of desmopressin for these indications is not supported by sound clinical evidence based on relevant end points.94 The most common adverse effects of desmopressin, facial flushing and transient hyponatremia, are usually mild. There have been reports of arterial thrombotic events, not only in patients with atherothrombosis but also in patients with bleeding disorders and in a blood donor.95,96,97,98,99,100 A systematic review showed that for patients with acute myocardial infarction who underwent cardiac surgery, the frequency of these adverse events among patients who received desmopressin was twice that among patients who received placebo, with no improvement in clinical outcomes.33 However, another review, evaluating 16 trials of desmopressin in cardiac surgery and in other high-risk operations, showed that the rate of thrombosis did not differ significantly between patients who received desmopressin and patients who received placebo (3.4% vs. 2.7%).101第十部分Hemostatic agents for topical use (particularly "fibrin sealants" composed of human fibrinogen, human or bovine thrombin, and in some instances human factor XIII and bovine aprotinin) have been licensed in Europe.102,103 In several poorly controlled studies involving small series of patients, the efficacy of these agents has been reported for indications such as cardiovascular and。
FDA工业指南 非青霉素β内酰胺类药品防止交叉污染的指导原则2013.4
工业指南非青霉素β-内酰胺类药品防止交叉污染的指导原则目录I.简介II.背景III.建议You can use an alternative approach if the approach satisfies the requirements of the applicable statutes and regulations. If you want to discuss an alternative approach, contact the FDA staff responsible for implementing this guidance. If you cannot identify the appropriate FDA staff, call the appropriate number listed on the title page of this guidance.本指南代表当前FDA对本议题的看法。
本指南并不授予任何人任何特权，也不对FDA或公众起任何约束作用。
如果有替代的方法能满足法律法规的要求，则可以使用该替代方法。
如果想要讨论替代方法，请与FDA负责实施该指南的工作人员联系。
如果不能与指定的合适FDA工作人员联系，请拨打该指南标题页列出的电话号码。
I. INTRODUCTIONI. 简介This guidance describes the importance of implementing manufacturing controls to prevent cross-contamination of finished pharmaceuticals and active pharmaceutical ingredients (APIs) with non-penicillin beta-lactam drugs. This guidance also provides information regarding the relative health risk of, and the potential for, cross-reactivity in the classes of sensitizing beta-lactams (including both penicillins and non-penicillin beta-lactams). Finally, this guidance clarifies that manufacturers generally should utilize separate facilities for the manufacture of non-penicillin beta-lactams because those compounds pose health risks associated with cross-reactivity.本指南描述了对非青霉素β-内酰胺类成品和原料药的生产过程进行控制，以防止交叉污染的重要性。
护理英语
[护理英语]查房护士：今天看来您精神好一些。
病人：是的，不过整天躺着我觉得全身不舒服。
护士：您今天可以下床了，但在下床前先要在床边坐坐，没有头晕才能下床。
病人：不过我感到腹胀得很。
护士：有气从肛门排出吗？病人：没有。
护士：可以多翻身，如果伤口不疼可下床活动，那样有助于恢复肠蠕动，使气体排出减轻腹胀。
病人：伤口疼，而且有痰又难咳出来。
护士：您应该坐起来，那样可以帮助您深呼吸，使痰较容易咳出，以防痰积在肺内引起肺炎。
病人：好的。
护士：您喝过水了吗？病人：喝过了。
护士：您感觉胃胀和恶心吗？病人：没有。
护士：那很好，您可以开始吃流质，过两天吃稀饭。
病人：谢谢。
病人：我住院还需多久？护士：一个星期左右便可出院了。
护士：医生，早晨好。
医生：早晨好，病人手术后情况如何？护士：伤口有点疼。
伤口引流有些渗血，换过一次敷料。
医生：那很好。
护士：静脉输液和青霉素是否继续给？医生：继续。
Nurse:Good morning, doctor.Doctor:Good morning. How is the patient after surgery?N:The patient has a slight pain in the wound. Some blood has been oozing from the draining wound, the dressing has been changed once.D:That's good.N:Does he still need inavenous infusion and penicillin?D:Yes.Nurse:You look a little better today.Patient:Yes, but lying in bed all day, I feel uncomfortable all over.N:You can get out of bed today. First, sit on the edge of the bed and if you don't feel dizzy then you can get out of bed.P:But I feel distended in the abdomen.N:Did you pass any wind by rectum?P:No.N:You can lie on your side more often, and if the wound does not hurt, you can get out of bed and walk around, that will help peristalsis of the intestine which will help to pass gas and lessens distension.P:The wound is painful and the sputum is difficult to expectorate.N:You should sit up. That will help your deep breathing, and help you to expectorate and preventthe sputum from accumulating in your lungs to cause pneumonia.P:All right.N:Did you drink any water?P:Yes.N:Do you feel distended and nausea?P:No.N:That's good. You can start on a fluid diet and congee in two days.P:Thank you.P:How long must I stay in hospital?N:You can go home in about a week.[护理英语]测量体温学生：测体温应该使用什么样的体温计？护士：常用有水银柱的摄氏或华氏体温计测量。
2024医学博士英语考试真题及答案
2024医学博士英语考试真题及答案2024 Medical Doctor English Exam Questions and AnswersAre you preparing for the 2024 Medical Doctor English Exam? Look no further! Below are some sample questions and answers that can help you ace the exam.Section 1: Reading ComprehensionRead the following passage and answer the questions that follow:The human body is a complex system of organs and tissues that work together to maintain health. One of the most vital organs in the body is the heart. The heart is responsible for pumping blood throughout the body, supplying oxygen and nutrients to all the organs and tissues. It is important to maintain a healthy lifestyle to keep the heart functioning properly.1. What is the main function of the heart in the human body?A) Pumping bloodB) Digesting foodC) Regulating body temperatureD) Filtering waste productsAnswer: A) Pumping blood2. Why is it important to maintain a healthy lifestyle?A) To stay young foreverB) To prevent diseases and illnessesC) To lose weight quicklyD) To increase stress levelsAnswer: B) To prevent diseases and illnessesSection 2: Listening ComprehensionListen to the following audio clip and answer the questions that follow:(Audio clip: A doctor is giving advice on how to prevent the flu)3. According to the doctor, what is the best way to prevent the flu?A) Getting enough sleepB) Eating junk foodC) Avoiding exerciseD) Washing hands frequentlyAnswer: D) Washing hands frequently4. What should you do if you start to feel symptoms of the flu?A) Go to workB) Stay at home and restC) Ignore the symptomsD) Exercise vigorouslyAnswer: B) Stay at home and restSection 3: Grammar and VocabularyChoose the correct answer to fill in the blank in the following sentences:5. The patient _____________ to the hospital last night.A) goB) goesC) wentD) goingAnswer: C) went6. The doctor _____________ the patient's blood pressure.A) is checkingB) checksC) checkedD) has checkedAnswer: B) checksSection 4: WritingWrite a short essay on the importance of vaccinations in preventing diseases. Include reasons why vaccinations are necessary, how they work, and any potential risks associated with vaccinations.Answer: Vaccinations are crucial in preventing diseases as they help to build immunity against harmful pathogens. They work by introducing a small amount of weakened or dead virus or bacteria into the body, allowing the immune system to recognize and fight off the pathogen more effectively in the future. Vaccinations have been instrumental in eradicating deadly diseases such as smallpox and polio. However, there are some potential risks associated with vaccinations, such as allergic reactions or rare side effects. Despite these risks, the benefits of vaccinations far outweigh the risks, as they protect individualsand communities from serious and potentially life-threatening diseases.Practice these sample questions and answers to prepare for the 2024 Medical Doctor English Exam. Good luck!。
头孢药物有过敏反应
头孢药物有过敏反应Title: Allergic Reactions Associated with Cephalosporin Agents Abstract:This paper aims to provide an overview of allergic reactions associated with cephalosporin drugs, which are widely used antibiotics in clinical practice. Cephalosporins, while effective in treating various bacterial infections, can also cause allergic reactions in some individuals. This paper will discuss the classification, mechanisms, clinical features, and management of allergic reactions associated with cephalosporin drugs. Understanding the risks and management strategies can help healthcare professionals minimize potential harm to patients receiving cephalosporin therapy.1. Introduction1.1 BackgroundCephalosporins are beta-lactam antibiotics commonly used to treat a range of infections, including respiratory tract, urinary tract, and skin infections. They are structurally related to penicillin and share similarities in their mechanisms of action. However, cephalosporins have a broader spectrum of activity against various bacteria, including both gram-positive and gram-negative organisms. These drugs are widely prescribed due to their efficacy and safety profile.1.2 PurposeThe purpose of this paper is to shed light on the allergic reactions associated with cephalosporin agents. Despite the overall safety of cephalosporins, allergic reactions can occur, particularly inindividuals with a history of penicillin allergy. Understanding the mechanisms, clinical manifestations, and appropriate management of these reactions is crucial for healthcare professionals.2. Classification and Mechanisms2.1 Classification of Cephalosporin Allergic Reactions Cephalosporin allergic reactions can be classified into immediate hypersensitivity reactions (type I), non-immediate hypersensitivity reactions (type IV), and pseudoallergic reactions. Immediate hypersensitivity reactions occur within minutes to a few hours after drug exposure and involve IgE-mediated mechanisms. Non-immediate hypersensitivity reactions typically manifest within hours to days after exposure and involve T-cell mediated mechanisms. Pseudoallergic reactions are characterized by symptoms similar to allergic reactions, but without an immunological basis.2.2 Mechanisms of Allergic ReactionsThe exact mechanisms of allergic reactions to cephalosporin drugs are still not fully understood. However, it is believed that cross-reactivity with penicillin is responsible for the majority of these reactions. The side chain structures of cephalosporins closely resemble those of penicillin, resulting in shared antigens that can trigger an allergic response. Other mechanisms include direct toxicity to immune cells and oxidative stress-induced damage.3. Clinical Features3.1 Immediate Hypersensitivity ReactionsImmediate hypersensitivity reactions to cephalosporins can present with various manifestations, including urticaria, angioedema,rhinitis, bronchospasm, and anaphylaxis. Anaphylaxis, the most severe form, can lead to life-threatening complications if not promptly recognized and treated.3.2 Non-immediate Hypersensitivity ReactionsNon-immediate hypersensitivity reactions typically present as exanthematous eruptions, maculopapular rashes, fixed drug eruptions, and drug-induced hypersensitivity syndrome. These reactions are often milder than immediate hypersensitivity reactions, but may still require discontinuation of cephalosporin therapy.4. Management4.1 Prevention and IdentificationPrevention and early identification of allergic reactions are crucial in managing patients receiving cephalosporin therapy. Proper patient evaluation and identification of risk factors, such as a history of penicillin allergy, can help guide antibiotic selection. Skin testing and provocation tests are valuable tools in identifying suspected allergies to cephalosporins.4.2 TreatmentThe management of allergic reactions associated with cephalosporins involves discontinuation of the offending drug and supportive measures. Antihistamines, corticosteroids, and epinephrine may be used to relieve symptoms and treat severe reactions. Desensitization protocols can be considered in cases where cephalosporin therapy is essential and there are no suitable alternatives.ConclusionWhile cephalosporins are generally safe and effective antibacterial agents, allergic reactions can occur in certain individuals. Understanding the classification, mechanisms, clinical features, and appropriate management of these reactions is vital for healthcare professionals to provide optimal care for patients receiving cephalosporin therapy. Timely recognition, appropriate response, and engagement in preventive strategies can help minimize the potential harm associated with cephalosporin-induced allergic reactions.5. Risk Factors5.1 History of Penicillin AllergyOne of the major risk factors for allergic reactions to cephalosporins is a history of penicillin allergy. Patients with a known penicillin allergy have a higher risk of cross-reactivity with cephalosporins due to the structural similarities between the two drug classes. It is estimated that the cross-reactivity rate between penicillins and cephalosporins ranges from 1% to 13%, depending on the specific cephalosporin agent used.5.2 Multiple Antibiotic AllergiesPatients with a history of multiple antibiotic allergies, including reactions to multiple beta-lactam antibiotics, may have an increased risk of allergic reactions to cephalosporins. This suggests that certain individuals may be more prone to developing drug allergies in general, including reactions to cephalosporins.5.3 Previous Allergic Reactions to CephalosporinsPatients who have experienced allergic reactions to a specific cephalosporin in the past are at a higher risk of developing similar reactions upon reexposure. The severity of the previous reactionshould be carefully evaluated to guide the selection of alternative antibiotics in future treatment.6. Diagnosis6.1 Patient EvaluationProper patient evaluation is essential in assessing the risk of allergic reactions to cephalosporins. A detailed medical history, including previous drug allergies and reactions, should be obtained. It is important to inquire about the specific symptoms experienced during previous allergic reactions, as this can provide clues