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Biomedical subjects

C D Ponte

Publications and source records attributed to C D Ponte.

At least 37 records · Page 2Linked to original sources
PubMed1990

A suspected case of trimethoprim/sulfonamide-induced localized exfoliation.

A variety of skin reactions have been associated with the use of sulfonamides. Most of the reactions are uneventful and abate with drug discontinuation. Rare but severe skin reactions can occur and include the Stevens-Johnson syndrome and exfoliative dermatitis. Dermal reactions appear to be the most commonly reported adverse effect in children. Drug continuance following the development of a mild skin rash may be associated with the development of a more severe dermal reaction. This report summarizes a case involving a six-year-old white girl who developed exfoliative dermatitis confined to the feet following a course of oral trimethoprim/sulfamethoxazole (TMP/SMX) for otitis media. Exfoliation is an uncommon cutaneous manifestation following sulfonamide use. Although usually a generalized process, it is unusual to find it confined to the feet. Unfortunately there is no useful diagnostic method that could specifically elucidate the cause of a dermatologic eruption. Available evidence suggest that TMP/SMX was the probable cause of our patient's rash. Adjunctive antihistamines and corticosteroids are often useful when pruritus is present. Severe reactions require vigorous supportive treatment.

Child↗
PubMed1990

The clinical use of oral sulfonylureas in the management of non-insulin dependent diabetes mellitus (NIDDM).

Eighty percent of Americans afflicted with diabetes mellitus have Type II or non-insulin dependent diabetes mellitus (NIDDM). Impaired or defective insulin secretion and insulin resistance are universal pathophysiologic findings. Management involves attention to diet, exercise, and commonly the use of insulin and/or oral sulfonylureas. Currently there are six marketed first and second generation agents available for use in the United States. Although the newer agents are more potent, they all share a similar mechanism of action. These agents can only be effective if the patient has retained beta cell secretory function. Pharmacokinetic and pharmacodynamic differences may make the newer agents, glyburide and glipizide, preferred in the management of Type II diabetes mellitus. The combined use of insulin and oral sulfonylureas may be useful for the patient exhibiting persistent fasting hyperglycemia despite maximal oral drug therapy. The precise role for combination therapy and optimal patient characteristics awaits further study.

Administration, Oral↗
PubMed1989

Heinz-body hemolytic anemia associated with phenazopyridine and sulfonamide.

A 27-year-old white woman developed Heinz-body hemolytic anemia following multiple courses of oral phenazopyridine and trimethoprim-sulfamethoxazole. Her diagnosis was supported by the finding of bite cells on peripheral blood smear. The patient's rapid recovery and reversal of abnormal laboratory parameters were consistent with an acquired hemolytic disorder. This case should sensitize the clinician to the development of drug-induced oxidative hemolysis, its clinical features, and its reversibility. It is also important that the clinician recognize those drugs capable of causing this disorder and appreciate the methods available to establish the diagnosis.

Administration, Oral↗
PubMed1989

Estrogen replacement therapy: a pilot survey of primary care physicians in West Virginia.

Controversy surrounds the optimal use of estrogen replacement therapy (ERT) for the management of vasomotor instability and other perimenopausal symptoms. This fact and the obvious lack of published literature regarding physician prescribing behavior led the investigators to explore these issues with primary care physicians in West Virginia. Data were collected using a mailed, self-administered questionnaire. Issues addressed included reasons for using/not using ERT, patient symptoms, type of therapy prescribed, treatment duration, and symptom resolution or rebound. Approximately 25 percent of the 420 physicians contacted responded to the questionnaire. The overwhelming majority prescribes ERT for their patients. Most physicians prescribe an estrogen/progesterone combination for some or all patients, depending on the clinical situation. Conjugated estrogens in physiologic doses and synthetic progestins are most frequently prescribed and administered on a cyclic basis. Most women prescribed ERT experienced symptom resolution. Treatment outcome was not correlated with treatment duration.

Adult↗
PubMed1989

Monitoring the patient with diabetes mellitus--how to avoid medication errors.

