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1.
Br J Clin Pract ; 51(2): 91-6, Mar. 1997.
Artigo em Inglês | MedCarib | ID: med-2008

RESUMO

To assess the clinical characteristics and management of patients with atrial fibrillation (AF), we performed a prospective survey of all acute medical admission over six months to our hospital. Of 7,451 such admissions, 245 had AF (110 male, 135 female; mean age 74.4 years). Of these, 213 were Caucasian, 10 black/Afro-Caribbean and 22 Asian. Complete data were available for 185 patients. Of these, 82 had newly diagnosed AF, 83 had previous chronic AF and 20 had paroxysmal AF. The main presenting features were dyspnoea, stroke and syncope. A history of ischaemic heart disease was present in 64, heart failure in 46, hypertension in 51 and rheumatic heart disease in 13, while 31 had a previous stroke. Chest x-ray showed cardiomegaly and pulmonary oedema in 121 patients, but was normal in 28. Echocardiography showed poor cardiac function in eight patients and enlarged atria in five. Only 28 percent of those with previously diagnosed AF were on anticoagulation. Of the newly diagnosed patients, only 18 percent were started on anticoagulants. Cardioversion was attempted or planned in only 6 percent. The primary diagnosis on discharge was heart failure in 45, stroke in 24 and myocardial infarction in 12. AF remains a common arrhythmia among acute medical admissions and is commonly associated with heart failure and a high mortality. There is still a reluctance to start anticoagulant therapy or to perform cardioversion in such patients.(AU)


Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fibrilação Atrial/etnologia , Hospitalização , Anticoagulantes/administração & dosagem , Antiarrítmicos/uso terapêutico , Fibrilação Atrial/etiologia , Fibrilação Atrial/terapia , Digoxina/uso terapêutico , Cardioversão Elétrica , Hospitalização/estatística & dados numéricos , Tempo de Internação , Estudos Prospectivos
2.
Br Med J ; 1(6068): 1051-4, 1977.
Artigo em Inglês | MedCarib | ID: med-9927

RESUMO

The leucocyte data on four malnourished children who died suddenly when high-energy feeding was started were retrospectively analysed. The pretreatment rate constant for sodium efflux in leucocytes was higher and the intracellular sodium concentration lower in this group than in 13 malnourished children who recovered uneventfully with feeding. Two other children with unusual leucocyte electrolyte values and sodium pump activity were identified and closely monitored when high-energy treatment was begun. They rapidly developed the syndrome of extracellular fluid overload but were successfully treated with diuretics and digoxin. Though the precise relation between the findings in the leucocytes and the development of this overload syndrome is not clear, the pretreatment leucocyte values are nevertheless valuable in predicting which malnourished children are at risk of sudden death when refeeding is started.(AU)


Assuntos
Humanos , Lactente , Pré-Escolar , Masculino , Feminino , Morte Súbita/etiologia , Distúrbios Nutricionais/complicações , Sódio/metabolismo , Digoxina/uso terapêutico , Furosemida/uso terapêutico , Distúrbios Nutricionais/dietoterapia , Potássio/metabolismo , Morte Súbita do Lactente/etiologia , Desequilíbrio Hidroeletrolítico/tratamento farmacológico
3.
Br Med J ; 1(6020): 1254-5, May 1976.
Artigo em Inglês | MedCarib | ID: med-10777

RESUMO

Sodium and potassium levels in plasma and leucocytes and the sodium efflux rate constants of leucocytes were measured in patients with congenital heart disease not on treatment, patients with valvular heart disease being treated with digoxin and conventional diuretics showed low cellular potassium levels, low sodium levels. Patients given triamterene showed a rise in potassium levels in plasma and cells and in the sodium efflux rate constant (AU)


Assuntos
Humanos , Cardiopatias Congênitas/sangue , Doenças das Valvas Cardíacas/sangue , Leucócitos/metabolismo , Potássio/sangue , Sódio/sangue , Triantereno/farmacologia , Digoxina/administração & dosagem , Digoxina/uso terapêutico , Diuréticos/uso terapêutico , Doenças das Valvas Cardíacas/tratamento farmacológico , Leucócitos/efeitos dos fármacos
4.
West Indian med. j ; 22(3): 149, Sept. 1973.
Artigo em Inglês | MedCarib | ID: med-6183

