Inflammation, usually refers to the reaction after the bacteria invade the tissues and organs that occur. Thus, prostate inevitably contain different amounts of bacteria in its secretion of fluid in the event of inflammation. When sex with orgasm and semen into the vagina, prostate fluid is a part of the seminal fluid in which bacteria also entered the vagina, then it stands to reason that these bacteria can also cause inflammation in the female reproductive tract.
Are pathogenic bacteria there are many factors, mainly by: (1) the strength of the virulence of bacteria; the number (2) number of bacteria; (3) how the victims of violations of resistance. decided.
If you are in the acute phase, fever and other systemic symptoms, perineal pain or discomfort and feeling heavy urination, discharge of more bacteria, the possibility of infection as well.
Chronic prostatitis is a general term for a group of diseases, including chronic bacterial prostatitis, nonbacterial prostatitis and prostate pain. Among them, non-bacterial prostatitis Although the symptoms of prostatitis, prostatic fluid can also be found in the cells, but not bacterial culture. The prostate pain only appear like prostatitis patients as perineal soreness, micturition dribbling unclear, at the end of urinary symptoms turbid liquid, etc., but finding out prostatic fluid white blood cells may be due to pelvic floor muscle tension caused. Of course, the latter two cases will not cause infected.
Monday, May 23, 2016
Friday, May 20, 2016
semen on women's health benefit
A miraculous: help eliminate insomnia
Everyone is eager to have a deep, sweet sleep, but insomnia caused by a variety of reasons, often troubled you. Especially women, are more likely to insomnia. When undergoing a harmonious sexual life, the nervous excitement of the body began to relax tired muscles are able to meet later in the stretch, drowsiness naturally hit, help to eliminate insomnia. And sex life more happy, and afterwards the more easily fall asleep.
Miraculous II: relieve premenstrual syndrome
Women in 5-7 days before menstruation, pelvic blood flow increases, it may cause swelling and spasm, causing abdominal pain or bloating. The sex life of muscle contraction, can promote blood flow to accelerate the pelvic area into the general blood circulation, and relieve pressure on the pelvis, thus reducing abdominal discomfort.
Miraculous three: semen help women vaginal disinfection
Experiments show that there is an antibacterial substance in semen - semen cytoplasm, it can kill staphylococcus, streptococcus, pneumococcus bacteria. So it can help female genital against microorganisms. Long-term no sexual life of women, more prone to vaginitis, endometritis, salpingitis and other illnesses.
Miraculous four: help protect the young minds
According to the Japanese medical research shows that: "use and disuse" of atrophy, but also to a lack of sexual life. Proper sex life helps prevent brain aging and metabolism, memory is also strong.
The benefits of semen semen semen on women's health benefits
Miraculous Five: effective to reduce the incidence of heart disease and myocardial infarction
Sex can make the pelvis, limbs, joints, muscles, spine more activities to promote blood circulation, strengthen the heart and lung capacity. Dangerous people have a harmonious sexual life of heart disease than people who sexual disharmony at least 10% reduction in risk.
Miraculous Six: alleviate or relieve pain disorder
Sex even with aspirin have the same effect, it sounds a bit marvelous. However, a large number of medical institutions feedback confirmed the sex life can stimulate the central nervous system that secrete a chemical called amine polyphenols, weakened pain quite effective.
The benefits of semen semen semen on women's health benefits
Miraculous Seven: reduce the incidence of skin diseases
Poor skin blood circulation, can cause acne, dark spots and other skin diseases. And moderate sex will accelerate blood circulation, balance metabolism, make the skin smooth and delicate, and play a role in prevention and treatment of skin diseases.
Miraculous eight: improve resistance to diseases of the immune system
Modern civilized life, but let people's immune systems are more vulnerable than ever. Colds, high blood pressure, all kinds of ulcers are often hide become obvious. Sex can make a balanced secretion of adrenaline, muscle contraction first, then relax, creating a virtuous cycle in which the immune system can be maintained in good condition.
The benefits of semen semen semen on women's health benefits
Miraculous nine: the promotion of women's reproductive health
Estrogen can make women maintain the structure and function of good blood circulation system, regular sexual life of women, estrogen levels than occasional sexual intercourse is much higher. Thereby strengthening the physiological function of the ovaries, normal menstruation, but also to postpone menopause, and every time sex will cause genital secretions increase, to prevent drying of the vaginal mucosa.
Miraculous ten: slow aging
Women in about thirty-five, began to loose bone, sex can regulate cholesterol and maintain bone density and slow down osteoporosis. So that the whole people look light gait, the body's flexibility is also strong.
Miraculous XI: to make men stronger
Moderate healthy sex life, can make men's testosterone secretion increased, so that more muscular men, weight gain, improved bone marrow function, but also to reduce body fat accumulation.
Everyone is eager to have a deep, sweet sleep, but insomnia caused by a variety of reasons, often troubled you. Especially women, are more likely to insomnia. When undergoing a harmonious sexual life, the nervous excitement of the body began to relax tired muscles are able to meet later in the stretch, drowsiness naturally hit, help to eliminate insomnia. And sex life more happy, and afterwards the more easily fall asleep.
Miraculous II: relieve premenstrual syndrome
Women in 5-7 days before menstruation, pelvic blood flow increases, it may cause swelling and spasm, causing abdominal pain or bloating. The sex life of muscle contraction, can promote blood flow to accelerate the pelvic area into the general blood circulation, and relieve pressure on the pelvis, thus reducing abdominal discomfort.
Miraculous three: semen help women vaginal disinfection
Experiments show that there is an antibacterial substance in semen - semen cytoplasm, it can kill staphylococcus, streptococcus, pneumococcus bacteria. So it can help female genital against microorganisms. Long-term no sexual life of women, more prone to vaginitis, endometritis, salpingitis and other illnesses.
Miraculous four: help protect the young minds
According to the Japanese medical research shows that: "use and disuse" of atrophy, but also to a lack of sexual life. Proper sex life helps prevent brain aging and metabolism, memory is also strong.
The benefits of semen semen semen on women's health benefits
Miraculous Five: effective to reduce the incidence of heart disease and myocardial infarction
Sex can make the pelvis, limbs, joints, muscles, spine more activities to promote blood circulation, strengthen the heart and lung capacity. Dangerous people have a harmonious sexual life of heart disease than people who sexual disharmony at least 10% reduction in risk.
Miraculous Six: alleviate or relieve pain disorder
Sex even with aspirin have the same effect, it sounds a bit marvelous. However, a large number of medical institutions feedback confirmed the sex life can stimulate the central nervous system that secrete a chemical called amine polyphenols, weakened pain quite effective.
The benefits of semen semen semen on women's health benefits
Miraculous Seven: reduce the incidence of skin diseases
Poor skin blood circulation, can cause acne, dark spots and other skin diseases. And moderate sex will accelerate blood circulation, balance metabolism, make the skin smooth and delicate, and play a role in prevention and treatment of skin diseases.
Miraculous eight: improve resistance to diseases of the immune system
Modern civilized life, but let people's immune systems are more vulnerable than ever. Colds, high blood pressure, all kinds of ulcers are often hide become obvious. Sex can make a balanced secretion of adrenaline, muscle contraction first, then relax, creating a virtuous cycle in which the immune system can be maintained in good condition.
The benefits of semen semen semen on women's health benefits
Miraculous nine: the promotion of women's reproductive health
Estrogen can make women maintain the structure and function of good blood circulation system, regular sexual life of women, estrogen levels than occasional sexual intercourse is much higher. Thereby strengthening the physiological function of the ovaries, normal menstruation, but also to postpone menopause, and every time sex will cause genital secretions increase, to prevent drying of the vaginal mucosa.
Miraculous ten: slow aging
Women in about thirty-five, began to loose bone, sex can regulate cholesterol and maintain bone density and slow down osteoporosis. So that the whole people look light gait, the body's flexibility is also strong.
Miraculous XI: to make men stronger
Moderate healthy sex life, can make men's testosterone secretion increased, so that more muscular men, weight gain, improved bone marrow function, but also to reduce body fat accumulation.
Wednesday, May 18, 2016
skin disease
skin disease
Summer weather, hot flashes, is conducive to all kinds of fungi, bacteria growth and reproduction, coupled with the summer people sweat easily prone skin moist, if not wipe and dry, the fungus will harm our skin, causing the skin disease psoriasis. The most common skin disease psoriasis have athlete's foot, which is what we call "beriberi", people who like to wear leather shoes easy to get athlete's foot, because shoes airtight, foot humidity and temperature increased. In addition, many young men in the summer easy infection and tinea versicolor (sweat stain), which is related to a large amount of perspiration. If sweating, not cleaned, fungi multiply on the skin, the formation of pimples, blisters, scaling, etc., damage the skin.
For infants and young children, summer is the most common skin prickly heat, heat rash is a common summer skin disease in infants, sweat, sweat pores lead to blockage of skin abnormalities. Occur in the neck, chest, back, armpits, the needle to the grain size of pimples, skin redness around, improper handling easy to secondary infection.
