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Biomedical subjects

F A Hubbell

Publications and source records attributed to F A Hubbell.

47 records · Page 3Linked to original sources
PubMed1982

Biochemical cardiac risk factors during diuretic therapy.

The effects of six weeks of treatment with fixed doses of the diuretics chlorthalidone and ticrynafen on serum total cholesterol, low density lipoproteins, high density lipoproteins, triglycerides and other biochemical parameters were studied in 24 hypertensive patients. Chlorthalidone increased total serum cholesterol by 40 +/- 11 (SEM) mg/dl (P less than 0.01) and triglycerides by 80 +/- 30 mg/dl (P less than 0.05). The increase of 16 +/- 12 mg/dl in low density lipoproteins and the decrease of 5 +/- 6 mg/dl in high density lipoproteins induced by this drug were not significant. An investigational uricosuric diuretic, ticrynafen, caused no significant changes in any of the serum lipid concentrations measured. Fasting blood glucose levels were elevated, but not significantly, by both diuretics. Serum uric acid concentrations tended to increase in patients given chlorthalidone while ticrynafen treatment decreased uric acid levels by 2.9 +/- 1.4 mg/dl (P less than 0.01). The elevations induced by chlorthalidone in serum lipid levels may partially counteract the potential benefits of its antihypertensive effects.

Adult↗
PubMed1981

Ticrynafen-induced acute renal failure.

Two cases of acute renal failure associated with ticrynafen administration are reported. Both patients had received hydrochlorothiazide prior to the institution of ticrynafen therapy and were mildly hyperuricemic. Flank pain, oliguria, and azotemia developed after the institution of ticrynafen in both cases. Clinical and laboratory features were consistent with acute uric acid nephropathy in both patients. In addition, a newly formed collection of radiolucent material was found by intravenous urography in the renal pelvis of one of the patients. Both patients were treated with intravenous fluids and sodium bicarbonate. One of the patients received allopurinol as well. Complete recovery of renal function was observed in both patients. Ticrynafen-induced hyperuricosuria in these previously volume-depleted and hyperuricemic subjects is felt to have been responsible for intrarenal and extrarenal deposition of uric acid in our patients.

Acute Kidney Injury↗
PubMed1980

Adverse effects of sudden withdrawal of antihypertensive medication.

The withdrawal syndrome following abrupt discontinuation of antihypertensive medication may consist of symptoms of sympathetic overactivity alone or in association with a rapid increase in blood pressure. The phenomenon may occur after discontinuation of any of a variety of drugs. Although the exact incidence of the syndrome is not known, it appears to be rare, at least in patients receiving standard doses of antihypertensive medications. The best treatment is prevention. However, if the syndrome does occur, reinstitution of the previously discontinued medication usually is successful in controlling the withdrawal events.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

The abrupt discontinuation of antihypertensive treatment.

Although deleterious events following abrupt withdrawal of antihypertensive treatment are relatively uncommon, considerable attention has recently been focused on this problem. A withdrawal syndrome may occur after termination of almost all types of antihypertensive drugs, but most experience has been with the centrally acting agents and with beta-adrenoreceptor blockers. Abrupt discontinuation of high doses of centrally acting drugs such as alpha-methyldopa, clonidine, and guanabenz can produce a syndrome of sympathetic overactivity that includes agitation, headache, sweating, and nausea and less commonly can provoke rapid upswings in blood pressure. If beta blockers are suddenly stopped, a similar pattern can occur that may be related to excessive activity of thyroid hormones as well as sympathetic factors. Additionally, patients with ischemic heart disease may be susceptible to an acute exacerbation of their cardiac disease when beta-blocker treatment is stopped. It seems likely that discontinuation events can be particularly severe when combinations of different types of antihypertensive medications are sud-disease when betablocker treatment is denly stopped. This problem can be dealt with by educating patients to avoid sudden drug cessation and when elective discontinuation is planned, by gradual dose reduction.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

Stress during internship: a prospective study of mood states.

