When Yuan Xiaoli heard about mitochondrial disease, he preferred academician Lin''s statement.


    But when he heard the whisper of the apprentice brought by academician Lin, his eyebrows wrinkled involuntarily.


    Every ward round should be recorded. Surgery may not do well, but physicians do very well. Muscle memory has almost been formed.


    Don''t even think about it. This missing past history must have been added to the hospital after I slept last night.


    Tinea pedis? What''s good, Yuan Xiaoli thought.


    Internal medicine records everything in detail, and each has its own views on it. Yuan Xiaoli stared at academician Lin closely and observed his expression.


    Academician Lin frowned first, and then his eyes leaned towards the screen, like looking at the course of the disease carefully, or finding something new.


    His eyes were shining, and he didn''t know whether they reflected the light and shadow of the screen.


    Is it tinea pedis? No, how can tinea pedis be associated with quadriceps femoris. Yuan Xiaoli looked at academician Lin in a daze and observed in doubt.


    After 32 ", academician Lin stretched out his right hand and patted academician Guo on the arm.


    "Lao Guo, come and see."


    "I''ve seen the first trip," academician Guo stopped to speak.


    "It''s not the first trip. It was a ward round last night."


    Academician Guo was stunned. What''s good about the ward round at night? He just skipped over and didn''t look at that.


    The hospital is a three-level ward round system. In the evening, it is the doctor on duty or the inpatient''s general disposal of patients, leaving records.


    For the two academicians, there is no need to look at everything, especially the contents of ward rounds. If the irrigation is serious, just jump and watch.


    Academician Guo stood up, walked behind academician Lin and squinted at the computer screen.


    "Here."


    Academician Lin reached out and pointed to a line of words on the computer screen.


    Other people are also curious. Except yuan Xiaoli, no one knows what happened last night. I want to go over and see what happened, but I''m afraid I''ll squeeze academician Guo.


    The old man is in his seventies. He looks hale and hearty, but he accidentally knocked. What can he do in case of fracture?


    And I don''t respect the elderly.


    Someone has quickly sat down, opened the doctor''s workstation and began to look for the ward round record last night.


    Anyway, the course records are not written much. Although I don''t know what academician Lin said, I just read them all.


    "Used itraconazole? So it is," academician Guo said. "No wonder there is pain in the quadriceps femoris."


    "Did itraconazole increase the concentration of simvastatin?"


    "It should be."


    The voice of the two old people communicating with each other was very small, and Yuan Xiaoli pricked his ears and barely heard it. He was nervous. Did itraconazole and simvastatin have drug reactions?


    No, it''s not written in the manual. Where''s the drug reaction!


    At this time, other people also saw the course record recorded by the general manager of the hospital last night. They knew that academician Che had tinea pedis and was treated with itraconazole.


    A month ago, less than a week after that, there was pain in the quadriceps femoris.


    Few people knew about simvastatin''s drug reaction. Everyone whispered. After more than ten minutes, academician Lin and academician Guo looked at each other. Finally, academician Guo returned to his seat and gave a light cough.


    "Let me have a word." academician Guo said, "now, the situation is obvious. Academician Che took itraconazole orally for the treatment of tinea pedis a month ago. This drug changes the concentration of simvastatin in the body, resulting in quadriceps femoris pain and decreased muscle tension."


    "Now academician Che still takes simvastatin orally?"


    "Yes, still taking it orally," said the director of the Department of Neurology of DIDU people''s hospital.


    "After stopping simvastatin, quadriceps femoris pain can be significantly improved in a week," academician Guo said.


    "Guo Lao, is itraconazole related to simvastatin?" the director asked suspiciously.


    "Statins are widely used in clinic, but some patients can have adverse reactions. Muscle pain and weakness is one of the most serious side effects," Guo said. "But they are very rare in clinic. I have only seen two similar patients so far."


    The crowd was awed and listened to academician Guo.


    "In fact, muscle pain and weakness caused by statins are not so rare, at least not as few as we have seen.


    Generally speaking, the doctor will give advice when prescribing the medicine, and the patient will pay attention to it. Once there is an uncomfortable situation, the medicine will be stopped. "


    People nodded. Normally, if they had time, they would say a word to the patient. But the details will depend on the situation at that time.


    "The most dangerous point is that the interaction between statins and other drugs increases the blood concentration of statins." academician Guo said seriously, "this must be paid great attention in clinic."


    "At present, there are few relevant studies, and it''s normal that you don''t know." academician Guo comforted when he saw the director of Neurology lowering his head. "In recent years, there have been studies on the interaction between statins and other drugs. The paper mentioned the effect between simvastatin and itraconazole, which increased the plasma concentration of simvastatin by 10 ~ 20 times."


    "Moreover, the time of concentration increase will not decay rapidly due to the cessation of oral itraconazole."


    "If you have to take itraconazole, you can suspend simvastatin; or switch to statins that are not affected by cytochrome CYP3A4 inhibitors, such as fluvastatin."


    "If simvastatin must be used, antifungal drugs should use antibiotics without inhibitory effect of CYP3A4, such as fluconazole."


    "Academician Che''s situation is relatively clear. Let''s see if there are any different opinions?" academician Guo asked.


    Yuan Xiaoli was a little confused. His eyes were full of khaki. As for sunglasses and lambskin gloves... He couldn''t see at all. He felt that he was lying in front of Wu Mian and could only see the windbreaker.


    Looking back on last night, Yuan Xiaoli was a little scary.


    Glancing at the medical records, he took photos and sent them. Wu Mian took a few minutes. What did he ask later? Is the car always has beriberi!


    Why do you ask? It''s obvious that he has judged that Che Lao has taken itraconazole orally!


    In other words, Wu Mian immediately determined that the pain and weakness of quadriceps femoris came from the drug reaction of simvastatin.


    In the whole process, Wu Mian is deduced inversely!


    He saw the essence of the problem at a glance, and then looked at it from the beginning, looking for clues.


    It may not be beriberi, but other drugs that need oral itraconazole. It''s just that beriberi is more likely and more common.


    Unknowingly, Yuan Xiaoli has replaced the concept of tinea pedis with beriberi, and unknowingly "Earth" like Wu Mian.


    This boy is really awesome! Yuan Xiaoli had to admit this.