about the type of hypersensitivity reaction involved.6.2 Skin TestingSkin testing is a useful diagnostic tool for identifying allergic reactions to cephalosporins. Skin prick tests and intradermal tests can help detect IgE-mediated immediate hypersensitivity reactions. However, it is worth noting that the sensitivity and specificity of skin tests for cephalosporin allergy are relatively low, and false-positive and false-negative results can occur. Therefore, interpretation of skin test results should be done in conjunction with the patient's clinical history.6.3 Drug Provocation TestsIn cases where alternative antibiotics are not available or deemed less suitable, drug provocation tests may be considered. These tests involve administering a small dose of the suspected cephalosporin under controlled conditions and closely monitoring the patient for any signs of allergic reaction. Drug provocation tests should only be performed in specialized medical settings with close monitoring and availability of emergency resuscitation measures.7. Management Strategies7.1 Risk Avoidance and Antibiotic SelectionTo minimize the risk of allergic reactions, patients with a history of penicillin allergy should be carefully evaluated before prescribing cephalosporins. If a patient has experienced a severe allergic reaction, such as anaphylaxis, to penicillin, cephalosporins should be avoided, and alternative antibiotic classes should be considered. If a patient has a history of mild or non-immediate reactions to penicillins, cephalosporins with dissimilar side chains can be cautiously used, with appropriate monitoring.7.2 Discontinuation of the Offending DrugOnce an allergic reaction to a cephalosporin is suspected or confirmed, the immediate discontinuation of the offending drug is necessary. Continuing the drug can exacerbate the reaction and potentially lead to more severe complications.7.3 Symptomatic TreatmentFor mild allergic reactions, such as urticaria or mild rash, symptomatic treatment with antihistamines may be sufficient. In more severe cases, systemic corticosteroids and epinephrine may be required to alleviate symptoms and prevent further progression of the reaction. Supportive measures, such as airway management and fluid resuscitation, should be implemented as necessary.7.4 Desensitization ProtocolsIn situations where cephalosporin therapy is deemed essential, and there are no suitable alternative antibiotics available, desensitization protocols can be considered. Desensitizationinvolves gradually exposing the patient to increasing doses of the suspected cephalosporin, under close supervision and monitoring for allergic reactions. Desensitization should only be performed by experienced healthcare professionals in specialized settings due to the potential risk of severe allergic reactions.8. ConclusionAllergic reactions to cephalosporin drugs can occur, particularly in patients with a history of penicillin allergy. Healthcare professionals should be aware of the risk factors, mechanisms, clinical features, and appropriate management strategies associated with these reactions. Early recognition, prompt discontinuation of the offending drug, and proper symptomatic treatment are essential in minimizing potential harm to patients. Risk avoidance through appropriate antibiotic selection and consideration of desensitization protocols can be important in situations where cephalosporin therapy is necessary. Overall, a thorough understanding of cephalosporin-induced allergic reactions is crucial for providing safe and effective care to patients receiving these antibiotics.。
喝奶茶危害英语作文例子
喝奶茶危害英语作文例子Title: The Hazards of Drinking Milk Tea。
In recent years, the popularity of milk tea has surged worldwide, becoming a staple beverage for many. However, despite its widespread appeal, there are significant health risks associated with excessive consumption. In this essay, we will explore the hazards of drinking milk tea.Firstly, let's address the issue of sugar content. Many milk tea variants contain high levels of sugar, sometimes surpassing recommended daily intake limits in a single serving. Excessive sugar consumption has been linked to various health problems, including obesity, type 2 diabetes, and heart disease. Consuming sugary beverages like milk tea regularly can contribute to weight gain and increase therisk of developing these chronic conditions.Secondly, the additives present in milk tea raise concerns. Ingredients such as artificial flavorings,sweeteners, and preservatives may have adverse effects on health. Some of these additives have been associated with allergic reactions, gastrointestinal issues, and even carcinogenic properties. Furthermore, the excessive consumption of these additives can disrupt the body'snatural balance and contribute to long-term health problems.Additionally, the caffeine content in milk tea posesits own set of risks. While moderate caffeine intake can offer temporary benefits like increased alertness and improved concentration, excessive consumption can lead to negative consequences. Too much caffeine can disrupt sleep patterns, cause nervousness, and even trigger heart palpitations in sensitive individuals. Moreover, dependency on caffeine to stay awake or alert can develop, leading to withdrawal symptoms when consumption is reduced or stopped.Furthermore, the potential harm to dental health cannot be overlooked. The combination of sugar and acidity in milk tea can erode tooth enamel and promote the growth ofharmful bacteria in the mouth. Over time, this can lead to tooth decay, cavities, and gum disease. Poor dental healthnot only affects one's appearance and self-confidence but also has wider implications for overall health and well-being.Moreover, the environmental impact of milk tea consumption is a growing concern. The production and disposal of single-use plastic cups, straws, and packaging contribute to plastic pollution, which poses a significant threat to ecosystems and marine life. As consumers, we must consider the environmental footprint of our beveragechoices and strive to reduce our reliance on disposable items.In conclusion, while milk tea may be a delicious treat enjoyed by many, it is essential to be aware of thepotential hazards associated with its consumption. Fromhigh sugar and additive content to caffeine-related health risks and environmental concerns, there are several factors to consider. By practicing moderation, choosing healthier alternatives, and being mindful of our environmental impact, we can enjoy milk tea responsibly while safeguarding our health and the planet.。
转基因危害英语作文
Genetically Modified Organisms GMOs have been a subject of intense debate for many years.While some argue that they offer significant benefits such as increased crop yields and resistance to pests and diseases,others warn of the potential dangers they pose to human health and the environment.One of the primary concerns about GMOs is the possibility of allergic reactions.Since GMOs are created by introducing genes from one organism into another,there is a risk that new proteins produced by these organisms could trigger allergic responses in some individuals.This is particularly concerning given that the process of creating GMOs is not always well understood,and the potential for unforeseen consequences is high.Another major issue is the impact of GMOs on biodiversity.The widespread use of genetically modified crops can lead to a reduction in genetic diversity within the crop itself,as well as in the surrounding environment.This can have serious implications for the longterm sustainability of agriculture,as it reduces the resilience of crops to changing conditions and pests.Furthermore,there are concerns about the potential for GMOs to crossbreed with wild plants,leading to the spread of modified genes into the wider environment.This could result in the creation of superweeds that are resistant to herbicides,making it more difficult to control them and potentially leading to a reduction in biodiversity.In addition to these environmental concerns,there are also questions about the longterm health effects of consuming GMOs.While studies have so far shown mixed results,some research suggests that there may be potential risks associated with the consumption of genetically modified foods.These risks could include potential hormonal disruptions,as well as the possibility of GMOs contributing to antibiotic resistance.The use of GMOs also raises ethical questions about the manipulation of nature and the potential for unintended consequences.Some argue that the creation of GMOs represents a form of playing God,and that we should be cautious about the potential longterm effects of altering the genetic makeup of organisms in this way.In conclusion,while GMOs may offer some benefits in terms of increased crop yields and resistance to pests,the potential risks to human health and the environment are significant.As such,it is important that we continue to research and monitor the impact of GMOs,and that we take a cautious approach to their use until we have a better understanding of the potential consequences.。
头孢药物的过敏反应
头孢药物的过敏反应Title: Allergic Reactions to Cephalosporin Drugs Introduction:Cephalosporin drugs are a class of antibiotics widely used for the treatment of various bacterial infections. Despite their efficacy, the occurrence of allergic reactions to cephalosporin drugs has been reported. This paper aims to explore the various aspects of allergic reactions associated with cephalosporin use.Chapter 1: Classification and Mechanism of Action of Cephalosporin Drugs- Overview of cephalosporin drugs and their classification into different generations.- Discussion on the mechanism of action of cephalosporins, focusing on their inhibition of bacterial cell wall synthesis.- Importance of cephalosporins in the treatment of bacterial infections.Chapter 2: Immunological Basis of Cephalosporin Allergic Reactions- Explanation of the immunological response to cephalosporin drugs.- Role of the immune system in recognizing and responding to foreign substances.- Discussion on the mechanisms leading to hypersensitivity reactions, including immediate and delayed hypersensitivity. Chapter 3: Types and Symptoms of Cephalosporin Allergic Reactions- Overview of the various types of allergic reactions associated with cephalosporin drugs.- Immediate hypersensitivity reactions, including anaphylaxis, urticaria, and angioedema.- Delayed hypersensitivity reactions, such as maculopapular rash, drug reaction with eosinophilia and systemic symptoms (DRESS), and Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN).Chapter 4: Diagnosis and Management of Cephalosporin Allergic Reactions- Diagnostic procedures, including skin prick testing, patch testing, and in vitro tests.- Importance of conducting a thorough patient history and physical examination.- Discussion on the management of cephalosporin drug allergies, including avoidance of cephalosporins and alternative antibiotic options.Conclusion:Cephalosporin drugs are essential for the treatment of bacterial infections, but allergic reactions to these medications can occur. Understanding the classification, mechanism of action, immunological basis, types, symptoms, diagnosis, and management of cephalosporin allergic reactions is crucial for healthcare professionals to provide appropriate care to patients. Further research is needed to develop better diagnostic tools and alternative treatment options for patients with cephalosporin allergies.Chapter 5: Risk Factors for Cephalosporin Allergic Reactions- Identification of risk factors that may predispose individuals to allergic reactions to cephalosporin drugs.- Genetic factors, such as a family history of drug allergies or atopy, that increase the likelihood of developing an allergic response.- Previous allergic reactions to cephalosporins or other beta-lactam antibiotics as a significant risk factor.Chapter 6: Prevention of Cephalosporin Allergic Reactions- Strategies to minimize the occurrence of allergic reactions to cephalosporins.- Importance of obtaining a detailed patient history to identify any previous allergic reactions to antibiotics.- Utilization of antibiotic allergy testing to guide appropriate prescribing and minimize the risk of allergic reactions.Chapter 7: Cross-Reactivity Between Cephalosporins and Penicillins- Explanation of the cross-reactivity between cephalosporin and penicillin drugs.- Recognition of the shared beta-lactam ring structure as the main contributor to cross-reactivity.- Discussion on the incidence and severity of cross-reactivity and its implications for antibiotic selection.Chapter 8: Management of Cephalosporin Allergic Reactions in Medical Settings- Guidelines for managing allergic reactions to cephalosporins in clinical settings.- Recognition and immediate treatment of severe allergic reactions,including anaphylaxis.- Importance of maintaining appropriate documentation and communication with the healthcare team to prevent future exposure to cephalosporins.Chapter 9: Patient Education and Shared Decision-Making- Role of healthcare providers in educating patients about allergic reactions to cephalosporins.- Importance of sharing information about alternative antibiotics and their safety profiles.- Engaging patients in shared decision-making regarding antibiotic selection, taking into account their previous antibiotic history and potential risks of cross-reactivity.Chapter 10: Future Directions and Research- Ongoing research efforts to improve the diagnosis and management of cephalosporin allergic reactions.- Development of new diagnostic tests with improved sensitivity and specificity.- Investigation into novel treatment strategies, including desensitization protocols and alternative antibiotic options. Conclusion:Allergic reactions to cephalosporin drugs can pose significant challenges in the treatment of bacterial infections. Understanding the risk factors, prevention strategies, cross-reactivity with penicillins, proper management in medical settings, patient education, and ongoing research efforts is crucial for healthcare providers to address and mitigate the impact of cephalosporin allergies. By actively working towards improved diagnosis,management, and alternative treatment options, healthcare professionals can ensure better outcomes for patients with cephalosporin allergies.。