The hospital pharmacist is in a unique position to assist in the management and monitoring of the diabetic patient. He can alert the nurse and physician concerning medication errors involving the use of insulin and oral sulfonylureas. Medication errors may not only jeopardize the metabolic control of a person with diabetes but may also result in the development of significant hypoglycemia. Insulin orders should be written clearly and concisely. The advocation for intensive split-dose regimens and the use of insulin infusion devices require careful attention to technique, administration times and insulin doses. Inappropriate doses of insulin given to patients suffering from diabetic ketoacidosis may lead to significant morbidity. The hospital pharmacist must also carefully survey insulin orders for patients requiring hyperalimentation solutions and those persons requiring reduced caloric intake. The rational use of oral sulfonylureas requires a knowledge of potency differences and appropriate dosage adjustments in order to avoid hypoglycemic reactions.

Diabetes Mellitus, Type 1↗
PubMed1983

A suspected case of codeine-induced erythema multiforme.

Erythema multiforme usually presents as an acute inflammatory reaction involving the skin and mucous membranes. Systemic symptoms and organ involvement also can occur. The disease is associated with many illnesses and drugs. A two-year-old child presented to the Family Practice Center with a probable codeine-induced episode of erythema multiforme. The patient had been treated with Actifed-C Expectorant for a suspected viral upper respiratory tract infection. The rash was characteristic of erythema multiforme, but there was no involvement of mucous membranes. The rash quickly abated after the discontinuation of the drug and the administration of hydroxyzine. A viral cause for the rash could not be ruled out. When erythema multiforme is precipitated by a particular drug, discontinuation of the offending agent is necessary. The rash should disappear quickly. Adjunctive use of antihistamines may offer some benefit for the patient. Systemic corticosteroids may be necessary for more severe cases.

Child, Preschool↗
PubMed1983

A mild case of toxic shock syndrome.

The toxic shock syndrome (TSS) most often is seen in young, healthy women who become symptomatic during menstruation. The association between TSS and the use of tampons is strong. The symptoms usually begin suddenly and are often nonspecific. Prostration and hypotensive shock can occur within 24 hours. Milder forms of the disease also may be seen. The overall mortality rate is approximately 8 percent. This report describes a mild case of TSS in a young, healthy, 16-year-old female who developed symptoms during menstruation. She had been using regular-size tampons, which were changed frequently, but she did not change tampons during the night. A positive cervical culture for Staphylococcus aureus confirmed the diagnosis. The patient responded to supportive care and intravenous oxacillin. Her generalized maculopapular rash disappeared within 24 hours of admission, and her hands began to desquamate by the time of discharge. The patient was urged to avoid the use of tampons for four months subsequent to discharge.

Adolescent↗
PubMed1983

Carbamazepine-induced thrombocytopenia, rash, and hepatic dysfunction.

Carbamazepine is an anticonvulsant agent that has been found clinically useful in the treatment of refractory seizure disorders. Its mechanism of action is not well understood. The drug also has been associated with several serious side-effects. These include bone marrow suppression, liver and renal dysfunction, water intoxication, and ocular lens opacities. A 33-year-old white female developed elevated liver enzymes, a rash, and thrombocytopenia following the short-term use of carbamazepine for temporal lobe seizures. All of these findings are consistent with literature reports. Other etiologic factors also are discussed. This case is presented to illustrate the importance of monitoring blood counts and liver function tests when carbamazepine is part of a particular treatment regimen. Clinicians must be aware that a variety of hematological disorders can occur with this drug. Liver dysfunction is usually first noted, with an elevation of liver function tests. When thrombocytopenia is noted, prompt withdrawal of the drug is required. The platelet count should return to normal within a few days.

Adult↗
PubMed1982

Delayed cutaneous hypersensitivity testing.

The topic of delayed cutaneous hypersensitivity testing is reviewed. When skin tests are used to determine whether an individual is anergic, T cell immunity is evaluated. Skin testing can be used to determine the causative organisms of infection or to discover an immunologic deficiency state. Characteristic skin lesions usually develop after intradermal injection of the antigen. Skin testing uses the most ubiquitous environmental antigens and those that are safe, cheap, and effective. Important issues dealing with skin tests include false-positive and false-negative reactions, which antigens to use in an antigen "battery," their lack of standardization, and the method of administration. Despite the problems, skin testing remains an easy, relatively safe method of assessing the immune system. Some investigators are developing more reliable testing methods and alternative antigens. Further research is needed to develop a reliable method for assessing delayed cutaneous hypersensitivity.

Antigens, Fungal↗