How to prevent
Whether summer or infant heat rash skin disease in adults, are due to sweat more, it can not be cleaned, due to dry, therefore, to prevent such skin diseases most important thing is to keep the skin clean and dry. Adults and children should bathe, to the timely replacement of sweat clothes, adults can choose some of the texture of fresh, breathable clothing and socks, living appliances apart to use. Infants may be appropriately prescribe air conditioning, rubbed lip.
Summer weather, hot flashes, is conducive to all kinds of fungi, bacteria growth and reproduction, coupled with the summer people sweat easily prone skin moist, if not wipe and dry, the fungus will harm our skin, causing the skin disease psoriasis. The most common skin disease psoriasis have athlete's foot, which is what we call "beriberi", people who like to wear leather shoes easy to get athlete's foot, because shoes airtight, foot humidity and temperature increased. In addition, many young men in the summer easy infection and tinea versicolor (sweat stain), which is related to a large amount of perspiration. If sweating, not cleaned, fungi multiply on the skin, the formation of pimples, blisters, scaling, etc., damage the skin.
For infants and young children, summer is the most common skin prickly heat, heat rash is a common summer skin disease in infants, sweat, sweat pores lead to blockage of skin abnormalities. Occur in the neck, chest, back, armpits, the needle to the grain size of pimples, skin redness around, improper handling easy to secondary infection.
How to prevent
Whether summer or infant heat rash skin disease in adults, are due to sweat more, it can not be cleaned, due to dry, therefore, to prevent such skin diseases most important thing is to keep the skin clean and dry. Adults and children should bathe, to the timely replacement of sweat clothes, adults can choose some of the texture of fresh, breathable clothing and socks, living appliances apart to use. Infants may be appropriately prescribe air conditioning, rubbed lip.
Heat stroke
Heat stroke
Hot summer weather, can easily lead to heat stroke, which is mainly because people in high temperature environments, temperature regulation loss of balance, excessive body heat savings, water and salt metabolism disorders caused. The disease usually occurs in the summer heat accompanied by humid weather, ranging appear sweating, dizziness after heat stroke, chest tightness, heart palpitations, nausea, vomiting and other symptoms; there will be severe cramps or fainting, life-threatening.
How to prevent
Summer heat stroke symptoms is not obvious, or did not pay attention, often overlooked. Therefore, if you find yourself or someone else has heat stroke performance, you should quickly leave the high-temperature environment to a cool well ventilated place to rest; more drinking salt water; you can also apply cool oil, wind spirits, etc. in the forehead, or taking Dishui Huoxiangzhengqi water and other traditional Chinese medicine. If lower blood pressure, exhaustion and other symptoms should immediately go to the hospital.
Summer to go out, it is best to avoid the 10:00 to 4:00 pm this time, we must go out to do protection work, such as playing beach umbrella, wear a hat, sunglasses, prepare adequate water and beverages; drugs carry some summer cooling as Dishui, wind spirits, etc; clothes also try to use cotton, linen, silk and other fabrics, chemical fiber category clothing and want to avoid the heat can not be sweating a lot, causing heat stroke.
Hot summer weather, can easily lead to heat stroke, which is mainly because people in high temperature environments, temperature regulation loss of balance, excessive body heat savings, water and salt metabolism disorders caused. The disease usually occurs in the summer heat accompanied by humid weather, ranging appear sweating, dizziness after heat stroke, chest tightness, heart palpitations, nausea, vomiting and other symptoms; there will be severe cramps or fainting, life-threatening.
How to prevent
Summer heat stroke symptoms is not obvious, or did not pay attention, often overlooked. Therefore, if you find yourself or someone else has heat stroke performance, you should quickly leave the high-temperature environment to a cool well ventilated place to rest; more drinking salt water; you can also apply cool oil, wind spirits, etc. in the forehead, or taking Dishui Huoxiangzhengqi water and other traditional Chinese medicine. If lower blood pressure, exhaustion and other symptoms should immediately go to the hospital.
Summer to go out, it is best to avoid the 10:00 to 4:00 pm this time, we must go out to do protection work, such as playing beach umbrella, wear a hat, sunglasses, prepare adequate water and beverages; drugs carry some summer cooling as Dishui, wind spirits, etc; clothes also try to use cotton, linen, silk and other fabrics, chemical fiber category clothing and want to avoid the heat can not be sweating a lot, causing heat stroke.
Sunday, May 8, 2016
Tuberculosis
Tuberculosis is a chronic infectious disease caused by Mycobacterium tuberculosis, can invade many organs, the formation of pulmonary involvement tuberculosis (pulrnonary tuberculosis) is the most common. Row of bacteria important source of infection for the patient. The human body is not necessarily infected with TB disease, when the resistance is reduced or increased cell-mediated allergy, it may cause clinical disease. The basic pathological features of the disease exudative, cheese necrosis and other proliferative tissue reaction, formation of voids. Apart from a few acute onset gather outside, mostly chronic clinical course. It manifested as fever, weight loss, fatigue and other symptoms of cough, hemoptysis and other respiratory manifestations. If timely diagnosis, and to the proper treatment, most of the available clinical recovery. Since the 1950s, the trend of tuberculosis has decreased, but the regional epidemic control is still uneven, it is still currently a prominent public health issue, is one of the top ten causes of death in the country.
Antituberculosis chemotherapy for TB control play a decisive role, reasonable intralesional chemotherapy can destroy the bacteria, ultimately recovered. Rest and nutrition therapy only play a supporting role.
First, the anti-TB chemotherapy (referred to chemotherapy)
(A) Principles of chemotherapy
The main effects of chemotherapy is to shorten the infectious period and reduce mortality, morbidity and infection. For each particular patient, for the main measures to achieve clinical and biological cure, chemotherapy is a reasonable means of active tuberculosis insisted early in conjunction with, adequate, regular and full use of the principles of sensitive drugs. Mainly refers to the so-called Early early treatment of patients, if it is found immediately after diagnosis and drug treatment; joint action is defined according to the characteristics of the disease and anti-TB drugs, combined with two or more drugs to enhance and ensure the efficacy; refers to an appropriate amount depending on the condition and provide for different dosage of different individuals; the law even if the patient must strictly follow the prescribed method of administration of chemotherapy, to adhere to a regular treatment, can not arbitrarily change the program or undue free withdrawal is also not free to intermittent medication; patients must follow the full program Naizhi adhere to the rule set by the full course of treatment, short-course chemotherapy is usually 6 to 9 months. Generally, untreated patients with standard treatment in accordance with the above principles, the efficacy of up to 98%, the recurrence rate of less than 2%.
Active TB are indications of chemotherapy. Induration of long lesions they do not need chemotherapy. As part of the induration, sputum negative, could observe a stage, if X-rays show no active lesions, sputum is still negative, no obvious toxic symptoms of tuberculosis, also do not need chemotherapy.
1, early, in conjunction with, adequate, regular and full medication active lesions in exudative stage, or cheese-like necrosis and even the formation of hollow, mainly Mycobacterium tuberculosis bacteria in Group A lesion growth metabolism, anti-TB drugs are often You can maximize the bactericidal or bacteriostatic effect. Local lesions rich blood supply, drug concentrations would also be conducted to help promote inflammation absorption components, reduced or closed cavity, sputum negative. Therefore, early active lesions reasonable chemotherapy, results were satisfactory.
Experiments show that lung lesions cheese per 1g tissue or cavity, about 106 to 1010 TB. Never had contact with TB TB drugs, sensitivity to drugs are not identical. About every 105 to 106 TB bacteria may have a genetic mutation because isoniazid or streptomycin resistance. Meanwhile the two drugs are resistant TB by about 1011, only one, but three kinds of bacteria resistant to drugs is less. As can be seen in a single-drug therapy, although can be nipped in the portion susceptible, but may leave a small number of resistant bacteria continue to multiply, eventually grow resistant advantages. Such as joint use of two or more drugs, reduce drug-resistant, the effect is better than single drugs.
The dose should be appropriate, inadequate dosage, the drug within the organization in order to achieve an effective concentration letter, and easy to produce bacterial secondary resistance. Excessive drug is easy to produce adverse reactions. TB slow growth, sometimes only occasionally breeding (B, C bacteria), and should therefore be the drug in the body long-term effective concentration. Regularly throughout treatment, but early withdrawal is the key to successful chemotherapy.
2, can play a bactericidal effect of TB drugs and blood (including macrophages) drug concentration in normal doses, to achieve the above in vitro minimum inhibitory concentration (MIC) of 10 times, otherwise the only antimicrobial effect. Conventional dosage isoniazid and rifampicin inside and outside the cell can reach that level, said the whole fungicides. Pyrazinamide and streptomycin are also fungicides, but streptomycin to play the biggest role in the slightly alkaline environment, and rarely penetrate phagocytic cells, intracellular TB invalid. Although pyrazinamide can penetrate phagocytic cells, but only have a bactericidal effect in acidic environments, so both are only half as fungicides. Ethambutol, sodium aminosalicylate, etc. are bacteriostatic agents, when conventional doses of the drug concentration can not be more than 10 times the MIC, increase the dose is prone to adverse reactions.