止咳糖浆英语作文
止咳糖浆英语作文Cough syrups have been a staple remedy for treating coughs and other respiratory ailments for decades. These liquid concoctions, often infused with various active ingredients, aim to provide relief and aid in the recovery process. As a widely used over-the-counter medication, cough syrups have become an integral part of many households' medical cabinets. In this essay, we will delve into the history, composition, and the ongoing debate surrounding the efficacy and safety of cough syrups.The origins of cough syrups can be traced back to ancient civilizations where various herbal remedies were used to alleviate coughing and respiratory distress. Early formulations often included plant-based ingredients such as honey, licorice, and various essential oils. Over time, as medical science progressed, the composition of cough syrups evolved to incorporate synthetic and pharmaceutical-grade active ingredients.One of the key active ingredients found in modern cough syrups is dextromethorphan, a cough suppressant that works by inhibiting thecough reflex in the brain. Other common components include expectorants like guaifenesin, which help loosen and thin mucus, making it easier to cough up. Antihistamines, such as diphenhydramine, are also frequently added to cough syrups to help alleviate the symptoms associated with allergic reactions or the common cold.While the active ingredients in cough syrups are designed to provide relief, the debate surrounding their efficacy and safety has been ongoing. Some studies have suggested that the effectiveness of cough syrups may be limited, especially for children. The American Academy of Pediatrics, for instance, has cautioned against the use of over-the-counter cough and cold medications in children under the age of six, citing concerns about potential side effects and the lack of conclusive evidence supporting their efficacy.On the other hand, proponents of cough syrups argue that they can provide symptomatic relief and aid in the recovery process, especially when combined with other supportive measures such as rest, hydration, and proper medication management. They contend that for certain individuals, cough syrups can offer a meaningful and effective solution to their respiratory ailments.The debate surrounding the safety of cough syrups has also been a topic of concern, particularly in relation to the potential for misuse orabuse. Dextromethorphan, a common active ingredient, has been known to produce psychoactive effects when taken in excessive doses, leading to concerns about its abuse potential, especially among adolescents and young adults. This has led to increased regulation and monitoring of the sale and distribution of cough syrups containing dextromethorphan.In response to these safety concerns, manufacturers of cough syrups have taken steps to address the issue. Some have implemented measures to limit the availability of their products, while others have reformulated their formulas to reduce the risk of abuse. Additionally, healthcare professionals and regulatory bodies have emphasized the importance of proper education and guidance regarding the safe and responsible use of cough syrups.Despite the ongoing debates, cough syrups remain a widely used and readily available remedy for those seeking relief from coughing and other respiratory symptoms. However, it is crucial for individuals to consult with healthcare professionals, follow dosage instructions carefully, and be aware of the potential risks and limitations associated with these products.In conclusion, cough syrups have a long and evolving history, with their composition and the debate surrounding their efficacy and safety continuing to evolve. As with any medication, it is essential toweigh the potential benefits against the risks and to use cough syrups responsibly and under the guidance of healthcare professionals. By understanding the complexities and nuances surrounding cough syrups, individuals can make informed decisions about their healthcare and find the most appropriate solutions for their individual needs.。
雾霾对人体的危害英语作文
雾霾对人体的危害英语作文英文回答：The Detrimental Effects of Air Pollution on the Human Body.Air pollution, a prevalent environmental concern, has become a menacing threat to human health. The tinyparticles and toxic pollutants suspended in the air can infiltrate our respiratory system, inducing a plethora of adverse effects on our physical and mental well-being.Respiratory Problems.One of the primary consequences of air pollution is the exacerbation of respiratory ailments. Inhaling particulate matter (PM), such as PM2.5 and PM10, can irritate the airways, causing inflammation and coughing. This can escalate into chronic respiratory diseases, including asthma, chronic bronchitis, and emphysema. Exposure to airpollution has also been linked to an increased risk of respiratory tract infections, such as pneumonia and bronchitis.Cardiovascular Issues.Air pollution has been implicated in a range of cardiovascular complications. The fine particles inpolluted air can enter the bloodstream, damaging blood vessels and increasing the risk of heart attacks, strokes, and arrhythmias. Air pollution can also contribute to hypertension (high blood pressure), a major risk factor for cardiovascular disease.Cognitive Impairment.Recent studies have suggested that prolonged exposure to air pollution may impair cognitive function,particularly in the elderly. Particulate matter and other pollutants can cross the blood-brain barrier and accumulate in the brain, potentially affecting neural development, memory, and learning ability.Cancer.Air pollution is a known carcinogen, linked to several types of cancer, including lung cancer, bladder cancer, and leukemia. Exposure to certain pollutants, such as benzene and formaldehyde, has been associated with an elevated risk of developing these malignancies.Other Effects.In addition to the aforementioned health concerns, air pollution can also lead to various other adverse effects, such as:Eye irritation and redness.Skin rashes and allergic reactions.Fatigue and headaches.Birth defects and premature birth.Vulnerable Populations.Certain individuals are more susceptible to the adverse effects of air pollution. These include:Children: Their developing respiratory and immune systems make them more vulnerable to respiratory problems.Elderly: They are more likely to have pre-existing health conditions that can be exacerbated by air pollution.Individuals with underlying health conditions: Those with asthma, heart disease, or lung conditions are particularly vulnerable to the detrimental effects of air pollution.Mitigating Measures.Addressing the problem of air pollution requires a multifaceted approach. Governments, industries, and individuals need to work together to reduce emissions andimprove air quality. Some key strategies include:Promoting clean energy sources.Reducing industrial emissions.Encouraging public transportation and walking.Using air purifiers in homes and public buildings.Monitoring air quality and providing alerts to the public.中文回答：雾霾对人体的危害。
2023届山东省潍坊市普通高等学校招生全国统一考试模拟卷六校统测英语试题(二)
2023届山东省潍坊市普通高等学校招生全国统一考试模拟卷六校统测英语试题（二）学校:___________姓名：___________班级：___________考号：___________一、阅读理解There really are apps for everything and some could end up saving your life.WhatsAppLots of us use WhatsApp for messaging and calling, but do you know it also has a Live Location feature that can let a loved one know your whereabouts in case you’re in danger? You simply press the “+” key in a chat, select “Location”, and then press “Share Live Location”, which enables any participant in the chat to see your location in real time for the duration you choose.SkinVisionYou will have to pay for this digital skin check app, either on an ad hoc or a subscription basis, but with an estimated fifth of skin cancers going undiagnosed (未确诊的) during lockdown, it could be well worth it. You simply take a photo of any suspicious (可疑的) spot with your phone and you’ll then receive a risk indication from SkinVision’s clinically acknowledged technology within 30 seconds.Stay AliveWith mental health problems on the increase, this prevention app could be extremely helpful. Developed by Grassroots, it offers a wealth of resources, ranging from strategies for staying grounded when you feel overwhelmed, to breathing exercises to direct links to national and local crisis resources.St John Ambulance First AidAn app like this is more useful for saving someone else’s life than your own, but arguably it’s a must-have on your smartphone. It gives advice in dealing with emergencies, including choking, allergic reactions and performing CPR. You don’t have to have an Internet connection in order to use it.1．What can Skin Vision users do?A．They can learn first aid skills.B．They can do skin check easily.C．They can take beautiful photos.D．They can share their accurate location.2．What makes St John Ambulance First Aid unique?A．It offers advice on mental health.B．It helps save both users and others.C．It is accessible only to online users.D．It is of great benefit to cancer patients.3．Which app may help track users?A．WhatsApp.B．Skin Vision.C．Stay Alive.D．St John Ambulance First Aid.A concert that features Ancient Tang poems is set to hit the US next month to celebrate the Chinese Lunar New Year and the 50th anniversary of The Philadelphia Orchestra’s historic 1973 tour of China. The program entitled Echoes of Ancient Tang Poems is set to be released on Jan 6 and 7,2023 in Philadelphia and New York. iSING! Suzhou and The Philadelphia Orchestra present the program. The show, led by former Philadelphia Orchestra Assistant Conductor Lio Kuokman, features ancient Chinese lyrical texts(剧本)from young composers who were selected from the 2020 iSING! Composition Competition.The 2020 iSING! Composition Competition is a five-month-long process of selecting winning composers from more than 200 entries from nine countries. The panel of judges included Hao Jiang Tian, well-known bass(男低音歌手), iSING! founder and artistic director. Founded in 2011, iSING! Art Festival is the first international vocal art festival in China. Since 2014, over 380 singers from more than 30 countries have been selected to come to China to participate in the annual iSING! Suzhou Art Festival. Poets of the Tang Dynasty featured in the incoming program Echoes of Ancient Tang Poems include Li Bai, Bai Juyi, Du Fu, Du Mu, Zhang Ji, and Wang Bo.“I was initially worried about being able to connect both historically and culturally,” said Fernando Buide del Real in an official press statement. “But I soon realized Tang poetic sentiments(诗意)are universal and go beyond geographical boundaries. During the COVID lockdown, I found resonance(共鸣)in Wang Bo’s poem about friendship, loneliness, and separation. The precision and depth of the Chinese language is amazing. Every character andevery phrase is filled with meaning.”January’s concert also aims to celebrate the 50th anniversary of The Philadelphia Orchestra’s 1973 tour of China. Over the past 50 years, the Orchestra has returned to China 12 times, more than any other US orchestra.“I think this event is very important to China and the US, especially in terms of cultural exchanges,” Hao Jiang Tian said. “During the COVID-19 pandemic, performing arts around the world has been greatly affected and impacted. Our incoming event integrates ancient Tang poems, new forms of music, and singers from 9 different countries—this is the first time in history. In the current situation, such performance is particularly important,” Tian said. 4．What can we learn about iSING! Art Festival?A．It was established in the year of 2014.B．Its founders include Conductor Lio Kuokman.C．It is the first international vocal art festival in China.D．It is held every other year in Suzhou and Philadelphia.5．How did Fernando Buide del Real like Wang Bo’s poem?A．He found it tough to understand.B．He couldn’t think too highly of it.C．He could hardly share Wangbo’s sad emotions.D．He felt its contents were unrealistic and strange.6．Which can replace the underlined word “integrates” in the last paragraph? A．Affects.B．Balances.C．Inspects.D．Combines. 7．What can be a suitable title for the news report?A．Tang Dynasty poems concert to celebrate Chinese New YearB．Poets of Tang Dynasty featured in Echoes of Ancient Tang PoemsC．50th anniversary of The Philadelphia Orchestra’s 1973 tour of ChinaD．