Mood changes of interns during the internship year were studied using the Profile of Mood States (POMS), a standardized adjective checklist. All 35 interns in the University of California, Irvine-Long Beach Medical Program completed the POMS at internship orientation and at five other times during the year. Of the six mood factors measured by the POMS, four changed significantly during the testing period. Anger-hostility scores were higher (p less than 0.01) in December than at orientation and remained so throughout the year. Tension-anxiety scores were higher (p less than 0.01) and fatigue-inertia scores were lower (p less than 0.01) at orientation than at any other time during the year. Vigor-activity scores were higher (p less than 0.01) at orientation than at the end of the year. Depression-dejection and confusion-bewilderment scores did not change significantly during the study period. Recognition of these mood changes is helpful for drawing the attention of house staff and faculty members to emotional stresses of training, and for identifying issues for discussion in intern support groups.

Adult↗
PubMedDate not supplied

Usefulness of routine admission complete blood cell counts on a general medical service.

The usefulness of three components of the routine admission complete blood cell count (leukocyte count, hematocrit, and platelet count) was evaluated in 301 patients consecutively admitted to the internal medicine wards of a university teaching hospital. Using a consensus analysis approach, three faculty members reviewed the patients' charts to determine which tests were performed routinely, which tests were abnormal, and which routine tests led to diagnostic or therapeutic changes. Overall, 55.3% of the tests were considered routine admission tests. Abnormalities were detected in 13.6% of the routine leukocyte counts, in 8.2% of the routine hematocrit levels, and in 12.4% of the routine platelet counts. However, treatment was changed for only three patients, all of whom had low hematocrits; this amounted to 0.6% of all tests. Furthermore, only one of the three patients received appropriate treatment that might have been withheld if a routine hematocrit determination had not been ordered. The authors conclude that the impact of routine admission complete blood cell counts on patient management is small and that the practice of ordering this test for all hospitalized patients could be eliminated with little adverse effect on patient care.

Adult↗
PubMedDate not supplied

Prevalence of domestic violence among patients in three ambulatory care internal medicine clinics.

OBJECTIVE: To determine the prevalence of domestic violence among patients seen in three university-affiliated ambulatory care internal medicine clinics and to assess the personal characteristics of those patients affected by domestic violence. DESIGN: Survey using a self-administered, anonymous questionnaire. SETTING: Three university-affiliated internal medicine clinics at the University of California Irvine Medical Center. PARTICIPANTS: We asked all patients on randomly selected days during the three-month study to participate. 453 (72%) of the 629 eligible English- and Spanish-speaking patients completed the questionnaire. MEASUREMENTS AND MAIN RESULTS: 28% of participants had experienced domestic violence at some time in their lives, and 14% were currently experiencing domestic violence. Logistic regression analysis showed that female gender, unmarried status, and poverty were important predictors of domestic violence. However, domestic violence occurred in all groups regardless of sex, ethnicity, age, or socioeconomic status. CONCLUSIONS: The study found an unexpectedly high prevalence of domestic violence in the three internal medicine clinics. Physicians should ask their patients routinely about domestic violence and, when domestic violence is present, should offer emotional support, information about social service agencies, and psychological care.

Adult↗
PubMedDate not supplied

Access to medical care in a medically indigent population.

OBJECTIVE: To study nature and extent of barriers to access to medical care in a single county and to define the nature of the illnesses in a population affected by those barriers. DESIGN: Descriptive study of consecutive patients not able to obtain medical care because of financial or other barriers. Financial barriers and medical diagnoses were categorized and the severity of illness and impact of unavailability of medical services were judged by a panel of internists using consensus analysis. The likelihood of obtaining care after refusal of assistance was also evaluated. SETTING: A social services eligibility office on the grounds of an urban, university teaching hospital that serves a largely medically indigent population. PATIENTS: 200 patients who presented to eligibility workers seeking financial assistance. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Sixty percent could not obtain care because they were illegal aliens, 40% could not obtain care because they did not meet the strict criteria of the assistance programs. Sixty percent of patients had a moderate to high likelihood of long-term disability from their illnesses; 38% of a subgroup were not able to find care four weeks after entering the study, and these patients appeared to have more severe disease than those who were able to find care. CONCLUSIONS: Many medically indigent persons with significant illnesses face serious financial barriers to access to medical care.