TB mostly in the early lesion within the extracellular, then isoniazid bactericidal effect is the strongest, followed by streptomycin. Inflammation of the tissue local pH decrease, slowing bacterial metabolism (C flora), together with some of phagocytic cells in the TB (B flora), are sensitive to rifampin and pyrazinamide. Such residual bacteria killing (B flora), helps to reduce future recurrence.
(B) chemotherapy
1, the "standard" chemotherapy and conventional short-course chemotherapy in the past 12 to 18 months using the therapy, known as the "standard" chemotherapy, but the long duration, many patients can not be completed, the effect is limited. Since the advent of rifampicin, and in combination with other drugs, found that 6 to 9 months of therapy (DOTS) with standard chemotherapy has the same effect, it is now widely used short-course chemotherapy, the program requested must comprise two bactericidal drugs, iso isoniazid and rifampicin, a strong bactericidal (bacteria of A) and sterilization (for B, C bacteria) effect.
2 ,. intermittent treatment, two-stage drug experiments showed that after a few hours in contact with TB drugs, often retard the growth of the number of days. Therefore, regular medication three times a week (intermittent treatment), can achieve the same effect with the drug every day. Within 1 to 3 months to start chemotherapy, daily dosing (strengthening stage), three times a week after intermittent treatment (consolidation phase), the effect of daily medication is basically the same, facilitate the monitoring of medication to ensure complete a full course of chemotherapy. When using intermittent therapy medication three times a week, should the combination, each of isoniazid, rifampicin, ethambutol dose may be appropriate to increase; however streptomycin, p-amino salicylic acid, sodium acetate, sulfur isonicotinoyl amine more adverse reactions, each dose should not be increased (table 1).
Table dose commonly used anti-TB drugs for adults and major adverse effects
Drug name abbreviations daily dose (g) intermittent treatment 1, (g) bacteriostatic mechanism of adverse reactions
Isoniazid H, INH0.30.6 ~ 0.8DNA peripheral neuritis synthesis, sometimes liver damage
Rifampicin R, RFP0.45 ~ 0.6 * 0.6 ~ 0.9mRNA synthetic liver damage, allergic reactions
Streptomycin S, SM0.75 ~ 1.0 △ 0.75 ~ 1.0 protein synthesis hearing loss, dizziness, impaired renal function
Pyrazinamide Z, PZA1.5 ~ 2.02 ~ 3 pyrazine acid inhibitory gastrointestinal discomfort, liver dysfunction, hyperuricemia, joint pain
Ethambutol E, EMB0.75 ~ 1.0 ** 1.5 ~ 2.0RNA synthetic optic neuritis
Amino salicylic acid sodium P, PAS8 ~ 12 *** 10 ~ 12 intermediary metabolism gastrointestinal discomfort, allergic reactions, liver damage
Propylthiouracil isonicotinoyl amines 1321Th0.5 ~ 0.750.5 ~ 1.0 protein synthesis gastrointestinal discomfort, liver damage
Kanamycin K, KM0.75 ~ 1.0 △ 0.75 ~ 1.0 protein synthesis hearing loss, dizziness, impaired renal function
Capreomycin Cp, CPM0.75 ~ 1.0 △ 0.75 ~ 1.0 protein synthesis hearing loss, dizziness, impaired renal function
Note: * weight <50kg 0.45="" 0.6="" 0.75g.="" 15mg="" 25mg="" 2="" according="" adjusted="" also="" amount="" are="" body="" daily="" doses="" drugs="" each="" elderly="" first="" font="" is="" kg="" minutes="" months="" of="" once="" other="" reduced="" s="" subsequently="" th="" to="" weight="" with="" z="">
3, anti-tuberculosis drug supervision administration at least six months, even take up to a year and a half, patients often difficult to adhere to. Urge timely medical treatment, strengthening visits, obtain the patient cooperation is particularly necessary. Strengthening stage once-daily administration, the peak plasma concentration can be formed, compared with daily fractionated treatment efficacy is preferred, and the convenience of patients, improve patient adherence to medication and complete the full rate.
(Iii) anti-TB drugs
Ideal anti-TB drugs sterilization, sterilization or strong antimicrobial effect, low toxicity and reduce adverse reactions, adequate inexpensive, easy to use, drug source; orally or injected drugs can achieve an effective concentration in the blood, and It can penetrate phagocytic cells, or cerebrospinal fluid within the peritoneal cavity, rapid and lasting effect.
1, isoniazid (isoniazid, H) has a strong bactericidal, it can be administered orally, fewer adverse reactions, low cost and other advantages. Its main function is to inhibit M. tuberculosis deoxyribonucleic acid (DNA) synthesis and hinder bacterial cell wall synthesis. After oral administration, rapid absorption, tissue infiltration, through blood-brain barrier, killing intracellular metabolism of active TB or stationary. Pleural effusion, cheese-like lesions and drug concentrations in cerebrospinal fluid are also quite high. The usual dose for adults daily 300mg (or daily 4 ~ 8mg / kg), an oral; children daily 5-10mg / kg (not to exceed daily 300mg). Tuberculous meningitis and acute tuberculosis millet dose may be increased (there may be complicated by peripheral neuritis, can prevent 300mg of vitamin B6 daily while increasing the dose; but large doses of vitamin B6 can affect the efficacy of isoniazid, so use when general dose of isoniazid, no need to add vitamin B6), until the acute toxicity symptoms recoverable conventional dose. Isoniazid in vivo inactivated by acetylation, acetylated individual differences in speed are often lower rapid acetylation blood concentration, there shall be considered to increase the dose intermittent administration.
Conventional dose of the drug adverse reactions occur rarely, occasionally peripheral neuritis, central nervous system toxicity (excitatory or inhibitory), liver damage (serum alanine aminotransferase) and the like. 3 months of isoniazid alone, sputum resistance rate up to 70%.
2, rifampicin (rifampin, R) is a semi-synthetic derivative of rifamycin, a broad-spectrum antibiotic. Its mechanism is to kill TB bacteria inhibiting RNA polymerase, hinder its mRNA synthesis. Intracellular rifampicin, a strong external metabolism and reproduction occasionally TB (A, B, C bacteria) have a role, often in combination with isoniazid. Adult 1 day, fasting oral administration of 450 ~ 600mg. The drug adverse reactions are mild, in addition to gastrointestinal discomfort, flu syndrome, the occasional transient hepatic dysfunction. Long rifamycin derivatives such as rifapentine (rifapentine, DL473) long half-life in humans, orally once a week, with daily rifampin similar effect. Rifamycin spiral piperidine (ansamycin, LM427, rifabutin) have some effect on other anti-TB drug failure strain (eg bird complex mycobacteria) than rifampin strong.
3, streptomycin (streptomycin, S) is a broad spectrum aminoglycoside antibiotic, has bactericidal action against TB, TB can interfere with the activity, impede protein synthesis. TB less effect on the cell. Dosage: Adult daily intramuscular injection 1g (50 years of age or renal dysfunction available 0.5 ~ 0.75g). Intermittent therapy twice a week, every muscle injection 1g. Pregnant women with caution.
The main side effects of streptomycin for the eighth cranial nerve damage, manifested as dizziness, tinnitus, deafness, severe cases should be promptly discontinued, severe renal impairment should not be used. Other allergic rash, exfoliative dermatitis, drug fever, etc., anaphylactic shock is rare. Monotherapy is easy to produce drug resistance. Other aminoglycoside antibiotics, such as kanamycin, capreomycin, purple neomycin although also anti-TB effect, but the effect is not and streptomycin, similar adverse reactions.
4, pyrazinamide (pyrazinamide, Z) can kill within phagocytes, acidic environment of TB. Dose: daily 1.5g, 3 times orally, occasionally hyperuricemia, joint pain, gastrointestinal discomfort and liver damage and other adverse reactions.
5, ethambutol (ethambutol, E) of TB has antibacterial effects, when combined with other anti-TB drugs and may retard bacterial resistance to other drugs. Dosage: 25mg / kg, 1 times a day orally for 8 weeks to 15mg / kg, adverse reactions to their little advantage, occasional gastrointestinal discomfort. Overdose can play the ball after optic neuritis, vision loss, reduced vision, central blind spot, etc., can be restored more than once the withdrawal.
6, p-aminosalicylic within (sodium para-aminosalicylate.P) of antibacterial drugs with streptomycin, isoniazid, or in combination with other anti-TB drugs, can delay the onset of resistance to other drugs. The antibacterial effect may during the synthesis of folic acid with TB ammonia acid (PABA) competition, affect the metabolism of Mycobacterium tuberculosis. Dosage: Adult daily 8 ~ 12g, every 2 to 3 times a day orally. Adverse reactions are loss of appetite, nausea, vomiting and diarrhea. The drug after meals can reduce gastrointestinal reactions, can also add a daily 12g dark intravenous infusion in 5% to 10% glucose solution 500ml, and a month later still changed to oral.
(Iv) chemotherapy
Depending on the severity, with or without sputum and bacterial resistance, as well as the economic situation, drug supply source, the choice of chemotherapy. No matter which must comply with the aforementioned principles can only be effective chemotherapy.
1 newly diagnosed cases of anti-TB program without drug treatment, some sputum smear-positive TB (smear), severe illness, infectious; and some smear-negative, small lesions, the use of chemotherapy also have different strength.