Process of selecting winning composers for 2020 iSING! Composition CompetitionA carbon capturing device, called Orca, began operating in Iceland in September. The machine was invented and made by a Swiss company called Climeworks. The name comes from the Icelandic word orka which means energy.Orca can pull carbon dioxide out of the air and send it deep into the ground, where it is turned into stone. The device is made up of four sections which look like giant airconditioners stacked together. Each section contains 12 large fans that suck air from outside into steel compartments.Inside, the air passes through a filter (过滤器) which gathers the carbon dioxide. It is then heated to a high temperature so the carbon dioxide can be collected from the filter. Then, the carbon dioxide is mixed with water and put deep in the ground into a type of rock called basalt. Basalt causes the carbon dioxide mixture to turn into stone after two or three years.Orca is an experimental device. It was built to demonstrate that it is possible to permanently remove carbon dioxide from the atmosphere. It can remove 4, 000 metric tons of carbon dioxide from the air each year. That’s about the same amount as the emissions produced by 850 cars in a year. In order to remove enough carbon dioxide to make a big difference to global warming, much larger devices like Orca would have to be built in many countries around the world.Some environmental activists say governments should spend more time and money on reducing the amount of greenhouse gas we produce each year, instead of investing in carbon capture methods. But others say that, in order for countries to meet their goal of net zero emissions by 2050, they will need to do both: reduce new emissions and remove the carbon dioxide already in the air.8．What’s the purpose of designing Orca?A．To conserve energy.B．To achieve zero emissions.C．To protect natural resources.D．To remove carbon dioxide in the air. 9．What does the underlined word “it” refer to in Paragraph 2?A．Orca.B．The basalt.C．The air.D．Carbon dioxide. 10．How does Orca work?a. Sucking the air.b. Collecting the carbon dioxide.c. Mixing with water.d. Filtering and heating.e. Putting into the ground.A．a, d, b, c, e B．a, c, d, b, e C．a, d, c, b, e D．a, b, c, d, e 11．Why are some environmentalists not in favor?A．Reducing emissions is more important.B．It might result in new pollution.C．The technology is not mature.D．It doesn’t work efficiently.Since the pre-historic times man has had an urge to satisfy his needs. Be it hunger, shelter or search for a mate, he has always controlled the situations to his advantage. Probably this might be the reason why we humans are the most developed of all living species on the earth. As we climbed the steps of development we somehow left behind common sense and logical thinking. We forgot that we have stopped thinking ahead of time.If you are hungry, what do you do? Get a piece of your favorite meal and stay quiet. Just like your stomach even your mind is hungry. But it never lets you know because you keep it busy thinking about your dream lover favorite star and many such things. So, it silently began to care about your needs and never let itself grow. When mind looses its freedom to grow creativity gets a full stop. This might be the reason why we all sometimes think “What happens next?” “Why can’t I think?” “Why am I always given the difficult problems?” Well this is the result of using our brain for thinking of not-so-worthy things.Hunger of the mind can be actually satisfied through reading. Now why reading and not watching TV? Because reading has been the most educative tool used by us right from the childhood. Just like that to develop other aspects of our life we have to turn to reading. You have innumerable number of books in this world which will answer all your “How to?” questions.Once you read a book, you just don’t run your eyes through the lines, but your mind decodes it and explains it to you. The interesting part of the book is stored in your mind as a seed. Now this seed is unknowingly used by you in your future to develop new ideas. The same seed if used many times can help you link and relate a lot of things of which you would have never thought in your wildest dreams! This is nothing but creativity. More the number of books you read your mind will open up like never before. Also this improves oral skills to a large extent and makes a significant contribution to your vocabulary. Within no time you start speaking English or any language fluently with your friends or other people. And you never seem to run out of the right words at the right time.12．What helps man become the most advanced species in the world?A．Searching for food and shelter.B．Taking good care of the young.C．Making the best of the surroundings.D．Adopting a great deal of logical thinking.13．Why do people ignore their mental starvation?A．They are occupied with absurd thoughts.B．They are too engaged with the daily routine.C．They lose the freedom to grow.D．They think little of mental health.14．How does reading benefit people’s creativity?A．By enlarging their vocabulary.B．By answering “how to” questions.C．By explaining the content of a book.D．By assisting in the formation of new ideas.15．What is the best title of the text?A．Reading helps realize one’s dream.B．Reading meets man’s hunger in mind.C．Reading is a best habit for teenagers.D．Reading can replace food for human.二、七选五The holiday season can bring much joy, but it can be a challenging time for keeping your health and fitness. Between the added pressure of social events and opportunities to overeat, it’s all too easy for you to throw in the towel, resolving to get back on track in the new year.___16___●Keep a healthy mindset.This time of year is meant to be enjoyed, but too many of us lose sight of that and spend a lot of time beating ourselves up for celebrating. Enjoying seasonal treats is OK, so let go of those feelings of guilt. You know those cookies Mum baked with love? No need to deny yourself. ___17___ You can eat one or two without eating a dozen. Remember, you are happily-not guiltily making decisions.●Stay satiated (吃饱).Stay satiated so you don’t arrive hungry at holiday events. If you’ve ever tried to grocery shop when you were hungry and ended up with lots of unhealthy snacks in your cart, you know why this is sound advice. If a possible, eat a healthy meal before heading to a party.___18___●Keep stress in check.Whether it’s the effects of shorter, darker days and increased schedule demands or family related anxiety, the holidays can have a bad influence. Added stress can result in poor decision making, stress eating and physical tension. ___19___ Carve out a few minutes day away for gratitude. As little as five minutes of this mindfulness practice each day can lower stress.●Get enough sleep.Too often during the holidays, we spread ourselves thin keeping up with work and daily life responsibilities while also meeting the season’s demands. It’s important that you give your body and mind the time and rest needed to recover each night.___20___ To adequately process those holiday meals and avoid picking up a seasonal sickness, you need to prioritize rest.A．Remind yourself that you have control.B．Chances are that there are limited healthy options there.C．That’s why it’s important to practice self-care.D．There are many competitive people around you.E．Having a healthy mindset builds a positive body image.F．Not getting enough sleep can lead to weight gain and illness.G．With these tips, you can enjoy the season without harming your well-being.三、完形填空Amy Jandrisevits knows the value of a good doll (玩具娃娃). “Dolls have a ____21____ we don’t completely understand,” she said. It’s a(n)____22____ she got while working as a social worker using dolls to help young kids ____23____ their changing medical situations.Seven years ago, a ____24____ said that her child was involved in a car accident, leaving a scar (伤疤) on his face. Jandrisevits knew what might help the youth through this ____25____ period. “It’s ____26____ to tell a kid, ‘You are perfect the way you are,’ and to build ____27____ that way,” she says.Jandrisevits went about ____28____ that. She made a doll by hand that looked like her friend’s child and sent it off. After the friend ____29____ a photo online of the happy childand doll, another woman asked Jandrisevits to make a doll for her baby, who was missing a leg.Word _____30_____ and soon Jandrisevits was making dolls for children with birthmarks or facial deformities (畸形), from photos sent by parents. She _____31_____ her previous job and started a nonprofit, A Doll Like Me. She hasn’t _____32_____ for a doll since she began her nonprofit.In all, she’s made more than 400 dolls. The waiting list is long but Jandrisevits is_____33_____. As she explains, “Every kid, _____34_____ gender, age, medical issue or body type, should look into the _____35_____ face of a doll and see their own.”21．A．power B．theme C．system D．fashion 22．A．lesson B．inspiration C．reward D．experience 23．A．turn to B．adapt to C．realize D．ignore 24．A．worker B．patient C．volunteer D．friend 25．A．unforgettable B．challenging C．complex D．impressive 26．A．natural B．generous C．helpful D．hard 27．A．confidence B．connection C．trust D．communication 28．A．following B．blessing C．explaining D．changing 29．A．took B．sent C．saw D．posted 30．A．came B．failed C．spread D．read 31．A．loved B．quit C．began D．lost 32．A．charged B．gone C．asked D．paid 33．A．tired B．curious C．determined D．famous 34．A．regardless of B．instead of C．apart from D．according to 35．A．restored B．beautified C．sweet D．funny四、用单词的适当形式完成短文阅读下面短文, 在空白处填入1个适当的单词或括号内单词的正确形式。
花粉过敏英语作文
文章标题：Pollen Allergy: A Hidden Menacein SpringtimePollen allergy, also known as hay fever, is a common allergic reaction triggered by the inhalation of pollen grains from various plants. It typically manifests during the spring and summer months, when flowers are in bloom and releasing their pollen into the air. This seemingly harmless natural phenomenon can, however, cause significant discomfort and even health issues for those who areallergic to pollen.The symptoms of pollen allergy can range from mild to severe, depending on the individual's sensitivity level. Common symptoms include itchy eyes, runny nose, nasal congestion, sneezing, and postnasal drip. In more severe cases, individuals may experience symptoms such as asthma attacks, fatigue, and even difficulty breathing. These symptoms can significantly impact an individual's quality of life, interfering with daily activities and sleep.The causes of pollen allergy are diverse and can vary depending on the type of pollen and the individual's immune system response. Some common sources of pollen allergiesinclude trees, grasses, and weeds. As these plants release their pollen into the air, it can be inhaled by individuals who are allergic, triggering an immune system response. The immune system mistakes the pollen as a harmful substanceand produces antibodies to attack it, leading to thevarious symptoms associated with the allergy.Treating pollen allergy typically involves managing the symptoms and avoiding exposure to the allergen. Medications such as antihistamines and nasal sprays can help to reduce symptoms, while over-the-counter decongestants can provide relief from nasal congestion. However, it is important to consult with a healthcare professional before taking any medication, as some individuals may have reactions or side effects.In addition to medication, individuals with pollen allergies can take steps to reduce their exposure to pollen. Staying indoors during peak pollen hours, using air conditioning or air filters, and showering and changing clothes after being outdoors can help to reduce the amountof pollen that enters the body. Wearing a mask whenoutdoors can also provide added protection.For those with severe allergies, immunotherapy, also known as allergy shots, may be an option. This treatment involves gradually exposing the immune system to small amounts of the allergen over time, helping to reduce the sensitivity and severity of the allergic response. However, immunotherapy is a long-term commitment and may not be suitable for everyone.It is important to note that pollen allergy is not a life-threatening condition in most cases, but it can significantly affect an individual's quality of life. Therefore, it is essential for individuals who experience symptoms of pollen allergy to consult with a healthcare professional for proper diagnosis and treatment.In conclusion, pollen allergy is a common but often overlooked condition that can have significant impacts on individuals' health and well-being. By understanding the symptoms, causes, and treatment options available, individuals can take steps to manage their allergies and enjoy a better quality of life during the spring and summer months.**花粉过敏：春季的隐形威胁**花粉过敏，又称花粉症，是一种常见的过敏反应，由吸入各种植物释放的花粉颗粒引起。
pdd药物过敏反应