California↗
PubMedDate not supplied

Combined central and peripheral sympathetic blockade: absence of additive antihypertensive effects.

Two antihypertensive agents that inhibits sympathetic activity by differing pharmacologic mechanisms, the centrally-acting alpha-adrenergic agonist, clonidine, and the peripheral alpha-adrenergic antagonist, prazosin, were compared and also given in combination in 24 patients with essential hypertension. The patients were randomized into two groups; 11 received chlorthalidone (50 mg) daily throughout the protocol, whereas 13 received no diuretic. In the 13 patients not receiving the diuretic, supine mean blood pressure fell by 11.0 +/- 3.5 mmHg (p less than 0.01) with clonidine (0.3 mg daily), 5.5 +/- 2.9 mm Hg (p less than 0.05) with prazosin (15 mg daily), and 12.7 +/- 5.2 mmHg (p less than 0.02) with the combination. In the 11 patients concurrently receiving chlorthalidone, supine mean blood pressure fell by 9.5 +/- 2.0 mmHg (p less than 0.01) when clonidine was added, 2.3 +/- 1.9 mmHg (ns) when prazosin was added, and 7.9 +/- 2.1 mmHg (p less than 0.01) with the combination. In both the presence and absence of concurrent diuretic treatment, the blood pressure-lowering effects of clonidine were greater than those of prazosin, but were not different from the antihypertensive effects of the combination of clonidine and prazosin. Therefore, the simultaneous administration of clonidine and prazosin in the doses used in this study does not appear to be more effective than clonidine alone in the treatment of patients with hypertension.

Adult↗
PubMedDate not supplied

The influence of fatalism on self-reported use of Papanicolaou smears.

OBJECTIVE: Our objective was to examine the demographic and other predictors of fatalistic beliefs among Latinas (Hispanic women) and Anglo (non-Hispanic Caucasian) women and to assess the impact of these beliefs on the use of cervical cancer screening services. METHODS: We used ethnographic interviews and a cross-sectional telephone survey in Orange County, California. Our sample included 94 Latinas and 27 Anglo women selected through organization-based network sampling for the ethnographic interviews and 803 Latinas and 422 Anglo women randomly selected for the telephone survey. RESULTS: Latina immigrants (Latinas born outside the United States) were more likely than U.S.-born Latinas or Anglo women to have fatalistic beliefs. Immigration, education levels, and insurance status predicted fatalistic beliefs. Fatalistic beliefs were independent predictors of Pap smear use by Latinas but not Anglo women. For example, after adjusting for potentially confounding variables, Latinas who believed that fate was a risk factor for cervical cancer (odds ratio [OR] = .58), that they would rather not know if they had the disease (OR = .58), and that there is nothing one can do to prevent it (OR = .45) were less likely than others to report that they have had a Pap smear within the prior three years. Health insurance status, marital status, and immigration also predicted use of Pap smears. Insured Latinas were more likely than uninsured Latinas (OR = 2.89) to report having a Pap smear within the prior three years. In addition, married Latinas (OR = 2.32) and Anglo women (OR = 3.09) were more likely than unmarried women to report having appropriate cervical cancer screening. Finally, Latina immigrants were less likely than other Latinas to report having a Pap smear (OR = .26). CONCLUSIONS: We conclude that fatalistic beliefs are among the factors that negatively influence Latinas' use of Pap smears and that it is important for health care professionals to address those beliefs. Continued efforts are also necessary to decrease the economic and structural barriers to cervical cancer screening.

Adult↗