Smear positive cases, regardless of whether the culture is positive, can be utilized to isoniazid (H), rifampicin (R) and pyrazinamide (Z) based on a combination of the six-month DOTS program. Soon sputum often negative, short course, to facilitate follow-up management.
(1) strengthen the first two months of streptomycin (or ethambutol), isoniazid, rifampin and pyrazinamide, 1 day; after four months continue with isoniazid and rifampicin flat, 1 day to 2S (E) HRZ / 4HR representation.
(2) may also be a period of consolidation in the drug every other day (ie medication three times a week) to 2S (E) HRZ / 4H3R3. (Lower right corner number is the number of drugs per week).
(3) can also be intermittent throughout the medication to 2S3 (E3) H3R3Z3 / 4H3R3 representation.
(4) to strengthen the use of isoniazid, streptomycin and sodium aminosalicylate (amine or an alcohol), a period of consolidation with two kinds of drugs for 10 months, to 2HSP (E) / 10HP (E) represented.
(5) strengthening of a month with isoniazid, streptomycin, consolidation of 11 months of treatment twice a week to 1HS / 11H2S2 representation.
Above (1), (2), (3) for the short term chemotherapy, (4), (5) the "standard protocol." If conditions permit, to make use of short-course chemotherapy program.
Smear Yin Pui Yin patient, except may be smear positive patients with significant new social program miliary tuberculosis or hole, using the following regimens: ①2SHRZ / 2H2R2; ②3H2R2Z2 / 2H2R2 (every other day throughout the application); ③1SH / 11HP (or E).
Of untreated patients, International Union Against Tuberculosis and Lung Disease Association recommended chemical solution is suitable for the national anti-TB (Table II), development of treatment programs available for reference.
Table II countries tuberculosis chemotherapy Tuberculosis Plan
Course of chemotherapy treatment regimens
6 months 2RHZ / 4RH8 months 2SRHZ / 6TH or 6EH
2ERHZ / 4RH or 4R2H22SRHZ / 6S2H2Z2
2SRHZ / 4RH or 4R2H2
2, retreatment regimen as the first treatment of chemotherapy unreasonable, TB produce secondary resistance, sputum remains positive, persistent recurrent disease. Retreatment cases should choose joint sensitive drugs. Drug sensitivity test helps select the medication, but time-consuming longer, larger expenses. Clinically patients according to previous drug use, select an unused past few used or has joint rules used drugs (which may still be susceptible to the bacteria), and the other set programs, joint two kinds or two kinds more sensitive drugs.
Retreatment cases, generally available the following scenario:
(1) 2S (E) HRZ / 4HR, supervise chemotherapy administration to ensure laws. At the end of six months of treatment, if still negative sputum, consolidation period may be extended for two months. As prolonged treatment is still sputum remains positive, retreatment may be following the program.
(2) newly diagnosed patients failed rule, available 2S3H3Z3E3 / 6H3R3E3.
(3) chronic row of bacteria sensitive to first-line drugs were available and combined with second-line drugs, such as kanamycin toxin (K), propylthiouracil isonicotinoyl amine (1321Th), capreomycin (Cp), should be closely observed adverse drug reactions, medication 6 to 12 months is appropriate. Fluoroquinolones have antituberculosis moderate effect on the cases commonly used drugs has generated resistance, may be added in combination with the program. If bacteria overcast fistula, or serious adverse reactions, indications are discontinued.
(V) determine the condition and efficacy assessment, treatment failure
1, according to the extent of disease and therapeutic evaluation of activities can be divided into the aforementioned known disease progression, and improved absorption of the stable. General improvement of absorption and stability of the condition improved, advanced for the worse. Its judgment should be based on clinical symptoms, X-ray showing the row of bacteria and comprehensive analysis of the situation.
(1) Clinical symptoms: observe whether the afternoon fever, night sweats, loss of appetite, general shortage, weight loss and other TB symptoms worsen and procedural changes. Such symptoms were relieved or disappeared prompted condition improved; or if symptoms significantly changed from a light weight indicates deterioration. In addition, cough, sputum, hemoptysis and other changes in respiratory symptoms may be used as a reference.
(2) X-ray examination: the condition is judged indispensable indicators, is also an important basis for monitoring of the disease outcome of patients with no obvious clinical symptoms mainly rely on X-ray, X-ray can determine the lesion location, extent, nature , but also to control observation of dynamic change. Cottony clouds infiltrates absorb, dissipate, narrow; or converted to higher density, clear boundary of proliferative diseases such as fibrosis, calcification; original narrow cavity, said Deng Jun closed condition improved or cured. Conversely, the proliferative lesions into exudative lesions or invasive lesions expand, bronchial disseminated or acute, subacute hematogenous, caseous necrotic lesions, cavitation, etc. are deteriorated performance.
(3) sputum: tuberculosis in the sputum bacteria row or not is an important indicator to determine the condition assessment procedures and efficacy. Sputum examination and high specificity less affected by human factors. If sputum remains positive, compared with open tuberculosis, suggesting a high degree of disease activity, and for the social source of infection of tuberculosis, pose a threat to the surrounding population. After treatment repeatedly checked and found negative for TB or less, which is indicative of better; such as monthly sputum examination at least once, months were negative, it means that into the stable. Then, if the row of bacteria appear again for disease worsening performance. ESR acceleration prompted active disease worsening; but not have active tuberculosis ESR growth, lesions improved and stable patients were nearly normal erythrocyte sedimentation rate.
2, the end of the course of treatment failure sputum negative conversion failed, or in transit positive effect, X-ray showed lesions not absorbed, stable, and further deterioration, both indicate treatment failure, a so-called refractory pulmonary tuberculosis. Study its causes, in addition to drug-resistant TB infection, medication is not standardized, intermittent medication or monotherapy, but still with some patients chemotherapy drug allergies, chemotherapy drugs can not be used because of serious adverse reactions or chemotherapy drugs is difficult to adhere to treatment, the body immunocompromised (HIV infection), poor physical and other factors.
Drug-resistant tuberculosis (DR-TB) especially multidrug-resistant tuberculosis (MDR-TB) epidemic seriously, we are making anti-TB treatment is facing new challenges. 1994, WHO and the International Union Against Tuberculosis Lung Disease began anti-TB drug resistance monitoring of global planning, which lasted 3 years of work showed that, in 35 countries on five continents monitoring delegates found 20 percent of the world's population of double-resistant HR MDR-TB accounted for 2% to 14%, most of them belonging monotherapy, irregular, secondary multidrug resistance unreasonable treatment of joint programs human factors caused. In countries with weak TB control, primary multi-drug resistance was also found an upward trend. Once the occurrence of drug-resistant tuberculosis, chemotherapy drugs they use expensive price, poor efficacy, serious adverse events, treatment costs may be 100 times the new smear positive pulmonary tuberculosis patients. Adhere to the rational use of chemotherapy, and adopt comprehensive prevention and control measures, improve immune function and help prevent the occurrence of drug-resistant TB.
In order to effectively prevent treatment failure, chemotherapy must be properly formulated, patients should insist on an early, regular, regular, full combined with sensitive drugs under the supervision of. Only in the case of resistance has serious adverse reactions or indeed confirmed that the bacteria has been generated, it changed to a new chemotherapy. The new program should include two or more sensitive drugs.
Second, symptomatic treatment
(A) toxic symptoms
Toxic symptoms of tuberculosis and more effective anti-TB treatment can disappear in 1 to week, usually you do not have special treatment. Severe toxic symptoms of tuberculosis caseous pneumonia, acute miliary tuberculosis, tuberculous meningitis, high fever, etc., or a large number of tuberculous pleurisy with pleural effusion, should be bed rest and the use of anti-TB drugs as soon as possible. Also in the use of effective anti-TB drugs at the same time, the addition of corticosteroids (commonly prednisone daily 15 ~ 20mg, three to oral) to reduce inflammation and allergic reactions, and promote absorption of exudate, reducing fibrous tissue formation and pleural adhesions. Toxicity symptoms to be severe, prednisone dose decreasing to 6 to 8 weeks withdrawal. Glucocorticoids pleural thickening and has no role in the formation of adhesions. Therefore, it should be used with caution in effective anti-TB treatment basis.
(B) hemoptysis
If only a small amount of bloody sputum or hemoptysis, symptomatic treatment, including rest, cough, sedation, commonly used drugs Pentoxyverine soil root powder, codeine, carbazochrome (security network of blood) and the like. Old and feeble, pulmonary insufficiency, caution strong antitussive, so as to avoid inhibiting reverse cough and respiratory center, so that can not be discharged blood clots caused by suffocation. To exclude other reasons hemoptysis, such as mitral stenosis, pulmonary infection, pulmonary infarction, coagulation disorders, autoimmune diseases.