pdd药物过敏反应Chapter 1: Introduction to PDD Drug Allergic ReactionsPDD (Pindolol) is a commonly prescribed medication for the treatment of high blood pressure and certain heart-related conditions. However, like any other medication, PDD can also cause allergic reactions in some individuals. Drug allergic reactions are undesired responses of the immune system to a medication, resulting in a range of symptoms that can vary from mild to severe. This paper aims to explore the incidence, symptoms, diagnosis, and management of PDD drug allergic reactions.Chapter 2: Incidence and Prevalence of PDD Drug Allergic ReactionsThe incidence and prevalence of PDD drug allergic reactions vary among different populations. Studies have reported that the overall prevalence of drug allergies ranges from 1 to 10 percent. However, specific data regarding the incidence and prevalence of PDD drug allergic reactions are limited. Further research is needed to determine the exact prevalence and risk factors associated with these reactions.Chapter 3: Symptoms and Diagnosis of PDD Drug Allergic ReactionsPDD drug allergic reactions can manifest in various ways, ranging from mild skin rashes to severe anaphylactic shock. Common symptoms include skin rash, itching, hives, swelling of the face or tongue, difficulty breathing, and gastrointestinal disturbances. Insome cases, PDD drug allergic reactions may present with fever, joint pain, or even organ involvement. Diagnosis of PDD drug allergic reactions involves a detailed patient history, physical examination, and allergen-specific testing, such as skin prick tests or blood tests for IgE antibodies.Chapter 4: Management and Prevention of PDD Drug Allergic ReactionsThe management of PDD drug allergic reactions primarily involves immediate discontinuation of the medication and symptomatic treatment. Depending on the severity of the reaction, treatment may range from over-the-counter antihistamines to epinephrine injections in cases of anaphylaxis. It is important to educate patients about the potential risk of allergic reactions associated with PDD and other medications. Additionally, alternative medications may be considered to minimize the risk of allergic reactions in individuals who have previously experienced PDD drug allergic reactions.Conclusion:In conclusion, PDD drug allergy reactions occur in a subset of individuals and can range in severity from mild to life-threatening. The exact incidence and prevalence of PDD drug allergic reactions need further investigation. Symptoms can vary, and diagnosis depends on a thorough patient history and appropriate testing. Management involves prompt discontinuation of the medication and symptomatic treatment. To prevent future allergic reactions, patients should be educated about PDD drug allergy andalternative treatment options should be considered. Overall, further research is needed to better understand and manage PDD drug allergic reactions.Chapter 5: Risk Factors and Mechanisms of PDD Drug Allergic ReactionsAlthough the specific risk factors for PDD drug allergic reactions are not well-established, there are several factors that may contribute to an increased likelihood of experiencing an allergic reaction to PDD or any other medication. These may include a personal or family history of drug allergies, a history of allergic reactions to other medications, and certain genetic predispositions. Additionally, individuals with certain underlying medical conditions, such as asthma or atopic dermatitis, may have an increased risk of developing drug allergies.The exact mechanisms underlying PDD drug allergic reactions are not fully understood. However, it is believed that these reactions initiate when the immune system mistakenly identifies PDD or its metabolites as a threat to the body. This triggers an immune response, leading to the production of antibodies (such as IgE) and the release of various chemicals, such as histamine, which are responsible for the symptoms observed during an allergic reaction. Furthermore, PDD drug allergic reactions can also be classified into different types based on their immune mechanisms. Type I hypersensitivity reactions, also known as immediate allergic reactions, occur within minutes to a few hours after exposure to the medication. These reactions are mediated by IgE antibodies and can manifest as hives, swelling, or even anaphylaxis.Type IV hypersensitivity reactions, also known as delayed-type hypersensitivity reactions, usually occur within 48 to 72 hours after exposure to the medication. These reactions are mediated by T cells and can present as a delayed skin rash or other inflammatory reactions.Chapter 6: Challenges in Diagnosis and Management of PDD Drug Allergic ReactionsThe diagnosis and management of PDD drug allergic reactions can be challenging due to several factors. Firstly, the symptoms of a drug allergic reaction can mimic other conditions or may be attributed to other factors. This can lead to a delayed or missed diagnosis, especially if the symptoms are nonspecific or mild.Another challenge lies in the identification of the specific medication responsible for the allergic reaction. In cases where a patient is taking multiple medications, it can be challenging to pinpoint which one is the culprit. This typically involves careful evaluation of the timing of symptom onset and the elimination or reintroduction of certain medications.Furthermore, there is limited awareness and knowledge about PDD drug allergic reactions among healthcare professionals. This can lead to underdiagnosis or misdiagnosis, potentially causing further harm to patients. It is crucial to improve education and awareness among healthcare providers to ensure accurate and timely diagnosis of PDD drug allergic reactions.Chapter 7: Future Directions and Research NeedsIn order to enhance the understanding and management of PDD drug allergic reactions, further research is warranted. Firstly, more data on the incidence, prevalence, and risk factors of PDD drug allergic reactions are needed to better identify at-risk populations and develop strategies for prevention.Additionally, research focusing on the immunological mechanisms underlying PDD drug allergic reactions could shed light on the specific pathways involved and potentially lead to the development of targeted therapies or preventive strategies.It is also essential to improve diagnostic tools and techniques for the identification of PDD drug allergic reactions. This may include the development of more accurate and reliable allergen-specific tests, as well as better strategies for drug provocation testing in cases where the diagnosis is uncertain.Furthermore, the development of alternative medications for individuals who have experienced PDD drug allergic reactions could significantly improve patient management. These alternative medications should have a comparable efficacy profile while minimizing the risk of allergic reactions.In conclusion, PDD drug allergic reactions are an important consideration for both healthcare professionals and patients. More research is required to understand the incidence, prevalence, and risk factors associated with these reactions. Improved diagnostic and management strategies are needed to ensure accurate andtimely diagnosis, as well as to provide optimal care for individuals who experience PDD drug allergic reactions.。
药物过敏反应的症状
药物过敏反应的症状Chapter 1: IntroductionDrug allergies are adverse reactions that occur when an individual's immune system reacts abnormally to a medication. It is estimated that about 10% of the global population experiences some form of drug allergy in their lifetime. These allergies can range from mild symptoms like rashes to severe and life-threatening reactions. Understanding the symptoms associated with drug allergies is of utmost importance in order to provide appropriate medical interventions and ensure patient safety. This paper aims to explore the various symptoms of drug allergies in four chapters: skin reactions, respiratory symptoms, gastrointestinal symptoms, and anaphylaxis.Chapter 2: Skin ReactionsSkin reactions are the most common manifestation of drug allergies. They can include a variety of symptoms, such as rashes, hives, itching, and swelling. Rashes may appear as red, itchy patches or raised bumps on the skin. Hives, or urticaria, are characterized by itchy welts that can be any size or shape and usually disappear within a few hours. Itching of the skin is a common symptom and can often be accompanied by a tingling or burning sensation. Swelling, also known as angioedema, typically occurs in the lips, face, throat, and extremities. In severe cases, it can lead to difficulty breathing or swallowing.Chapter 3: Respiratory SymptomsRespiratory symptoms are another significant category of drug allergy symptoms. These symptoms can affect the upper and lower respiratory tract. Common upper respiratory symptoms include sneezing, nasal congestion, runny nose, and itching or watering of the eyes. In some cases, these symptoms may mimic those of the common cold. Lower respiratory symptoms, such as coughing, wheezing, shortness of breath, and chest tightness, are more severe and may indicate the development of an allergic reaction, particularly in individuals with pre-existing respiratory conditions like asthma.Chapter 4: Gastrointestinal SymptomsGastrointestinal symptoms can also occur as a result of drug allergies. These symptoms primarily affect the digestive system and include nausea, vomiting, diarrhea, and abdominal pain. In some cases, these symptoms may be accompanied by loss of appetite and weight loss. Gastrointestinal symptoms may range from mild and transient to severe and persistent, and they can be indicative of an adverse reaction to a medication.Chapter 5: AnaphylaxisAnaphylaxis is a severe and potentially life-threatening allergic reaction that affects multiple organ systems. It is a medical emergency that requires immediate attention. Symptoms of anaphylaxis include difficulty breathing, wheezing, hives, swelling of the face or throat, rapid heartbeat, dizziness or faintness, and a sudden feeling of impending doom. If an individual experiences these symptoms after taking medication, it is crucial to seekimmediate medical help, as anaphylaxis can rapidly progress and become fatal.ConclusionDrug allergies can manifest in various ways, ranging from relatively mild skin reactions to severe anaphylaxis. Recognizing the symptoms associated with drug allergies is essential for prompt diagnosis, appropriate treatment, and preventing further complications. Healthcare professionals and patients should be educated about these symptoms to ensure proper management of drug allergies and improve patient outcomes.Chapter 6: Diagnosis and Treatment of Drug AllergiesDiagnosing drug allergies can be challenging as symptoms can often overlap with other conditions. In cases where a drug allergy is suspected, healthcare professionals may perform various tests to confirm the diagnosis. These tests can include skin prick tests, patch tests, blood tests, and drug provocation tests.Skin prick tests involve pricking the skin with a small amount of the suspected drug and observing for any allergic reaction, such as redness or swelling. Patch tests are used to identify delayed allergic reactions and involve applying small amounts of the suspected drug to the skin under a patch for 48 to 72 hours. Blood tests, such as the radioallergosorbent test (RAST) or enzyme-linked immunosorbent assay (ELISA), can measure the levels of specific antibodies associated with allergic reactions. Drug provocation tests are typically conducted in a controlled medical setting where small amounts of the suspected drug areadministered to determine if a reaction occurs.Once a drug allergy is diagnosed, the treatment involves avoiding the offending drug and finding suitable alternatives. Healthcare professionals must carefully review a patient's medical history and medication list to ensure that they do not unknowingly prescribe a medication to which the patient is allergic. In cases where the allergy is severe or life-threatening, patients may be advised to wear medical alert bracelets or carry an epinephrine auto-injector, which can be used to quickly treat an anaphylactic reaction.Chapter 7: Prevention and Patient EducationPreventing drug allergies can be challenging as they can occur unpredictably. However, there are certain steps that can be taken to minimize the risk. It is essential for healthcare professionals to obtain a comprehensive medical history from patients, including any previous allergies or adverse drug reactions. This information can help identify patients who may be at a higher risk of developing drug allergies.In addition to obtaining a medical history, healthcare professionals should educate patients about the signs and symptoms of drug allergies. Patients should be informed to report any unusual symptoms or allergic reactions to their healthcare provider immediately. Furthermore, patients should be educated about the importance of reading medication labels, following dosing instructions, and taking medications as prescribed.Patient education also plays a crucial role in the prevention of drugallergies. Patients should be encouraged to ask questions about medications, inform their healthcare provider about any known allergies or sensitivities, and be proactive in their healthcare decisions. Additionally, patients should be aware of the potential cross-reactivity between certain medications and allergens, such as penicillin and cephalosporins.Chapter 8: ConclusionDrug allergies are adverse reactions that can have a significant impact on patient health and safety. Understanding the symptoms associated with drug allergies is vital for timely diagnosis and appropriate treatment. Skin reactions, respiratory symptoms, gastrointestinal symptoms, and anaphylaxis are some of the common manifestations of drug allergies. Diagnosis involves various tests, and treatment primarily focuses on avoidance of the offending drug and finding suitable alternatives. Prevention and patient education are crucial in minimizing the risk of drug allergies and ensuring patient safety. Healthcare professionals should remain vigilant and stay updated on the latest research and guidelines regarding drug allergies to provide optimal care for their patients.。
输血过滤器的临床应用
1990 Dr. Pall is awarded the National Medal of Technology by President George Bush Sr.
A Culture of Innovation
1991 The Pall CentriSep® System provides innovative protection for the military’s intake systems in harsh conditions during operation “Desert Storm”.
