Archive for the ‘Main’ Category
Posted by Alex
Although we have an emotional commitment to improving the welfare of children, we have morbidity and mortality statistics that call into question the level of that commitment. More than 20% of children in the United States live in poverty, and millions do not have access to basic medical care. Approximately one third of all children are either unserved or underserved. Infant mortality is as high as 11% in some communities. Among certain groups of minority youth, death from homicide approaches 160 per 100,000.
canada pharmacy mall
Although we tend to distinguish the statistical differences between ethnic groups, we should be aware of the substantial variations within these groups as well. For example, the Hispanic Health and Nutrition Examination Survey of 1982-1984 (HHANES) reports varying prevalences of medical, behavioral, and developmental disorders among different Hispanic or Latino groups. According to this survey, Puerto Rican children have a higher prevalence of asthma than Mexican American or Cuban American children. Mexican American and Cuban American children have higher birth weights than Puerto Rican children. Thus, given the variations among populations, minorities should not be grouped into a single category for statistical purposes.
Read the rest of this entry »
Posted by Alex
The photograph:
Oakland, California,
History Room; 1918 flu
epidemic; auditorium
filled with cots of people
dying! Crosscurrents
in memory…
a little girl running our
farm’s meadow like a
young doe wide-eyed
startled wonderment;
eyes flooded, dark-ringed
in Argyrol, keep flu away!
Leaning into the photograph,
swift heartbeat, the story came…
Philadelphia; my 18-year-old
cousin, hopping his bike,
delivering, door to door,
the corner druggist’s medicines;
home, exhausted to bed,
doctor said, Too late.
He’s gone. Flu, three days, dead!
1997: photograph “in time,” emotion
feeling his dark curly hair
neatly arranged over a passive,
pale face, movement of the glide
into death, mine.
Posted by Alex
HICCUPS OR SINGULTUS are transient events experienced occasionally by most people. They are usually benign and of brief duration, but may become persistent. Although the cause of most episodes is never determined, many known associated conditions have been identified, including medications. We present a case of hiccups induced by the administration of dexamethasone.
Report of a Case
The patient, a 30-year-old man with no relevant medical history, presented with coffee-ground emesis on the day of admission and persistent hiccups for two days. He had recently been evaluated by a dermatologist in Mexico and had received 16 mg of dexamethasone intravenously for “allergic skin lesions.” Unfortunately, no further information was available. He denied prior intake of any medications, alcohol, or tobacco. Canadian Pharmacy
A physical examination showed persistent hiccups at a rate of 6 to 9 per minute, mild epigastric tenderness, and heme-positive stools. Multiple circumscribed papular skin lesions were seen over the flexor surface of the upper extremities, consistent with urticaria. Laboratory evaluation revealed a leukocyte count of 17.27×10^9 per liter with a normal differential cell count, a hemoglobin level of 158 grams per liter, and a hematocrit of 0.45. The results of electrolyte tests, liver function tests, and coagulation studies were normal.
Read the rest of this entry »
Posted by Alex
THE ANTICOAGULANT EFFECT of warfarin sodium is influenced by several disease states, most notably renal and hepatic dysfunction, and by pharmacokinetic interactions with drugs that either induce or inhibit the hepatic microsomal mixed-function oxidase system. Although thyrotoxicosis has been reported to potentiate the anticoagulant effect of warfarin, necessitating a reduction in dosage, this phenomenon is not generally appreciated because the dosage requirements of most other drugs are increased in patients with thyrotoxicosis. We report the case of a patient with severe cardiac disease taking stable maintenance doses of warfarin and generic amiodarone in whom the emergence of amiodarone-induced thyrotoxicosis was heralded by an abrupt increase in the prothrombin time.
Read the rest of this entry »
Posted by Alex
Regional practice-based network research has grown significantly in the past 15 years. Previous studies have reported on characteristics of physicians who participate in network research, but little is known about the specific a priori research interests of practicing physicians. Knowledge of such interests could be useful in planning network research studies. We conducted a mail survey to assess the research interests of primary care physicians in two contiguous research networks at the University of California at San Francisco (UCSF) and at Stanford University. Among 120 respondents from the UCSF Collaborative Research Network and 85 from the Stanford Ambulatory Research Network, the most common topics of interest were disease prevention, communication and compliance, and managed care. Among specific conditions, heart disease, hypertension, and respiratory infection were of interest to the majority of respondents. Topics not of interest to network members were obstetrics, diagnostic procedures, alcoholism, drug abuse, tuberculosis, male genito-urinary problems, occupational hazards, domestic violence, and AIDS and HIV. Identification of network physician research interests can help focus research and recruitment efforts on topics of interest and provide estimates of participation levels for planning studies and preparing funding applications for research networks.
Read the rest of this entry »
Posted by Alex
Simultaneous pancreas-kidney transplantation: an overview of indications, complications, and outcomes.
Simultaneous pancreas-kidney transplantation (SPK) has become an accepted therapy for the treatment of patients with insulin-dependent diabetes mellitus and renal failure from diabetic nephropathy. The procedure has evolved over the last twenty years, and refinements in technique, better organ preservation solutions, and more potent immunosuppressive therapies have improved one-year graft-survival rates to 81% for the pancreas and 88% for the kidney (International Pancreas Transplant Registry Data-1996). Proper patient selection is important, given the increased complexity of the procedure, the increased need for immunosuppression, and the need for compliance with postoperative medications and monitoring. The benefits of a successful SPK include more physiologic glucose metabolism and freedom from dialysis. This review will describe the indications and selection process for potential candidates, outline the procedure and postoperative care, and discuss the potential impact on secondary complications of diabetes mellitus. It will then discuss results and complications from the use of current protocols and immunosuppression at the University of California at San Francisco. Canadian Pharmacy
Read the rest of this entry »
Posted by Alex
As the history of medicine has evolved, a number of trends and prevailing opinions have swept the profession. One of the most subtle, and yet most revealing results of these sweeping trends manifests itself by altering the tone in medical conversations and dialogues, often available to the non-medical person in the form of texts and literature. A relatively current example appears in the form of Perri Klass’ A Not Entirely Benign Procedure, a text dedicated to the experiences of the author at Harvard Medical School. Published in 1987, Klass’ work offers an interesting, if not shocking comparison to Philippe Pinel’s “The Clinical Training of Doctors,” an article published in 1783. It seems that, despite the obvious advancements and progress in medical technology and general care, the modern Klass presents less certainty about the profession and its abilities than does the eighteenth century article. In Pinel’s article, however, a distinct tone of holistic healing pervades the proposed training of physicians—the lack of which Klass bemoans in her work. The contrast between the two works affords the reader a view into two parallel transitions in medicine: the decline of certainty and the decline of holistic care.