Moderate or heavy hemoptysis should be strict bed rest, ice packs placed chest and alternate with blood. Lateral position, will remain in the blood gently intratracheal cough. Vasopressin 10U applied to 20 ~ 30ml saline or glucose solution, the slow intravenous infusion (15 to 20 minutes), then 10 ~ 40U in 500ml of 5% glucose solution intravenous maintenance therapy. Posterior pituitary is known as contraction of small arteries, including the coronary artery and capillary action to reduce pulmonary blood flow, thereby reducing hemoptysis. The drug can still smooth muscle contraction of the uterus and therefore avoid for pregnant women and patients with hypertension, coronary atherosclerotic heart disease. Injection too fast can cause nausea, it is intended, palpitations, pale and other adverse reactions.
If excessive hemoptysis, blood transfusion may be appropriate discretion. Than those who hemoptysis, bleeding sites can be found by bronchoscopy, noradrenaline 2 ~ 4mg + 4 ℃ saline 10 ~ 20ml topical instillation. Or placed Fogarty balloon catheter (outer diameter 1mm, inflatable 0.5 ~ 5.0ml) with bronchoscopy clogging the bleeding site to stop bleeding. In addition to still use Kinoshita method with thrombin or fibrinogen bronchoscopy lavage hemostasis, should be fully prepared to make the necessary rescue. Repeated hemoptysis by the above method is invalid, no activity contralateral lung disease, pulmonary function reserve acceptable nor obvious contraindications, consider lobectomy, segmentectomy in clear bleeding site conditions.
Hemoptysis suffocation is the leading cause of hemoptysis necrosis, need to guard against, and actively preparing for the rescue before hemoptysis asphyxia symptoms include chest tightness, gas hold back, a lip cyanosis, pallor, cold sweat dripping, irritability. Rescue measures should be particularly injection keep the airway open, take Trendelenburg prone position high of 45 °, pat the back, the rapid discharge of blood, and dig or suction outlet as soon as possible, pharynx, larynx, nasal blood clots. Rigid bronchoscopy is necessary to attract, endotracheal intubation or tracheotomy to relieve airway obstruction.
Third, the surgical treatment
Surgery has been less used in the treatment of tuberculosis. Of greater than 3cm of tuberculosis and lung cancer is difficult to identify the ball, one-sided hollow fiber retreatment thick, long-term medical treatment failed to sputum conversion by, or unilateral destroyed lung with bronchiectasis, has lost function and have repeatedly hemoptysis or secondary infection, can be used for lung or pneumonectomy. Tuberculous empyema and (or) bronchial fistula after medical therapy and ipsilateral active TB, it is desirable for the lung - pleural resection. Surgical treatment contraindications are: bronchial mucosa with active tuberculosis, but not removed within the scope of those poor general condition or have significant heart, lung, liver and kidney dysfunction.
Antituberculosis chemotherapy for TB control play a decisive role, reasonable intralesional chemotherapy can destroy the bacteria, ultimately recovered. Rest and nutrition therapy only play a supporting role.
First, the anti-TB chemotherapy (referred to chemotherapy)
(A) Principles of chemotherapy
The main effects of chemotherapy is to shorten the infectious period and reduce mortality, morbidity and infection. For each particular patient, for the main measures to achieve clinical and biological cure, chemotherapy is a reasonable means of active tuberculosis insisted early in conjunction with, adequate, regular and full use of the principles of sensitive drugs. Mainly refers to the so-called Early early treatment of patients, if it is found immediately after diagnosis and drug treatment; joint action is defined according to the characteristics of the disease and anti-TB drugs, combined with two or more drugs to enhance and ensure the efficacy; refers to an appropriate amount depending on the condition and provide for different dosage of different individuals; the law even if the patient must strictly follow the prescribed method of administration of chemotherapy, to adhere to a regular treatment, can not arbitrarily change the program or undue free withdrawal is also not free to intermittent medication; patients must follow the full program Naizhi adhere to the rule set by the full course of treatment, short-course chemotherapy is usually 6 to 9 months. Generally, untreated patients with standard treatment in accordance with the above principles, the efficacy of up to 98%, the recurrence rate of less than 2%.
Active TB are indications of chemotherapy. Induration of long lesions they do not need chemotherapy. As part of the induration, sputum negative, could observe a stage, if X-rays show no active lesions, sputum is still negative, no obvious toxic symptoms of tuberculosis, also do not need chemotherapy.
1, early, in conjunction with, adequate, regular and full medication active lesions in exudative stage, or cheese-like necrosis and even the formation of hollow, mainly Mycobacterium tuberculosis bacteria in Group A lesion growth metabolism, anti-TB drugs are often You can maximize the bactericidal or bacteriostatic effect. Local lesions rich blood supply, drug concentrations would also be conducted to help promote inflammation absorption components, reduced or closed cavity, sputum negative. Therefore, early active lesions reasonable chemotherapy, results were satisfactory.
Experiments show that lung lesions cheese per 1g tissue or cavity, about 106 to 1010 TB. Never had contact with TB TB drugs, sensitivity to drugs are not identical. About every 105 to 106 TB bacteria may have a genetic mutation because isoniazid or streptomycin resistance. Meanwhile the two drugs are resistant TB by about 1011, only one, but three kinds of bacteria resistant to drugs is less. As can be seen in a single-drug therapy, although can be nipped in the portion susceptible, but may leave a small number of resistant bacteria continue to multiply, eventually grow resistant advantages. Such as joint use of two or more drugs, reduce drug-resistant, the effect is better than single drugs.
The dose should be appropriate, inadequate dosage, the drug within the organization in order to achieve an effective concentration letter, and easy to produce bacterial secondary resistance. Excessive drug is easy to produce adverse reactions. TB slow growth, sometimes only occasionally breeding (B, C bacteria), and should therefore be the drug in the body long-term effective concentration. Regularly throughout treatment, but early withdrawal is the key to successful chemotherapy.
2, can play a bactericidal effect of TB drugs and blood (including macrophages) drug concentration in normal doses, to achieve the above in vitro minimum inhibitory concentration (MIC) of 10 times, otherwise the only antimicrobial effect. Conventional dosage isoniazid and rifampicin inside and outside the cell can reach that level, said the whole fungicides. Pyrazinamide and streptomycin are also fungicides, but streptomycin to play the biggest role in the slightly alkaline environment, and rarely penetrate phagocytic cells, intracellular TB invalid. Although pyrazinamide can penetrate phagocytic cells, but only have a bactericidal effect in acidic environments, so both are only half as fungicides. Ethambutol, sodium aminosalicylate, etc. are bacteriostatic agents, when conventional doses of the drug concentration can not be more than 10 times the MIC, increase the dose is prone to adverse reactions.
TB mostly in the early lesion within the extracellular, then isoniazid bactericidal effect is the strongest, followed by streptomycin. Inflammation of the tissue local pH decrease, slowing bacterial metabolism (C flora), together with some of phagocytic cells in the TB (B flora), are sensitive to rifampin and pyrazinamide. Such residual bacteria killing (B flora), helps to reduce future recurrence.
(B) chemotherapy
1, the "standard" chemotherapy and conventional short-course chemotherapy in the past 12 to 18 months using the therapy, known as the "standard" chemotherapy, but the long duration, many patients can not be completed, the effect is limited. Since the advent of rifampicin, and in combination with other drugs, found that 6 to 9 months of therapy (DOTS) with standard chemotherapy has the same effect, it is now widely used short-course chemotherapy, the program requested must comprise two bactericidal drugs, iso isoniazid and rifampicin, a strong bactericidal (bacteria of A) and sterilization (for B, C bacteria) effect.
2 ,. intermittent treatment, two-stage drug experiments showed that after a few hours in contact with TB drugs, often retard the growth of the number of days. Therefore, regular medication three times a week (intermittent treatment), can achieve the same effect with the drug every day. Within 1 to 3 months to start chemotherapy, daily dosing (strengthening stage), three times a week after intermittent treatment (consolidation phase), the effect of daily medication is basically the same, facilitate the monitoring of medication to ensure complete a full course of chemotherapy. When using intermittent therapy medication three times a week, should the combination, each of isoniazid, rifampicin, ethambutol dose may be appropriate to increase; however streptomycin, p-amino salicylic acid, sodium acetate, sulfur isonicotinoyl amine more adverse reactions, each dose should not be increased (table 1).