Frequency of Occurrence
24 Types of Adverse Reactions 19%
Nearly 1 in 5 transfusions are associated with an adverse reaction
CM V seroconversion 7%
NHFTR 0.5% Alloimmunization 10% Remaining 1.7%
Attenuated CMV infection and 4-6 diseaseiv,v,vi High risk patients (e.g., neonates) may
receive seronegative products with false 7 negative rates as high as 1.3%vii or even 8 4.5%viii
Type of Filter Characteristic Removal
Clot Screen size of 170 um Microaggregate size of 20 40 um Leukocyte removal
抽血的英语口语情景对话
抽血的英语口语情景对话在医院检查时，抽血很常见，围绕着它进行的英语对话也比较简单。
下面是店铺给大家带来抽血英语对话，供大家参阅!抽血英语对话1(In a hospital)A:I am diagnosed with anaemia,so Dr.Lee ask me to exsanguinate.Here's my information.B:OK.Here is your registration card,wait here until we call you.(After a while)B:Number 48?A:I'm here.B:Go to room 24(In room 24)C:Are you here to exsanguinate?Show me your information.A:Here you areC:All right.Please sit here and let's get started.A:Will it be hurt?C:As long as you don't get nervous.(A few minutes later)C:OK.We are done.We'll examine your blood sample.Please get back here a few hours later.A:Got it,thanks.C:You are welcome.抽血英语对话2student： How many types of blood are there in the numan being?Teacher： The four major blood types of clinical importance in this genetic system are A， B， AB and O.S： Are there any blood for the patient in the hospital?T：Every hospital has a lot of blood for the transfusion.S：Where is it preserved?T：The blood is preserved in the blood bank of the hospital.S： Where is the blood from?T： It is given by the donor.S： What is the requirement to the donor?T：A person 18 to 65 years old with a negative medical history， capable of passing the required physical examination.S：Why is the donor given physical examination?T：Before giving blood，the donor is given tests to determine his blood group and make sure he is not suffering from certain disease . When this has been done his blood can be taken.S： A person with what disease can not be taken the blood?T：Malaria，anemia，infectious hepatitis，tuberculosis and so on.S： What is the preparation before blood transfusion?T：First，we get blood group of patient. And then the patient's and donor's blood make crossmatching. If it is negative it can be used.S： What are the equipments for transfusion?T： The equipments for transfusion are：①Tubing with attached two chambers; an upper filter chamber and a lower drip-rate chamb er.②Needle 18 to 20 gauge.③Antiseptic pledget.④tourniquet.⑤adhesive plaster.S： What attention should we pay to blood transfusion for the patient?T：①All the instruments that come into contact with the patient must be sterilised.②Check up blood group e arnestly.③Transfuse a little normal saline before blood transfusion.④During the blood transfusion，we should payattention to reaction of patient.S： How many drips a minute in the blood transfusion.T： The usual rate of infusion is from 40 to 60 dropsper minute.S： Why do the arms and legs twitch during the blood transfusion?T： Some citrate have been transfused into the body during the blood transfusion. The sodium citrate combines with free calcim into the body. So blood calcim descend and the twitch of arms and legs appear.S：What are the reactions in the blood transfusion?T： Allergic reactions， circulatory overload， airembolism，infectious diseases， such as malaria and infective hepatitis.S：What reaction is severe during the blood transfusion?T： Hemoly sis reaction.S： What medicine may be used to prevent the reaction of blood transfusion?T： Benadzy1， Promethazine and Dexamethasoul.学生：人类的血型有几种?老师：人类有重要临床意义的4种主要血型是A，B，AB和O型。
抗生素的不良反应(Adversereactionsofantibiotics)[修改版]
![抗生素的不良反应(Adversereactionsofantibiotics)[修改版]](https://img.taocdn.com/s3/m/306986ea650e52ea54189818.png)
第一篇：抗生素的不良反应(Adverse reactions of antibiotics)抗生素的不良反应（Adverse reactions of antibiotics）Adverse reactions of antibiotics[Abstract] objective to help clinicians understand the adverse drug reactions of antibiotics and promote rational use of antibiotics in clinic, so as to ensure the safety, effectiveness and rationality of the use of antibiotics. Methods: review of literature from allergic reaction and toxicity, specific reaction, double infection, drug combination cause or aggravate adverse reactions and other aspects, summarizes the antibiotic adverse drug reactions and clinical harm. Results the adverse reactions of antibiotics can be prevented and controlled, and the clinical monitoring should be paid attention to during the process of taking drugs. Conclusion the adverse drug reactions of antibiotics should be paid more attention to by clinicians.Key words] antibiotics; adverse reactionsAdverse drug reactions are common in clinical medication. It refers not only to the side effects of drugs, but also to the toxicity, specific reactions, allergic reactions, secondary reactions, etc. [1]. Antimicrobial agents are the most commonly used drugs in clinic, including antibiotics, anti fungi, anti tuberculosis and antibacterial agents. Among them, there are the most varieties and quantities of antibiotics used in clinic. At present, there are more than 100 kinds of antibiotics commonly used in clinic. Antibiotics have saved countless lives, but their clinical use has also caused some adverse reactions [2]. The adverse clinical consequences of antibiotic adverse drug reactions are severe. After a few seconds to a few hours or even a long period of time after the drug withdrawal, adverse reactions can occur. Common allergic shock, fixed drug eruption, urticaria, vascular edema and other allergic reactions, gastrointestinal reactions, aplastic anemia, etc., and even cause death of patients (3). Therefore, to strengthen the supervision and rational use of antibiotics in the course of clinical medication is of great significance to reduce the incidence of adverse reactions [4].1 allergic reactionsAntibiotic induced allergic reactions are most common [5], mainly due to possible impurities in the drug, as well as the effects of oxidation, decomposition, polymerization, degradation products in vivo, or individual differences in the patient. Allergic reactions occur in many patients with allergic diseases, and a few are specific Gao Min constitutions.1.1 anaphylactic shock, this type of reaction is type I allergy, all routes of administration can cause. For example, penicillins, aminoglycosides and cephalosporins can cause such reactions, and cross allergic reactions can also occur between cephalosporins and penicillins. Therefore, the skin test must be done before using this drug.1.2 hemolytic anemia belongs to type II allergy, which is manifested by various kinds of blood cell reduction. Such as: thiophene thiophene and chloramphenicol can cause thrombocytopenia, penicillin and cephalosporins can cause hemolytic anemia.1.3 serum drug fever disease, belongs to the type III allergy symptoms, for seventh to 14 days of urticaria,angioedema, joint pain and joint peripheral edema and fever, gastrointestinal ulcer and intestinal necrosis. For example, penicillins, cephalosporins, lincomycin and streptomycin can all cause the above reactions. Cephalosporins, chloramphenicol and other antibacterial drugs can also cause drug fever.1.4 allergic reactions, this is a type of allergic reactions belonging to type IV allergy. Frequent exposure to streptomycin or penicillin usually occurs within 3~12 months.No allergic reaction in 1.5 types of rash (urticaria is common) 6, angioedema, dermatitis, erythroderma, erythema multiforme, fixed exudative erythema, severe bullous erythema, toxic epidermal necrolysis, found in penicillins, cephalosporins, streptomycin four ring and lincomycin; visceral lesions, including acute and chronic interstitial pneumonia, bronchial asthma, allergic hepatitis, diffuse allergic nephritis, penicillin, streptomycin and in common. Compound sulfamethoxazole can also cause severe exfoliative dermatitis.2 toxicityThe toxic reaction of antibiotic drugs is the direct damage to the organs and tissues of human body caused by drugs, which leads to the pathological changes of the physiological and biochemical functions of the body,Usually associated with dosage and duration.2.1, the toxicity of the nervous system, such as penicillin, G, ampicillin and so on, can cause central nervous system toxicity, severe cases may occur epileptic seizures. Penicillin and tetracycline can cause mental disorders. Aminoglycoside, vancomycin, polymyxin, and tetracycline can cause toxicity to the ear and vestibular nerve. Streptomycin, multi - viscosity, chloramphenicol, rifampicin and erythromycin can cause eye accommodation, dysfunction, optic neuritis and even optic atrophy.Clarithromycin, a new macrolide drug, can cause psychiatric adverse reactions. In addition, macrolides, clarithromycin and azithromycin may reduce presynaptic acetylcholine release or enhance postsynaptic receptor inhibition, which can lead to myasthenia crisis.2.2 renal toxicity. Many antibiotics can cause kidney damage, such as aminoglycosides, polymyxin, vancomycin. The most important side effect of aminoglycosides is ear kidney toxicity. In the patients with renal insufficiency, the half-life of the third generation cephalosporin has been extended to varying degrees, which should be paid more attention to by clinicians.2.3 liver toxicity 7: amphotericin B and lincomycin can cause toxic hepatitis, large dose of tetracycline can cause severe hepatitis caused by invasive, macrolides and oxacillin cholestatic hepatitis, cephalosporins in cephalothin and cefaloridine and penicillin in oxacillin, carbenicillin I ampicillin resistant, can cause elevated transaminase, streptomycin, tetracycline and amphotericin B can cause liver cell jaundice.2.4 of the blood system toxicity such as chloramphenicol can cause aplastic anemia and poisoning of agranulocytosis, a large dose of penicillin may occasionally result in abnormal blood coagulation, third generation cephalosporins such as cefotaxime and moxalactam due to intestinal flora of normal synthesis of vitamin K can cause bleeding reaction.2.5 the toxicity of the immune system, such as amphotericin B, cefoxitin, chloramphenicol, clindamycin and tetracycline [6]. It has toxic effects on the immune system and mechanism.2.6 gastrointestinal toxicity, gastrointestinal adverse reactions are more common. Drugs that can cause gastrointestinal reactions, such as oral tetracycline, penicillins, etc., including macrolides, chloramphenicol and other drugs, even if injected, can also cause gastrointestinal reactions.2.7 cardiac toxicity, large doses of penicillin, chloramphenicol and streptomycin can cause cardiotoxicity, and amphotericin B can cause myocardial damage, and lincomycin can occasionally lead to arrhythmias.3 specific reactionThe specific response is a very different reaction to the drug action in a small number of patients. The reaction is related to the lack of a genetic enzyme system in the patient. Chloramphenicol and amphotericin B enters the body, can enter the red cells with red cell membrane, hemoglobin into denatured hemoglobin, the enzyme system for normal persons, use of these drugs had no effect; but for hereditary methemoglobinemia, enhance the body's sensitivity to the drug, even if the use of small doses of drugs, but also can lead to degeneration of hemoglobin.4 double infectionUnder normal circumstances, there are many bacterial and fungal parasites on the surface of human body and lumen mucosa. Because of their existence, the microbial ecosystem of the body is kept in balance with each other. When high doses or long-term use of antibiotics, parasitic sensitive bacteria are killed, not sensitive strain and resistant bacteria proliferation become dominant, alien bacteria could get inside, when this kind of bacteria pathogens, can cause the double infection. The common clinical symptoms of double infection are digestive tract infection, enteritis, pneumonia, urinary tract infection and septicemia.5 antibiotics can cause or aggravate adverse reactions when used in combination with other drugs [8]In the process of clinical treatment, most cases need combination therapy, such as chronic diseases (diabetes and cancer) infection, surgical prophylaxis, severe infection, with organ symptoms, need to symptomatic treatment.Because of the