RESUMO

All admissions to the Paediatric wards of the University Hospital of the West Indies for the 12-year period, February 25, 1961 to February 28, 1973, have been examined. 130 cases of poisoning or drug overdosage were admitted during this period. 101 children (78 percent) were between the ages 1 and 4 years. The yearly incidence of admissions varied from only one case in 1962 to 18 in 1971, and 60 percent of them were admitted in the latter half of the study period. Kerosene ingestion resulting in aspiration pneumonitis was the commonest cause of poisoning. Only 2 cases of salicylate poisoning were admitted - one was mildly affected while the other due to ingestion of 'oil of winter-green' was of modern severity. Phenothiazines (13 cases), acid or caustic substances (11 cases), ferrous sulphate (10 cases), barbiturates (7 cases), ackee with toxic hypoglycaemia (6 cases), digoxin (5 cases) and organic phosphate insecticides (5 cases) accounted for most of the other admissions. 2 cases of lead poisoning and 2 children with severe vomiting and diarrhoea due to ingestion of 'Physic nut' (Jatropha curcas) were admitted and there were single cases of poisoning from a variety of toxic substances including napthalene (camphor balls), oil of chenopodium and nitrobenzene. One child was admitted following an overdose of lignocaine administered in Casualty for local anaesthesia and another from linctus codeine given for diarrhoea. 5 patients died, one from severe pneumonitis. 3 from toxic hypoglycaemia and the 5th from an unknown poison. Examination of the admission records of all children admitted to the Casualty Observation ward during a 20-month period, 1971-1972, revealed 54 cases of poisoning. 37 of these were due to kerosene ingestion and only 2 of these were admitted to the ward, the others being discharged after 1 to 3 days of observation. Many milder cases of poisoning are seen in Casualty and treated and sent home without further observation (AU)


Assuntos
Humanos , Criança , Intoxicação , Intoxicação por Chumbo , Querosene/envenenamento , Fenotiazinas/envenenamento , Ácidos/envenenamento , Cáusticos/envenenamento , Compostos Ferrosos/envenenamento , Barbitúricos/envenenamento , Hipoglicemiantes/envenenamento , Digoxina/envenenamento , Inseticidas Organofosforados/envenenamento , Jamaica
5.
West Indian med. j ; 37(Suppl. 2): 22-3,
Artigo em Inglês | MedCarib | ID: med-5838

RESUMO

For many drugs there is a close relationship between plasma concentration and biological/therapeutic effects. Laboratory services for estimating plasma drug concentrations (Therapeutic Drug Monitoring or TDM) are now provided in most major hospitals of the developing world, including most of the Caribbean, for three major reasons: 1) the variable but generally long lag period in the transfer of new technology, 2) the perceived cost of the new technology, 3) the dearth of clinical pharmacologists, the specialists most closely involved in the provision and interpretation of plasma drug levels. A TDM service was set up in Barbados in 1982, in the Clinical Pharmacology Laboratory at the Queen Elizabeth Hospital using the Syva Enzyme Mediated Immuno Assay/spectophotometric system. Eight drugs are now routinely assayed, using (since January 1987) a flourescence polarisation immuno assay (Abbott), which permits rapid estimation and a same day service, facilitating immediate feedback of emergency and out-patient results. Drugs assayed include the top four anti-epileptics (phenytoin, phenobarbitone, carbamazepine and valproate), two cardiac drugs (digoxin and quinidine), theophylline and gentamycin. Assay services (including pharmacokinetic interpretation and advice on dose regimes) are provided for hospital in-and out-patients, private and polyclinic patients and, on request, to other Caribbean countries, i.e. countries of the Organisation of Eastern Caribbean States (OECS) and occasionally Jamaica. In Trinidad TDM services are provided for anti-epileptics at the Port-of-Spain General Hospital. Review of anti-epileptic TDM in Barbados indicates that drug management is usually far less than optimal. Because of its saturation kinetics, phenytoin is particularly difficult to achieve correct therapeutic levels and good results with, only 25 percent of assays falling in the recommended therapeutic range. Improved patient compliance and doctor education both require the concerted attention of the health services if the present poor epilepsy management is to be improved. TDM is less costly than perceived if the service: 1) uses a system where equipment is provided by the Company, with a contract for purchase of a minimal number of kits, rather than purchase of equipment, at high capital costs, and having to pay for service; 2) is centralised, providing large runs and minimising cost of controls, etc. Current costs per test for anti-epileptics to our lab (e.g. carbamazepine US$3.50) are comparable with basic cost to QEH of hormone assays (e.g. prolactin US$2.50, testosterone US$3.50, cortisol US$2.30). These costs are, however, multiplied by about four for private patients, or six or more by the commercial labs, where routine assays, e.g. amylase and blood count costs US$6.00 and $15.00 respectively. Since most other lab test costing must include capital equipment and service costs, the comparisons become even more favourable. Finally, assay costs are negligible compared to annual Drug costs for all relevant drugs except phenobarbitone. A select number of drug assays provide invaluable guidance in treating difficult patients with drugs which have a narrow therapeutic/toxic ratio. Anti-epileptic assays in particular are increasingly recognised to be as valuable in treating epilepsy as blood sugars in treating diabetics. No major hospital in the Caribbean or elsewhere should be without a Clinical Pharmacologist or a TDM service, providing assays for anti-epileptics, gentamycin and digoxin at least (AU)


Assuntos
Humanos , Monitoramento de Medicamentos/economia , Epilepsia/tratamento farmacológico , Educação de Pacientes como Assunto , Digoxina , Carbamazepina/farmacologia , Índias Ocidentais
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