Table dose commonly used anti-TB drugs for adults and major adverse effects
Drug name abbreviations daily dose (g) intermittent treatment 1, (g) bacteriostatic mechanism of adverse reactions
Isoniazid H, INH0.30.6 ~ 0.8DNA peripheral neuritis synthesis, sometimes liver damage
Rifampicin R, RFP0.45 ~ 0.6 * 0.6 ~ 0.9mRNA synthetic liver damage, allergic reactions
Streptomycin S, SM0.75 ~ 1.0 △ 0.75 ~ 1.0 protein synthesis hearing loss, dizziness, impaired renal function
Pyrazinamide Z, PZA1.5 ~ 2.02 ~ 3 pyrazine acid inhibitory gastrointestinal discomfort, liver dysfunction, hyperuricemia, joint pain
Ethambutol E, EMB0.75 ~ 1.0 ** 1.5 ~ 2.0RNA synthetic optic neuritis
Amino salicylic acid sodium P, PAS8 ~ 12 *** 10 ~ 12 intermediary metabolism gastrointestinal discomfort, allergic reactions, liver damage
Propylthiouracil isonicotinoyl amines 1321Th0.5 ~ 0.750.5 ~ 1.0 protein synthesis gastrointestinal discomfort, liver damage
Kanamycin K, KM0.75 ~ 1.0 △ 0.75 ~ 1.0 protein synthesis hearing loss, dizziness, impaired renal function
Capreomycin Cp, CPM0.75 ~ 1.0 △ 0.75 ~ 1.0 protein synthesis hearing loss, dizziness, impaired renal function
Note: * weight <50kg 0.45="" 0.6="" 0.75g.="" 15mg="" 25mg="" 2="" according="" adjusted="" also="" amount="" are="" body="" daily="" doses="" drugs="" each="" elderly="" first="" font="" is="" kg="" minutes="" months="" of="" once="" other="" reduced="" s="" subsequently="" th="" to="" weight="" with="" z="">
3, anti-tuberculosis drug supervision administration at least six months, even take up to a year and a half, patients often difficult to adhere to. Urge timely medical treatment, strengthening visits, obtain the patient cooperation is particularly necessary. Strengthening stage once-daily administration, the peak plasma concentration can be formed, compared with daily fractionated treatment efficacy is preferred, and the convenience of patients, improve patient adherence to medication and complete the full rate.
(Iii) anti-TB drugs
Ideal anti-TB drugs sterilization, sterilization or strong antimicrobial effect, low toxicity and reduce adverse reactions, adequate inexpensive, easy to use, drug source; orally or injected drugs can achieve an effective concentration in the blood, and It can penetrate phagocytic cells, or cerebrospinal fluid within the peritoneal cavity, rapid and lasting effect.
1, isoniazid (isoniazid, H) has a strong bactericidal, it can be administered orally, fewer adverse reactions, low cost and other advantages. Its main function is to inhibit M. tuberculosis deoxyribonucleic acid (DNA) synthesis and hinder bacterial cell wall synthesis. After oral administration, rapid absorption, tissue infiltration, through blood-brain barrier, killing intracellular metabolism of active TB or stationary. Pleural effusion, cheese-like lesions and drug concentrations in cerebrospinal fluid are also quite high. The usual dose for adults daily 300mg (or daily 4 ~ 8mg / kg), an oral; children daily 5-10mg / kg (not to exceed daily 300mg). Tuberculous meningitis and acute tuberculosis millet dose may be increased (there may be complicated by peripheral neuritis, can prevent 300mg of vitamin B6 daily while increasing the dose; but large doses of vitamin B6 can affect the efficacy of isoniazid, so use when general dose of isoniazid, no need to add vitamin B6), until the acute toxicity symptoms recoverable conventional dose. Isoniazid in vivo inactivated by acetylation, acetylated individual differences in speed are often lower rapid acetylation blood concentration, there shall be considered to increase the dose intermittent administration.
Conventional dose of the drug adverse reactions occur rarely, occasionally peripheral neuritis, central nervous system toxicity (excitatory or inhibitory), liver damage (serum alanine aminotransferase) and the like. 3 months of isoniazid alone, sputum resistance rate up to 70%.
2, rifampicin (rifampin, R) is a semi-synthetic derivative of rifamycin, a broad-spectrum antibiotic. Its mechanism is to kill TB bacteria inhibiting RNA polymerase, hinder its mRNA synthesis. Intracellular rifampicin, a strong external metabolism and reproduction occasionally TB (A, B, C bacteria) have a role, often in combination with isoniazid. Adult 1 day, fasting oral administration of 450 ~ 600mg. The drug adverse reactions are mild, in addition to gastrointestinal discomfort, flu syndrome, the occasional transient hepatic dysfunction. Long rifamycin derivatives such as rifapentine (rifapentine, DL473) long half-life in humans, orally once a week, with daily rifampin similar effect. Rifamycin spiral piperidine (ansamycin, LM427, rifabutin) have some effect on other anti-TB drug failure strain (eg bird complex mycobacteria) than rifampin strong.
3, streptomycin (streptomycin, S) is a broad spectrum aminoglycoside antibiotic, has bactericidal action against TB, TB can interfere with the activity, impede protein synthesis. TB less effect on the cell. Dosage: Adult daily intramuscular injection 1g (50 years of age or renal dysfunction available 0.5 ~ 0.75g). Intermittent therapy twice a week, every muscle injection 1g. Pregnant women with caution.
The main side effects of streptomycin for the eighth cranial nerve damage, manifested as dizziness, tinnitus, deafness, severe cases should be promptly discontinued, severe renal impairment should not be used. Other allergic rash, exfoliative dermatitis, drug fever, etc., anaphylactic shock is rare. Monotherapy is easy to produce drug resistance. Other aminoglycoside antibiotics, such as kanamycin, capreomycin, purple neomycin although also anti-TB effect, but the effect is not and streptomycin, similar adverse reactions.
4, pyrazinamide (pyrazinamide, Z) can kill within phagocytes, acidic environment of TB. Dose: daily 1.5g, 3 times orally, occasionally hyperuricemia, joint pain, gastrointestinal discomfort and liver damage and other adverse reactions.
5, ethambutol (ethambutol, E) of TB has antibacterial effects, when combined with other anti-TB drugs and may retard bacterial resistance to other drugs. Dosage: 25mg / kg, 1 times a day orally for 8 weeks to 15mg / kg, adverse reactions to their little advantage, occasional gastrointestinal discomfort. Overdose can play the ball after optic neuritis, vision loss, reduced vision, central blind spot, etc., can be restored more than once the withdrawal.
6, p-aminosalicylic within (sodium para-aminosalicylate.P) of antibacterial drugs with streptomycin, isoniazid, or in combination with other anti-TB drugs, can delay the onset of resistance to other drugs. The antibacterial effect may during the synthesis of folic acid with TB ammonia acid (PABA) competition, affect the metabolism of Mycobacterium tuberculosis. Dosage: Adult daily 8 ~ 12g, every 2 to 3 times a day orally. Adverse reactions are loss of appetite, nausea, vomiting and diarrhea. The drug after meals can reduce gastrointestinal reactions, can also add a daily 12g dark intravenous infusion in 5% to 10% glucose solution 500ml, and a month later still changed to oral.
(Iv) chemotherapy
Depending on the severity, with or without sputum and bacterial resistance, as well as the economic situation, drug supply source, the choice of chemotherapy. No matter which must comply with the aforementioned principles can only be effective chemotherapy.
1 newly diagnosed cases of anti-TB program without drug treatment, some sputum smear-positive TB (smear), severe illness, infectious; and some smear-negative, small lesions, the use of chemotherapy also have different strength.
Smear positive cases, regardless of whether the culture is positive, can be utilized to isoniazid (H), rifampicin (R) and pyrazinamide (Z) based on a combination of the six-month DOTS program. Soon sputum often negative, short course, to facilitate follow-up management.
(1) strengthen the first two months of streptomycin (or ethambutol), isoniazid, rifampin and pyrazinamide, 1 day; after four months continue with isoniazid and rifampicin flat, 1 day to 2S (E) HRZ / 4HR representation.
(2) may also be a period of consolidation in the drug every other day (ie medication three times a week) to 2S (E) HRZ / 4H3R3. (Lower right corner number is the number of drugs per week).
(3) can also be intermittent throughout the medication to 2S3 (E3) H3R3Z3 / 4H3R3 representation.
(4) to strengthen the use of isoniazid, streptomycin and sodium aminosalicylate (amine or an alcohol), a period of consolidation with two kinds of drugs for 10 months, to 2HSP (E) / 10HP (E) represented.
(5) strengthening of a month with isoniazid, streptomycin, consolidation of 11 months of treatment twice a week to 1HS / 11H2S2 representation.
Above (1), (2), (3) for the short term chemotherapy, (4), (5) the "standard protocol." If conditions permit, to make use of short-course chemotherapy program.
Smear Yin Pui Yin patient, except may be smear positive patients with significant new social program miliary tuberculosis or hole, using the following regimens: ①2SHRZ / 2H2R2; ②3H2R2Z2 / 2H2R2 (every other day throughout the application); ③1SH / 11HP (or E).
Of untreated patients, International Union Against Tuberculosis and Lung Disease Association recommended chemical solution is suitable for the national anti-TB (Table II), development of treatment programs available for reference.
Table II countries tuberculosis chemotherapy Tuberculosis Plan
Course of chemotherapy treatment regimens
6 months 2RHZ / 4RH8 months 2SRHZ / 6TH or 6EH
2ERHZ / 4RH or 4R2H22SRHZ / 6S2H2Z2
2SRHZ / 4RH or 4R2H2
2, retreatment regimen as the first treatment of chemotherapy unreasonable, TB produce secondary resistance, sputum remains positive, persistent recurrent disease. Retreatment cases should choose joint sensitive drugs. Drug sensitivity test helps select the medication, but time-consuming longer, larger expenses. Clinically patients according to previous drug use, select an unused past few used or has joint rules used drugs (which may still be susceptible to the bacteria), and the other set programs, joint two kinds or two kinds more sensitive drugs.
Retreatment cases, generally available the following scenario:
(1) 2S (E) HRZ / 4HR, supervise chemotherapy administration to ensure laws. At the end of six months of treatment, if still negative sputum, consolidation period may be extended for two months. As prolonged treatment is still sputum remains positive, retreatment may be following the program.