interaction of drugs, it may cause or aggravate the adverse reactions of antibiotics.5.1, in combination with cardiovascular drugs, erythromycin and tetracycline can inhibit the metabolism of digoxin. When used in combination, it can lead to a marked increase in serum concentration and digoxin intoxication.5.2, combined with anticoagulant drugs, cephalosporins and chloramphenicol can inhibit the metabolism of coumarin anticoagulant in the liver, which can prolong the half-life of the latter, increase the effect and prolong the clotting time. Erythromycin can increase the effect of Hua Falin and prolong the clotting time. Tetracycline can affect the synthesis of vitamin K in intestinal flora, thus enhancing the effect of anticoagulant.5.3 、in combination with theophylline drugs, macrolides can inhibit the cytochrome P450 enzyme systemand increase the serum concentration of theophylline. When the combination of erythromycin and theophylline, theophylline serum concentration can increase by about 40%, while theophylline can affect the absorption of erythromycin and reduce the peak concentration of erythromycin.5.4, in combination with hypoglycemic agents, the use of chloramphenicol, toluene, sulfonylurea, and sulfonylurea can inhibit the metabolism of the latter, prolong its half-life, increase serum concentration, and increase its effect, which can lead to acute hypoglycemia.5.5 combined with diuretics aminoglycoside gentamicin and furan aniline in combination with acids, caused by the increase in reported ototoxicity. The use of ceftazidime in combination with furosemide increases nephrotoxicity, probably because the rate of clearance is lower in combination. Cyclosporine and mannitol, can cause severe kidney necrotic changes after discontinuation of mannitol renal allograft function, can be recovered.5.6, in combination with other drugs, erythromycin, tetracycline and antacids can reduce the absorption of antibiotics. Macrolide erythromycin and C Masi Bing can cause poisoning symptoms when combined with C Masi Bing.To sum up, the rational use of antibiotics and clinical monitoring in the process of patient medication are of great significance for clinicians to safely use drugs, to ensure the health of patients and to reduce the incidence of adverse reactions.The correct diagnosis is to distinguish whether it is a bacterial infection, such as using the culture of the specimen to judge that it is a bacterial infection, which is the indication of the application of antibiotics. Familiar with the pharmacological effects of antibiotics and adverse reaction characteristics, clinical pharmacology, drug control antimicrobial spectrum, indications, contraindications, adverse reactions and preparation, dosage, ways and methods, to understand patients drug allergy history, the use of drugs targeted to avoid the occurrence of the adverse reactions. Strengthening ADR monitoring [9~11] in the three aspects of medicine, nursing and medicine. Drug monitoring, clinical blood and biochemical tests, monitoring, nursing care and so on [12]. Especially the monitoring of serum concentration of aminoglycosides and renal function should be monitored and listening; monitoring of blood concentration affected by drug combination, such as erythromycin or tetracycline and digoxin, monitoring or avoid the combination of digoxin concentration; oral anticoagulants and chloramphenicol, tetracycline, erythromycin when combined, patients should be monitored for the coagulation time, or avoid the combination; must be combined to adjust the dose of oral anticoagulants.Nursing staff have more contact with patients, careful and meticulous nursing work, especially for children and elderly patients, is an important link to discover and deal with adverse drug reactions in time. To train nurses in clinical pharmacology knowledge and increase their knowledge in order to find out problems and report and deal with them in time.Once adverse reactions are detected, drastic steps, such as withdrawal or change of dressings, should be taken. If an allergic reaction occurs, immediate rescue measures should be taken. These practices are effective in preventing and remedying the adverse effects of antibiotics.[References]1 Zhang Keyi, Zhao Naicai. Grand ceremony for clinical adverse drug reactions. Shenyang: Liaoning science and Technology Press, 2001, 96.2 Yang Liping. Talk about the rational use of antimicrobial drugs. The theory and practice of medicine, 2004,17 (2): 229.3 Wang Zhengchun, Li Qiu, Wang Shan. Analysis of 803 cases of adverse drug reactions. Journal of medicine, 2004,23 (9): 695-696.4 tickets, Wang XiumeiAnd analysis of antibiotic application. Journal of practical medical technology, 2004,11 (8):1498-1499.5 Zidong, bear Fangwu. Drug induced allergy, allergic reaction. Anti infection medicine, 2004,1 (2): 49-52.6 Wu Wenzhen, Liu Jianhui. Clinical analysis of 220 cases of drug eruption. Journal of modern Chinese medicine and Western medicine, 2004,13 (13): 1739.7 Liu Bin, Peng Jun. Analysis of 136 cases of drug-induced hepatitis. Journal of pharmaceutical epidemiology, 2004,13 (5):251-253.8 Cheng Yue. Analysis of allergic reactions induced by combined administration. Journal of modern Chinese medicine and Western medicine, 2004,13 (13): 1793-1794.9 Ma Dongmei, Li Jing, Shu Liwei. How to make rational use of antibiotics. Heilongjiang medical journal, 2004,28 (12): 925.10 Wu Anhua. Some questions to be considered before prescribing antibiotics for clinicians. Chinese hospital, 2004,8 (8):19-22.11 China. Harm overuse of antibiotics. Inner Mongolia medical journal, 2005,37 (11): 1056-1057.12 Wei Jian, Li Bai Ping, Zhao Yonggen, et al. Construction of automatic monitoring system for the rational use of antibiotics. Chinese Journal of hospital management, 2004,20 (8):479-481.第二篇：抗生素的不良反应抗生素的不良反应一、药物不良反应（advense drug reactions，简称ADR）的定义：WHO国际药物监察合作中心规定：药物不良反应是指在预防、诊断、治疗疾病或调节生理机能的过程中，给予正常用法、用量的药物所出现的任何有害的、非预期的和与作用目的无关的反应。
【独家解读】Nature：药物过敏患者的福音——潜在治疗靶点MRGPRX2
【独家解读】Nature：药物过敏患者的福音——潜在治疗靶点MRGPRX2所有的药物都有引起副作用的可能，这种副作用也称为“药物不良反应”，但并不是所有这些反应都是过敏性质的。
其他反应有异质的、假性过敏的或药物不耐受所引起。
英国变态反应与临床免疫学会（BSACI）将药物过敏定义为一种已建立免疫机制的药物不良反应。
从临床病史的角度来看，其所呈现的机制可能并不是显而易见的，而且在没有研究的情况下我们并不总是能够确定一种药物反应是过敏性的还是非过敏性的。
因此，有报道将药物过敏定义为具有临床特征或免疫机制的药物所引起的任何反应。
药物不良反应是临床用药过程中遇到的棘手问题，这当中免疫系统参与所导致的药物过敏反应约占药物不良反应发生率的1/6。
美国一项调查报告显示其国内每年有23万人因为免疫介导的药物过敏反应而住院。
免疫机制所参与的药物过敏反应其临床表现十分复杂，涉及皮肤、肝脏、肾脏、心脏以及造血系统等多种组织和器官，病变时常表现为皮肤潮红、发痒、心悸、皮疹、呼吸困难，严重者可出现休克或死亡。
药物在体内分布以及代谢的复杂性决定了在新药筛查过程中很难预测到会有药物不良反应的发生。
肥大细胞是过敏反应的主要效应器，并可能通过分泌组胺以及各种炎症和免疫调节相关物质而在疾病中发挥重要作用。
虽然都是经由免疫球蛋白（Ig）E抗体活化这种经典活化途径，肥大细胞的一个独特功能是他们对于一系列阳离子物质可产生与抗体无关的免疫应答。
这些阳离子物质统称为基础促分泌素，包含与过敏性反应相关的炎症因子以及药物。
如果我们能够找到人体内与这些基础分泌素特异性结合并产生药物不良反应的受体（靶点），那么就能从一定程度上为新药筛查提供有力的依据，为药物过敏患者带来福音。
值得庆幸的是，2015年Nature报道了一篇关于美国约翰霍普金斯大学B.D. McNeil和加拿大艾伯塔大学P. Pundir课题组联合研究的成果：他们通过引进一种小鼠模型来研究基础促分泌素刺激的肥大细胞活化以及确定MRGPRX2可作为一种潜在的治疗靶点来减轻一系列药物引起的不良效应。
麻醉英文-
麻醉英文AnesthesiaIntroductionAnesthesia is one of the most important advances in medical science. It allows for the safe and painless performance of surgical procedures with the least amount of risk to the patient. Anesthesia is a field of medicine that is dedicated to providing the right amount of sedation, analgesia, and amnesia during a surgical procedure.Anesthetics are drugs that are used during surgery to reduce or eliminate pain, to relax muscles, to induce unconsciousness, and to suppress the patient's ability to remember the procedure. Anesthesia can be administered in many different ways, including general anesthesia, regional anesthesia, and local anesthesia.General AnesthesiaGeneral anesthesia involves the administration of drugs that induce unconsciousness, muscle relaxation, and analgesia. General anesthesia is used for major surgical procedures that require the patient to be completely unconscious. The drugs used in general anesthesia include propofol, barbiturates, and inhalational anesthetics such as halothane, isoflurane, and sevoflurane.Regional AnesthesiaRegional anesthesia involves the administration of local anesthetics directly into the area that is being operated on. Regional anesthesia is used for procedures that involve only a specific area of the body, such as a limb or the abdomen. The drugs used in regional anesthesia include lidocaine, bupivacaine, and ropivacaine.Local AnesthesiaLocal anesthesia involves the administration of drugs directly into the area that is being operated on. Local anesthesia is used for minor surgical procedures, such as the removal of a mole or cyst. The drugs used in local anesthesia include lidocaine, bupivacaine, and ropivacaine.Anesthesia TechniquesThe administration of anesthesia can be done in different ways depending on the type of surgery being performed and the individual needs of the patient. Some common anesthesia techniques include:Inhalation AnesthesiaInhalation anesthesia involves the use of gases such as nitrous oxide and halothane that are inhaled by the patient through a mask. The drugs are then absorbed into the bloodstream through the lungs, causing the patient to become unconscious.Intravenous AnesthesiaIntravenous anesthesia involves the administration of drugs directly into the bloodstream through a vein. The drugs used in intravenous anesthesia include propofol, barbiturates, and benzodiazepines.Epidural AnesthesiaEpidural anesthesia involves the administration of local anesthetics directly into the epidural space surrounding the spinal cord. This technique is used for procedures involving the lower half of the body, such as childbirth.Spinal AnesthesiaSpinal anesthesia involves the administration of local anesthetics directly into the cerebrospinal fluid that surrounds the spinal cord. This technique is used for procedures involving the lower half of the body, such as childbirth and operations on the lower extremities.Factors Affecting AnesthesiaSeveral factors can affect the administration of anesthesia, including the patient's age, weight, medical history, and the type of surgery being performed. Other factors that can affect anesthesia include the patient's level of anxiety, the skill of the anesthetist, and the choice of anesthetic agent.Complications of AnesthesiaAnesthesia is generally considered safe, but like any medical procedure, there are risks involved. Complications can include allergic reactions, respiratory depression, and cardiovascular problems. To reduce the risk of complications, it is important to carefully evaluate the patient's medical history and monitor the patient closely during the procedure.ConclusionAnesthesia is an essential component of modern medicine, allowing for the safe and painless performance of surgical procedures. The administration of anesthesia is a complex process that requires the careful evaluation of the patient's medical history and the use of appropriate drugs and techniques. While there are risks and complications associated with anesthesia, it remains one of the safest and most effective ways to manage pain and minimize the risk of complications during surgery.。
能出现过敏反应的药物
