Objective: To analyze the clinical characteristics and management strategies of metronidazole-associated Stevens-Johnson syndrome (SJS), and to provide a clinical basis for medication safety during the oral perioperative period. Methods: The study adhered to the tenets of the Declaration of Helsinki and was approved by the Ethics Committee of Stomatological Hospital of Xi'an Jiaotong University. A retrospective analysis was conducted on a case of SJS following mandibular impacted tooth extraction, for which the patient had taken metronidazole. Additionally, a literature review was performed by searching databases including China National Knowledge Infrastructure, Wanfang, PubMed, and Web of Science to identify reported cases of metronidazole-associated SJS. Demographic features, medication regimens, latency periods, clinical signs, interventions, and prognosis were analyzed. Results: The patient presented with lip swelling, extensive erosion and ulceration of the oral mucosa, and severe odynophagia. Scattered erythematous macules and bullae were observed on the trunk and extremities, with a positive Nikolsky sign. Additionally, there was erosion of the perineal skin and glans penis mucosa, along with skin desquamation of the scrotum. The patient with SJS was managed in the hospital by discontinuing metronidazole and administering sequential treatments, including glucocorticoids, immunomodulators, intravenous immunoglobulin, and plasma exchange. The condition gradually improved; after a 14-month follow-up, only mild dry eye remained, with no significant scarring of the skin or mucosa. However, delayed recognition of early warning signs resulted in delayed drug withdrawal and intervention. The literature review identified 6 additional cases (3 males, 3 females) with a median age of 45.5 years (range 31-61). Indications for metronidazole included postoperative sepsis prophylaxis after duodenal ulcer perforation repair, digestive system infections, mucosal diseases, pelvic inflammatory disease, septic cellulitis with pneumonia, and gingivitis. Administration routes comprised oral (n = 2), intravenous (n = 3), and topical (n = 1). The latency period from drug administration to onset ranged from 0.25 to 7 days (median 4 days). All of the cases presented with oral mucosal erosion, and a positive Nikolsky’s sign was noted for five patients. Discontinuation of the causative drug was the cornerstone of treatment, supplemented by immunomodulatory therapy, symptomatic support, and multidisciplinary collaboration. Prognoses varied significantly: among the four patients treated with “drug withdrawal + glucocorticoids + supportive care,” three recovered fully and one improved; among the two patients receiving “drug withdrawal + simple supportive care,” one recovered and one died Conclusion Although metronidazole-associated SJS is rare, it progresses rapidly and frequently involves oral mucosal damage, typically occurring within one week of administering the medication. Early drug withdrawal and prompt initiation of glucocorticoid therapy can improve prognosis. During the oral perioperative period, strict adherence to metronidazole indications, enhanced monitoring for early warning symptoms, and the establishment of a multidisciplinary collaborative diagnosis and treatment model are essential to minimize the risk of severe adverse drug reactions.

Objective To investigate the rehabilitation needs and technical support for people with disabilities in rural areas. Methods From October, 2017 to February, 2018, 800 persons with disabilities, aged five to 80 years, from 23 villages in five township, Xi'an, Shaanxi, were surveyed with self-designed questionnaire and interview, including the basic situation, disability and training plan, rehabilitation support and skills maintained. Results The persons were mainly aged 50 to 80 years (58.37%), male (65.37%), accepting middle school education or less (46.63%), married (70.63%), living with their family (77.38%), income less than 2000 Yuan (66%), mainly from their family labor (62.62%). Their disabilities were mainly of grade 3 (40.63%), from hemiplegia (30.63%), dependence in living (45.38%), and no systematic rehabilitation program (55.25%). Most of them needed rehabilitation of self-care (40%), accessible guidance (30.63%) and reimbursement from medicare of Rural Cooperative Medical Scheme (50.63%), and hoped to participate social activities (41.87%). The rehabilitation supports were as that: the rehabilitation services were mobile or none (67.58%), the guiders of rehabilitation were few or none (48.88%), knew some or less rehabilitation knowledge (64.25%), the professionals accepted no continue education training (40%).Conclusion It is important to improve the rehabilitation technical support system for rural people with disabilities.