(2) newly diagnosed patients failed rule, available 2S3H3Z3E3 / 6H3R3E3.
(3) chronic row of bacteria sensitive to first-line drugs were available and combined with second-line drugs, such as kanamycin toxin (K), propylthiouracil isonicotinoyl amine (1321Th), capreomycin (Cp), should be closely observed adverse drug reactions, medication 6 to 12 months is appropriate. Fluoroquinolones have antituberculosis moderate effect on the cases commonly used drugs has generated resistance, may be added in combination with the program. If bacteria overcast fistula, or serious adverse reactions, indications are discontinued.
(V) determine the condition and efficacy assessment, treatment failure
1, according to the extent of disease and therapeutic evaluation of activities can be divided into the aforementioned known disease progression, and improved absorption of the stable. General improvement of absorption and stability of the condition improved, advanced for the worse. Its judgment should be based on clinical symptoms, X-ray showing the row of bacteria and comprehensive analysis of the situation.
(1) Clinical symptoms: observe whether the afternoon fever, night sweats, loss of appetite, general shortage, weight loss and other TB symptoms worsen and procedural changes. Such symptoms were relieved or disappeared prompted condition improved; or if symptoms significantly changed from a light weight indicates deterioration. In addition, cough, sputum, hemoptysis and other changes in respiratory symptoms may be used as a reference.
(2) X-ray examination: the condition is judged indispensable indicators, is also an important basis for monitoring of the disease outcome of patients with no obvious clinical symptoms mainly rely on X-ray, X-ray can determine the lesion location, extent, nature , but also to control observation of dynamic change. Cottony clouds infiltrates absorb, dissipate, narrow; or converted to higher density, clear boundary of proliferative diseases such as fibrosis, calcification; original narrow cavity, said Deng Jun closed condition improved or cured. Conversely, the proliferative lesions into exudative lesions or invasive lesions expand, bronchial disseminated or acute, subacute hematogenous, caseous necrotic lesions, cavitation, etc. are deteriorated performance.
(3) sputum: tuberculosis in the sputum bacteria row or not is an important indicator to determine the condition assessment procedures and efficacy. Sputum examination and high specificity less affected by human factors. If sputum remains positive, compared with open tuberculosis, suggesting a high degree of disease activity, and for the social source of infection of tuberculosis, pose a threat to the surrounding population. After treatment repeatedly checked and found negative for TB or less, which is indicative of better; such as monthly sputum examination at least once, months were negative, it means that into the stable. Then, if the row of bacteria appear again for disease worsening performance. ESR acceleration prompted active disease worsening; but not have active tuberculosis ESR growth, lesions improved and stable patients were nearly normal erythrocyte sedimentation rate.
2, the end of the course of treatment failure sputum negative conversion failed, or in transit positive effect, X-ray showed lesions not absorbed, stable, and further deterioration, both indicate treatment failure, a so-called refractory pulmonary tuberculosis. Study its causes, in addition to drug-resistant TB infection, medication is not standardized, intermittent medication or monotherapy, but still with some patients chemotherapy drug allergies, chemotherapy drugs can not be used because of serious adverse reactions or chemotherapy drugs is difficult to adhere to treatment, the body immunocompromised (HIV infection), poor physical and other factors.
Drug-resistant tuberculosis (DR-TB) especially multidrug-resistant tuberculosis (MDR-TB) epidemic seriously, we are making anti-TB treatment is facing new challenges. 1994, WHO and the International Union Against Tuberculosis Lung Disease began anti-TB drug resistance monitoring of global planning, which lasted 3 years of work showed that, in 35 countries on five continents monitoring delegates found 20 percent of the world's population of double-resistant HR MDR-TB accounted for 2% to 14%, most of them belonging monotherapy, irregular, secondary multidrug resistance unreasonable treatment of joint programs human factors caused. In countries with weak TB control, primary multi-drug resistance was also found an upward trend. Once the occurrence of drug-resistant tuberculosis, chemotherapy drugs they use expensive price, poor efficacy, serious adverse events, treatment costs may be 100 times the new smear positive pulmonary tuberculosis patients. Adhere to the rational use of chemotherapy, and adopt comprehensive prevention and control measures, improve immune function and help prevent the occurrence of drug-resistant TB.
In order to effectively prevent treatment failure, chemotherapy must be properly formulated, patients should insist on an early, regular, regular, full combined with sensitive drugs under the supervision of. Only in the case of resistance has serious adverse reactions or indeed confirmed that the bacteria has been generated, it changed to a new chemotherapy. The new program should include two or more sensitive drugs.
Second, symptomatic treatment
(A) toxic symptoms
Toxic symptoms of tuberculosis and more effective anti-TB treatment can disappear in 1 to week, usually you do not have special treatment. Severe toxic symptoms of tuberculosis caseous pneumonia, acute miliary tuberculosis, tuberculous meningitis, high fever, etc., or a large number of tuberculous pleurisy with pleural effusion, should be bed rest and the use of anti-TB drugs as soon as possible. Also in the use of effective anti-TB drugs at the same time, the addition of corticosteroids (commonly prednisone daily 15 ~ 20mg, three to oral) to reduce inflammation and allergic reactions, and promote absorption of exudate, reducing fibrous tissue formation and pleural adhesions. Toxicity symptoms to be severe, prednisone dose decreasing to 6 to 8 weeks withdrawal. Glucocorticoids pleural thickening and has no role in the formation of adhesions. Therefore, it should be used with caution in effective anti-TB treatment basis.
(B) hemoptysis
If only a small amount of bloody sputum or hemoptysis, symptomatic treatment, including rest, cough, sedation, commonly used drugs Pentoxyverine soil root powder, codeine, carbazochrome (security network of blood) and the like. Old and feeble, pulmonary insufficiency, caution strong antitussive, so as to avoid inhibiting reverse cough and respiratory center, so that can not be discharged blood clots caused by suffocation. To exclude other reasons hemoptysis, such as mitral stenosis, pulmonary infection, pulmonary infarction, coagulation disorders, autoimmune diseases.
Moderate or heavy hemoptysis should be strict bed rest, ice packs placed chest and alternate with blood. Lateral position, will remain in the blood gently intratracheal cough. Vasopressin 10U applied to 20 ~ 30ml saline or glucose solution, the slow intravenous infusion (15 to 20 minutes), then 10 ~ 40U in 500ml of 5% glucose solution intravenous maintenance therapy. Posterior pituitary is known as contraction of small arteries, including the coronary artery and capillary action to reduce pulmonary blood flow, thereby reducing hemoptysis. The drug can still smooth muscle contraction of the uterus and therefore avoid for pregnant women and patients with hypertension, coronary atherosclerotic heart disease. Injection too fast can cause nausea, it is intended, palpitations, pale and other adverse reactions.
If excessive hemoptysis, blood transfusion may be appropriate discretion. Than those who hemoptysis, bleeding sites can be found by bronchoscopy, noradrenaline 2 ~ 4mg + 4 ℃ saline 10 ~ 20ml topical instillation. Or placed Fogarty balloon catheter (outer diameter 1mm, inflatable 0.5 ~ 5.0ml) with bronchoscopy clogging the bleeding site to stop bleeding. In addition to still use Kinoshita method with thrombin or fibrinogen bronchoscopy lavage hemostasis, should be fully prepared to make the necessary rescue. Repeated hemoptysis by the above method is invalid, no activity contralateral lung disease, pulmonary function reserve acceptable nor obvious contraindications, consider lobectomy, segmentectomy in clear bleeding site conditions.
Hemoptysis suffocation is the leading cause of hemoptysis necrosis, need to guard against, and actively preparing for the rescue before hemoptysis asphyxia symptoms include chest tightness, gas hold back, a lip cyanosis, pallor, cold sweat dripping, irritability. Rescue measures should be particularly injection keep the airway open, take Trendelenburg prone position high of 45 °, pat the back, the rapid discharge of blood, and dig or suction outlet as soon as possible, pharynx, larynx, nasal blood clots. Rigid bronchoscopy is necessary to attract, endotracheal intubation or tracheotomy to relieve airway obstruction.
Third, the surgical treatment
Surgery has been less used in the treatment of tuberculosis. Of greater than 3cm of tuberculosis and lung cancer is difficult to identify the ball, one-sided hollow fiber retreatment thick, long-term medical treatment failed to sputum conversion by, or unilateral destroyed lung with bronchiectasis, has lost function and have repeatedly hemoptysis or secondary infection, can be used for lung or pneumonectomy. Tuberculous empyema and (or) bronchial fistula after medical therapy and ipsilateral active TB, it is desirable for the lung - pleural resection. Surgical treatment contraindications are: bronchial mucosa with active tuberculosis, but not removed within the scope of those poor general condition or have significant heart, lung, liver and kidney dysfunction.
Thursday, May 5, 2016
Malocclusion
Malocclusion refers to children in the growth process can be due to many other genetic and environmental factors, resulting in teeth, jaw, facial malformations (over normal jaw means all present on the lower teeth, arranged in neat rows, good tip recess opposed contact relationship, maxillary normal, good arch form) and affect the face of beauty and health.