能出现过敏反应的药物Chapter 1: IntroductionAllergic reactions to medications have been a common concern in healthcare settings. These reactions can range from mild symptoms, such as rashes and itching, to severe anaphylaxis, which can belife-threatening. Understanding the drugs that are commonly associated with allergic reactions is crucial for healthcare professionals to provide appropriate care and prevent adverse outcomes. This review aims to discuss four medications known to cause allergic reactions: penicillin, sulfa drugs, nonsteroidal anti-inflammatory drugs (NSAIDs), and radiocontrast media.Chapter 2: PenicillinPenicillin and its derivatives are among the most common medications associated with allergic reactions. Penicillin allergy can be classified into immediate or delayed hypersensitivity reactions. Immediate reactions occur within an hour of drug administration and commonly manifest as urticaria, angioedema,or anaphylaxis. Delayed reactions, on the other hand, may take several days to develop and often present as maculopapular rashes. Cross-reactivity may exist within the penicillin family, making it important to consider alternate antibiotics in patients with known allergy.Chapter 3: Sulfa DrugsSulfa drugs, also known as sulfonamides, are another class of medications with a well-established association with allergicreactions. These drugs are commonly used for various infections. Allergic reactions to sulfa drugs can range from mild skin rashes to severe systemic reactions, such as Stevens-Johnson syndrome or toxic epidermal necrolysis. Individuals with a known sulfa allergy should avoid all medications containing sulfonamides and related compounds.Chapter 4: Nonsteroidal anti-inflammatory drugs (NSAIDs)Although NSAIDs are widely used for their analgesic and anti-inflammatory properties, they can also induce allergic reactions. Aspirin, a common NSAID, can cause respiratory symptoms like asthma exacerbations, nasal congestion, and rhinorrhea, known as aspirin-exacerbated respiratory disease (AERD). Cross-reactivity among different NSAIDs, such as ibuprofen and naproxen, is observed in some individuals. Patients with a history of NSAID allergy are often advised to avoid all non-selective NSAIDs and instead use selective COX-2 inhibitors if clinically necessary.Chapter 5: Radiocontrast MediaRadiocontrast media, used in diagnostic imaging procedures, can lead to allergic reactions in certain individuals. These reactions are usually non-IgE-mediated and are classified as immediate or delayed. Immediate reactions occur within an hour and may present as skin rashes, urticaria, bronchospasm, or anaphylaxis. Delayed reactions, such as skin eruptions or eosinophilia, can occur several days after exposure. Precautions, such as the administration of premedication, are often taken in patients with a history of contrast media reactions during future imagingprocedures.In conclusion, several medications have been associated with allergic reactions, which range from mild symptoms to severe, life-threatening anaphylaxis. Healthcare professionals should be aware of the potential for allergic reactions to penicillin, sulfa drugs, NSAIDs, and radiocontrast media. A comprehensive understanding of the mechanisms, presentation, and management of these reactions is essential to ensure patient safety and well-being.Chapter 6: Diagnosis and ManagementDiagnosing allergic reactions to medications can be challenging as the symptoms can vary widely and may overlap with other conditions. However, a thorough history taking and physical examination are crucial in identifying potential drug allergies. It is essential to investigate the timing and sequence of symptoms in relation to the drug administration.Skin tests, such as skin prick tests or intradermal tests, can be useful in diagnosing immediate hypersensitivity reactions. However, these tests are contraindicated in patients with severe anaphylaxis or uncontrolled asthma. Patch testing can be performed for suspected delayed hypersensitivity reactions, such as those caused by sulfonamides.In cases where skin testing is not feasible or inconclusive, drug provocation testing may be considered. This involves administering the suspected medication under controlled conditions, closely monitoring the patient for any adverse reactions. This diagnostic method should be performed by experiencedhealthcare professionals in a setting equipped to manage severe allergic reactions.Management of allergic reactions to medications primarily involves avoidance of the offending drug and prompt treatment of symptoms. In mild cases, symptomatic relief with antihistamines, corticosteroids, and topical creams may be sufficient. However, in severe or life-threatening reactions like anaphylaxis, immediate medical intervention is crucial.The treatment of anaphylaxis follows the basic principles of advanced cardiac life support (ACLS). Immediate administration of epinephrine is the cornerstone of therapy to reverse bronchospasm, improve blood pressure, and alleviate symptoms. Supportive measures such as intravenous fluids, oxygen, and antihistamines are also provided. In some cases, corticosteroids and bronchodilators may be necessary.In patients with a known drug allergy, it is essential to document the allergy prominently in the medical record and communicate this information to all healthcare providers. Patients often wear medical alert bracelets or carry an allergy card to notify others about their medication allergies. Education on medication avoidance and alternative treatment options is crucial to prevent further allergic reactions.Chapter 7: Prevention StrategiesPreventing allergic reactions to medications requires a multidisciplinary approach involving healthcare professionals,patients, and medication safety programs. All healthcare providers should obtain a detailed medication history, including any known drug allergies, during the initial assessment. This information should be clearly communicated and documented in the patient's record to ensure continuity of care.Patients with known drug allergies should receive education on avoiding the offending medication and strategies for medication safety. They should be informed about potential cross-reactivity among drugs within the same class and be advised to inform all healthcare providers about their allergies. Patients should also be educated on how to recognize the signs and symptoms of an allergic reaction and when to seek medical attention.Medication safety programs within healthcare institutions play a vital role in preventing allergic reactions. These programs should include strategies such as flagging patient records with allergy alerts, implementing drug allergy screening upon admission, and providing education to healthcare professionals on recognizing and managing drug allergies. Regular medication review with patients can help identify any new allergies or changes in medication allergies.Research efforts should continue to focus on improving the understanding of drug allergies, including the underlying mechanisms and risk factors. This knowledge can aid in the development of new diagnostic tests, preventive strategies, and alternative medications for individuals with known allergies. Continued education and awareness campaigns for both healthcare professionals and the general public are essential to promotepatient safety.Chapter 8: ConclusionAllergic reactions to medications remain an important issue in healthcare settings. Healthcare professionals should be familiar with the common medications associated with allergic reactions, such as penicillin, sulfa drugs, NSAIDs, and radiocontrast media. Proper diagnosis and management of these reactions are crucial to prevent adverse outcomes.Diagnosing drug allergies can be challenging, but a comprehensive history, physical examination, and appropriate diagnostic testing can aid in accurate identification. Management primarily involves avoiding the offending drug and providing symptomatic relief. Prompt treatment of severe allergic reactions like anaphylaxis is crucial to prevent life-threatening complications.Prevention strategies involve a multidisciplinary approach, including education, medication safety programs, and research efforts. Patients should be educated on medication avoidance and the recognition of allergic reactions. Medication safety programs should focus on preventing allergic reactions through proper documentation, screening, and education of healthcare professionals.By improving knowledge, diagnosis, management, and prevention of drug allergies, healthcare professionals can promote patient safety and provide appropriate care for individuals with known allergies. Continuous education and research in this field areessential to further advance our understanding and management of drug allergies.。
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Key words: fish; food hypersensitivity: inhalation. Dr J. F. Crespo Laboratorio de Inmunoalergia Hospital Infantil La Paz Castellana. 261 28046 Madrid Spain
Accepted for publication 30 August 1994
Fish has been reported to be an important cause of IgE-mediated hypersensitivity reactions to foods. In our area, fish has been implicated in 17.8",, of allergic reactions to foods (3). I^KtrapoIated results from Martino et al. showed that about 4-5 1000 children may have allergy to codfish (5). fhe vast majority of IgE-mediated allergic reactions to fish result from ingestion. However, a few cases of allergic reactions to fish through inhalation have also been reported. Upon inhalation, fish allergens elicited respiratory symptoms. These infrequent reports refer mainly to cases of occupational exposure, including fish processing, handling, and cooking activities (6). However, as reported for other foods (9), nonoccupational exposure to airborne fish odors and fumes could have a potential role in provoking clinica! manifestations in subjects with IgEmediated hypersensitivity to fish. The present investigation constitutes an extension of previous research on fish hypersensitivity. In this work, we report chnical characteristics found in 21
SuhjecLs
We selected our study population from 197 children diagnosed with IgE-mediated fish hypersensitivity at La Paz Children's Hospital (Madrid, Spain). Twenty-one of these 197 patients were selected to be included in this study because they reported immediate symptoms after exposure to fish odors or fumes. All these patients had been diagnosed as having IgE-tnediated fish hypersensitivity and placed on a strict fish-avoidance diet. These patients were followed-up for periods of 2-14 years. Eish hypersensitivity was re-evaluated after every 2 or 3 years of a fish-avoidance diet. In these re-evaluations, patients were specifically asked about accidental or incidental contacts with fish.
Crespo JF, Pascual C, Dominguez C. Ojeda 1. Munoz FM. Fsteban MM. Allergic reactions associated with airborne fish particles in IgF-mediated fish hypersensitive patients. Allergy 1995: 50: 257-261. 0 Munksgaard 1995. We evaluated the clinical characteristics found in 21 children who showed allergic reactions upon incidental inhalation offish odors or fumes, from 197 diagnosed with IgF-mediated fish hypersensitivity. Allergic reactions to fish via ingestion began in most patients (86",,) within the first 24 months of life. The vast majority (19/21) of patients showed cutaneous symptoms, either alone or. less frequent!}. associated with other clinica! manifestations. Hake and flounder were the species offish most frequently imp!icated in eliciting clinical manifestations upon ingestion. After diagnosis, all these patients were placed on a strict fish-avoidance diet. During this period of avoidance, patients reported allergic reactions (mean age 7 years) after incidental exposure to airborne fish odors or fumes. Clinical manifestations through inhalation were respiratory (main!\ wheezing) in 12 patients and cutaneous (mainly urticaria) in nine patients. Nineteen of 21 patients reported three or more episodes upon exposure to fish aerosols: in most cases, these episodes occurred at home when other people were eating fish. In conclusion, incidental inhalation of fish odors or fumes could play an important role in accidental and unknown encounters with fish in children on fish-avoidance diets for fish IgF-mediated hypersensitivity. Such exposures could elicit clinical symptoms and could have some eflect in delaying the development of tolerance. J. F. Crespo, C. Pascual, C. Dominguez, I. Ojeda, F. M. Munoz, M. M. Esteban
A/hrgy 1995: 5il: 257-261 Printed in Belgium - all rights reserved
C'opvrighl & Munksgaard 1995
ALLERGY
/ \ \ V (l!<)5-45J.\
Allergic reactions associated with airborne fish particleatients
children diagnosed with IgE-mediated fish hypersensitivity who showed allergic reactions upon incidental inhalation offish allergens.
Material and methods
257
C respo et aL
Materials Fi.sh antigens. The antigens utilized were of two kinds: 1) commercial extracts of codfish, trout, and tuna (Beneard-Bayer, Germany; Leti, Spain); 2) extracts produced from fish not commereially available, sueh as hake, flounder, sole, swordfish, and sardine. Fish extracts prepared in the La Paz Children's Hospital inimunoallergy laboratory were extracted in PBS, defatted if neeessary. dialyzed, and lyophilized. Extracts were reconstituted lo 10 mg ml in PBS-glycerol for priek test and to 1 mg ml in PBS for binding to eellulose CN Bromide activated disks.