Biomedical subjects
Publications and source records attributed to A J Costa.
An elderly patient who falls is at significant risk for disability or death. In this article, Dr Costa explains how a carefully taken history, detailed physical examination, and appropriate laboratory studies can help to discern the cause of a fall. He also describes a multifaceted approach to preventing falls in elderly patients that involves a partnership of the physician, the patient, and the family.
Drug interactions are a common cause of iatrogenic disease in geriatric patients. Computer programs now exist which allow one to analyse groups of drugs for potential interactions. In an audit of charts of 100 geriatric patients seen in the Family Practice Center at Barberton Citizens Hospital, a computer printout was obtained, listing all patients aged 60 years and over who were seen at the Center during 1989. Names were selected randomly from this list by the head nurse and their charts were obtained for review, generating information on patient identification number, age, sex, diagnoses, medications, and allergies. The medications were analysed using the Hansten Drug Interaction Knowledge Base Program, which identified 27 patients as being on a combination of medications which had one or more potential drug interactions. A total of 37 potential drug interactions were identified in this group of 27 patients. Relative risk ratios were determined using the computer program, 'Epi Info,' for sex (female versus male), age (greater than or equal to 75 vs. 60-75 years), number of diagnoses greater than or equal to 3 vs. 0-2), and number of medications (greater than or equal to 4 vs. 0-3). The five medications, or groups of medications, which were most likely to be involved in potential drug interactions were digoxin, beta-blockers, oestrogen, oral hypoglycaemic agents, and diuretics.
The wide clinical spectrum of neurocysticercosis has led to many attempts at clinical, radiological, CSF and other classifications. Based on an objective review of the relevant literature and on a prospective study of 42 patients with active neurocysticercosis, a new classification is proposed, based on clinical, tomographic, magnetic resonance and CSF evidence of viability of cysts. The first step is to define whether the disease is active or not. Inactive disease may be parenchymal calcifications or hydrocephalus. Active disease may be intraparenchymal, extraparenchymal or mixed. Statistical analysis of 42 cases with active disease shows intraparenchymal disease to occur in younger patients, perhaps more frequently in females, and to have a better prognosis than extraparenchymal of mixed disease. The latter appears to have the worst prognosis. Therapeutic implications are that only active disease warrants etiological therapy. There remain doubts about the best therapy for some infrequent subtypes of extraparenchymal and mixed disease.
In the international, but more so in the latin-american, medical literature infarction of the spinal cord has been rarely described except in relationship with surgery of the abdominal aorta. The objective of this report is to describe the diagnostic approach including clinical, electrophysiological, imaging and cerebrospinal fluid criteria. With these methods 17 cases were diagnosed between 1982 and 1989, one related to surgery of the abdominal aorta. This series suggests that infarction of the spinal cord is a more common clinical entity than presently considered. Its rarity may be due to a high diagnostic threshold related to the perception that there is no specific therapy.
Cigarette smoking is the single largest preventable cause of premature death and disability in our society. Although the incidence of smoking has gone down in the last 20 years, it is still very prevalent among teen-agers. Several good methods of smoking cessation are available to the physician for use in his/her office. This article summarizes these methods and outlines a simple program of intervention which can be used in any primary care setting.
Chlamydia trachomatis infection is currently among the most prevalent sexually transmitted diseases in the United States. A review of three textbooks of obstetrics reveals that none of them recommend routine chlamydia screening in prenatal patients, although two recommend routine screening for gonorrhea. A study was done at the Barberton Citizens Hospital Family Practice Residency Program to determine the incidence of asymptomatic chlamydia infection in pregnant women and to compare this to the incidence of asymptomatic Neisseria gonorrhoeae infection in the same population. A total of 69 patients were screened for Neisseria gonorrhoeae and Chlamydia trachomatis as part of their routine prenatal evaluations at the first prenatal visit and the visit of 36 weeks gestation. Neisseria gonorrhoeae was detected by growth on standard Martin-Lewis culture plates. Chlamydia trachomatis was detected by positive immunofluorescence using a standardized specimen kit (Syva Company, Palo Alto, California). The data were collected over a 12-month period from July of 1987 through July of 1988. There were no positive cultures for Neisseria gonorrhoeae (0%) in this group of patients. On the other hand, five patients tested positive for Chlamydia trachomatis (7.2%). The results of this study indicate that routine screening for Chlamydia trachomatis should be considered as part of the routine prenatal care. A larger, multi-centered study could be done in the future to confirm these results, as well as to determine if any regional differences exist.
With the pathophysiology of anaphylaxis firmly in mind, the primary care physician can accurately diagnose and effectively treat this acute, life-threatening condition. The necessary drugs and equipment must be present in the office of any physician who performs skin testing, administers immunotherapy or intramuscular antibiotics, or uses local anesthetics. The drug of choice, epinephrine, must be administered as soon as the diagnosis is made, and hospitalization is necessary to guard against recurrent anaphylaxis. Preventive measures, including identification of the offending antigen, avoidance instructions, epinephrine for self-administration, and immunotherapy should be considered for all patients.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Calves aged 3 months were readily infected with oocysts and cysts of Toxoplasma gondii administered by oral route. Fever, respiratory distress, nasal discharge and hyperemia of the conjunctivas were the most significant clinical signs noted in the infected animals. Parasitemia was demonstrated in all infected calves. It occurred on different days and up to 62 days after the infection. Toxoplasma was demonstrated in tissues of all infected calves, and the organ most frequently parasitized was the lymph node. Parasitism of the retina was demonstrated in two calves. All infected animals had antibody against T. gondii in their serum. The Sabin-Feldman dye test and the indirect immunofluorescent test were both useful in detecting antitoxoplasma antibody.
After surgery or traumatic injury, bone defects may heal slowly or they may completely fail to heal. In most cases, these delayed unions and nounions results from lack of proper immobilization. Motion at the site of an injury interferes with proper organization of the hematoma or causes the fragments to separate or become displaced.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Sera of 204 cows in Jaboticabal, S.P., Brazil were examined by indirect immunofluorescent test for detecting anti-Toxoplasma antibody. Assuming titers from 1:64 as indicative of toxoplasmic infection it was observed 32.3% of positive reactions. The antibody titers even to 1:256 represented 7.8% of the reacting animals. The serological titers varied from 1:64 to 1:256. No clinical story could be correlated with the reacting animals and no isolation was performed.
The finding of Chorioptes bovis, the agent of corioptic mange in bovines in the region of São Carlos, State of São Paulo. A description of clinical aspects and treatments is given.
Proceeding with their observations on bovine nematode epidemiology in Guaíra, State of São Paulo, the authors carried a study on the natural development of nematode infections in crossbred calves born at the dry season. The fecal nematode egg counts per gram (e.p.g.) performed every fortnight were positive at the start, in October, when calves were two months old, and reached the peak when they were five months old; cultures of faeces revealed larvae of Cooperia, Haemoncus, Oesophagostomum and Trichostrongylus. From this time on, until 12.5 months old, when the calves were slaughtered, the variable e.p.g. decreased continually, the average being, in the last examinations, 40 e.p.g. Strongyloides eggs were present in the faeces when the calves were two months old but they disappeared by the 5th month of age. The post-mortem examination revealed the following species of nematodes: Haemoncus similis, Haemoncus contortus, Trichostrongylus axei, Bunostomum phlebotomum, Cooperia punctata, Cooperia pectinata, Oesophagostomum radiatum, Trichuris discolor and Dictyocaulus viviparus.