1. affect the face of some beautiful malocclusion resulting maxillary hypoplasia, facial shape bilateral asymmetry, or even seriously affect the appearance of the face. Such as deep coverage, patient front anterior teeth protrusion, mandibular retrusion, opening lip formed teeth, commonly known as "snag." Another example is the anti-jaw deformity, mandibular protrusion, formed "to package Days" and so on. These will give the children spiritually, ideologically, suffered stimulate the mind, causing stress and trauma. It can therefore produce inferior eccentric anomaly character.
2. The impact of language features such as anterior open jaw deformities dentition larger gap, for some literal language is not allowed to speak, slurred speech.
3. Impact dental malocclusion due chewing function, not the normal line of rotary cutting and chewing food can not be broken, hinder food digestion and nutrient absorption, is bound to affect children's growth and development.
4. Effect of the balance due to the teeth bite jaw dislocation, hinder, coordinated development under the arch, crowded arrangement of teeth, which are not easy to clean, food residues remain prone to dental caries, gingivitis and periodontal disease.
5 Effect of temporomandibular joint function due to dental malocclusion can change condyle within the glenoid fossa normal position, causing the normal structure changed.
It has been formed malocclusion children should try to go to hospital orthopedic examination and treatment. Since the beginning of malocclusion mostly limited to a few teeth, or confined within the range of the alveolar bone, orthodontic treatment is relatively simple and easy to effect Ye Hao. With regard to treatment should first remove the cause, the removal and retention of teeth in dental, oral correct bad habits, clinical manifestations, according to the anti-jaw, open jaw, jaw and other deep overbite carefully analyze causes, develop a specific treatment plan, design the best solution, select a different effective treatment. Common appliance can be classified as removable appliance fixed appliance. Their power sources can be divided into mechanical appliance and functional appliance. Usually about 12 years of age is the best period of treatment malocclusion, obtained the best effect. Therefore, during the second permanent molars have erupted, jaw development has reached the final stage.
1. affect the face of some beautiful malocclusion resulting maxillary hypoplasia, facial shape bilateral asymmetry, or even seriously affect the appearance of the face. Such as deep coverage, patient front anterior teeth protrusion, mandibular retrusion, opening lip formed teeth, commonly known as "snag." Another example is the anti-jaw deformity, mandibular protrusion, formed "to package Days" and so on. These will give the children spiritually, ideologically, suffered stimulate the mind, causing stress and trauma. It can therefore produce inferior eccentric anomaly character.
2. The impact of language features such as anterior open jaw deformities dentition larger gap, for some literal language is not allowed to speak, slurred speech.
3. Impact dental malocclusion due chewing function, not the normal line of rotary cutting and chewing food can not be broken, hinder food digestion and nutrient absorption, is bound to affect children's growth and development.
4. Effect of the balance due to the teeth bite jaw dislocation, hinder, coordinated development under the arch, crowded arrangement of teeth, which are not easy to clean, food residues remain prone to dental caries, gingivitis and periodontal disease.
5 Effect of temporomandibular joint function due to dental malocclusion can change condyle within the glenoid fossa normal position, causing the normal structure changed.
It has been formed malocclusion children should try to go to hospital orthopedic examination and treatment. Since the beginning of malocclusion mostly limited to a few teeth, or confined within the range of the alveolar bone, orthodontic treatment is relatively simple and easy to effect Ye Hao. With regard to treatment should first remove the cause, the removal and retention of teeth in dental, oral correct bad habits, clinical manifestations, according to the anti-jaw, open jaw, jaw and other deep overbite carefully analyze causes, develop a specific treatment plan, design the best solution, select a different effective treatment. Common appliance can be classified as removable appliance fixed appliance. Their power sources can be divided into mechanical appliance and functional appliance. Usually about 12 years of age is the best period of treatment malocclusion, obtained the best effect. Therefore, during the second permanent molars have erupted, jaw development has reached the final stage.
Monday, May 2, 2016
How to care for sensitive skin in spring?
Spring is the recovery of all things, gaining growing season, the skin's metabolism gradually accelerated, but the climate of this season, the breeding of bacteria provides a "breeding ground" for, if improper care, so that the skin's metabolism can not keep up climate change, it is easy a variety of skin allergy problems itchy skin, burning skin, minor skin erythema, rash appears. So, how to care for sensitive skin in spring it? Guangdong Province MCH Cosmetology Hu Kui Kui chief physician to teach you five strokes respond, learn it together!
How to care for sensitive skin in spring? Experts teach you to deal with five strokes
The first one: a good face wash
After the spring, the secretion of sebum and sweat more and more exuberant, so pay attention to the face clean, wash the spring can be wet face with water, then squeeze the appropriate amount of cleanser in the palm of your hand and rub gently applied face, then hands pulp gently massage in various parts of the face, especially pay attention to T-zone and other large pores, oil production more places, and finally with the flow of warm water rinse face cleanser can.
The second measure: supplement water
Some people think that spring air humidity is relatively large, the skin replenishment work may not be so important. In fact, spring skin moisturizing is also very important, especially for sensitive skin, because the skin of their shallow stratum corneum can not keep enough water, so they are more likely to feel keenly dry skin than the average person dry, if not timely make up the water, it is easy due to external stimuli and the emergence of various skin problems. Therefore, the spring can use some pure vegetable spray moisturizing, nourishing food, water regularly to the skin, the skin supple and healthy, but also not so prone to all kinds of allergies.
The third measure: good sunscreen
Spring poor skin tolerance, coupled with the spring sun's ultraviolet intensity rising, if you ignore the sun, and it is easy to skin sunburn, especially those with skin pigmentation, but also can not ignore the spring before the sun, spring is also a need to go out to smear a good sunscreen or an umbrella to block the strong ultraviolet radiation. In the choice of sunscreen for sensitive skin, the skin in order not to be overly burdensome, it is generally recommended to select no more than SPF25 sun protection factor of sunscreen can be, if there are skin care products containing sunscreen ingredients, you can no additional use sunscreen.
Fourth trick: to the skin "burden"
Spring sensitive skin easier, some people prone to erythema, rash, skin in order to cover these issues, some people will be coated with a thick foundation or Cream. In fact, for sensitive skin, a high concentration, good cosmetic effect means high risk, high sensitive, so it will stimulate the skin, increase the burden on the skin, and even induce a variety of dermatitis. When spring with dry skin, scaling, redness, itching and other sensitive signs, you need to do is for the skin "burden", what should be properly streamlined maintenance procedures, to the most basic skin cleansing, moisturizing and other maintenance can .
Fifth trick: to ensure adequate sleep
Spring in the care of sensitive skin care at the same time, "beauty sleep" is also very important, usually pay attention to develop and rest rules, avoid staying up late at night to allow the skin can break this time to get a good rest.
How to care for sensitive skin in spring? Experts teach you to deal with five strokes
The first one: a good face wash
After the spring, the secretion of sebum and sweat more and more exuberant, so pay attention to the face clean, wash the spring can be wet face with water, then squeeze the appropriate amount of cleanser in the palm of your hand and rub gently applied face, then hands pulp gently massage in various parts of the face, especially pay attention to T-zone and other large pores, oil production more places, and finally with the flow of warm water rinse face cleanser can.
The second measure: supplement water
Some people think that spring air humidity is relatively large, the skin replenishment work may not be so important. In fact, spring skin moisturizing is also very important, especially for sensitive skin, because the skin of their shallow stratum corneum can not keep enough water, so they are more likely to feel keenly dry skin than the average person dry, if not timely make up the water, it is easy due to external stimuli and the emergence of various skin problems. Therefore, the spring can use some pure vegetable spray moisturizing, nourishing food, water regularly to the skin, the skin supple and healthy, but also not so prone to all kinds of allergies.
The third measure: good sunscreen
Spring poor skin tolerance, coupled with the spring sun's ultraviolet intensity rising, if you ignore the sun, and it is easy to skin sunburn, especially those with skin pigmentation, but also can not ignore the spring before the sun, spring is also a need to go out to smear a good sunscreen or an umbrella to block the strong ultraviolet radiation. In the choice of sunscreen for sensitive skin, the skin in order not to be overly burdensome, it is generally recommended to select no more than SPF25 sun protection factor of sunscreen can be, if there are skin care products containing sunscreen ingredients, you can no additional use sunscreen.
Fourth trick: to the skin "burden"
Spring sensitive skin easier, some people prone to erythema, rash, skin in order to cover these issues, some people will be coated with a thick foundation or Cream. In fact, for sensitive skin, a high concentration, good cosmetic effect means high risk, high sensitive, so it will stimulate the skin, increase the burden on the skin, and even induce a variety of dermatitis. When spring with dry skin, scaling, redness, itching and other sensitive signs, you need to do is for the skin "burden", what should be properly streamlined maintenance procedures, to the most basic skin cleansing, moisturizing and other maintenance can .
Fifth trick: to ensure adequate sleep
Spring in the care of sensitive skin care at the same time, "beauty sleep" is also very important, usually pay attention to develop and rest rules, avoid staying up late at night to allow the skin can break this time to get a good rest.
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