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Biomedical subjects

J H Levenstein

Publications and source records attributed to J H Levenstein.

14 recordsLinked to original sources
PubMed1991

Clarithromycin versus penicillin in the treatment of streptococcal pharyngitis.

The safety and efficacy of oral clarithromycin 250 mg every 12 h treatment and of oral penicillin VK (the potassium salt of phenoxymethylpenicillin) 250 mg every 6 h were compared in the treatment of streptococcal pharyngitis caused by Streptococcus pyogenes in an eight centre in-vivo study. A total of 243 patients were enrolled in the study and 125 patients were evaluated for efficacy; evaluable patients included 67 patients in the clarithromycin treatment group and 58 patients in the penicillin VK group. Both antibiotic regimens were effective in the treatment of streptococcal pharyngitis. The clinical cure rate during the initial post-treatment period (between two and ten days post-treatment) for the penicillin VK treated group was 98% (57/58) and for the clarithromycin treated group was 96% (64/67). The bacteriological cure rate during the initial post-treatment period for the penicillin VK treated group was 97% (56/58) and for the clarithromycin treated group was 100% (67/67). A total of 17 patients reported adverse events; seven patients were in the clarithromycin treatment group and ten patients in the penicillin VK treatment group. One patient in the penicillin VK group was withdrawn because of the severity of the adverse advent (balanitis). No clinically significant differences were reported between the two treatment groups for haematology, blood chemistry, or urinalysis evaluations. Oral clarithromycin 250 mg 12-hourly treatment was as safe and effective as penicillin VK 250 mg 6-hourly in the treatment of streptococcal pharyngitis.

Adolescent↗
PubMed1986

The patient-centred clinical method. 1. A model for the doctor-patient interaction in family medicine.

This article describes a patient-centred clinical method appropriate for family medicine. The method is designed to attain an understanding of the patient as well as his disease. This two-fold task is described in terms of two agendas: the physician's and the patient's. The key to an understanding of the patient's agenda is the physician's receptivity to cues offered by the patient, and behaviour which encourages him to express his expectations, feelings and fears. The physician's agenda is the explanation of the patient's illness in terms of a taxonomy of disease. In the patient-centred clinical method, both agendas are addressed by the physician and any conflict between them dealt with by negotiation. This is contrasted with the disease-centred method in which only the doctor's agenda is addressed. Further articles will describe the patient-centred method in operational terms.

Aged↗
PubMed1985

Isoxicam and indomethacin in acute osteo-arthritis. A GP multicentre double-blind comparison.

A study was conducted in general practice to assess the efficacy and safety of isoxicam 200 mg once daily compared with indomethacin 25 mg 3 times a day in the treatment of acute exacerbations of osteo-arthritis. The trial was conducted as a multicentre, double-blind, randomized parallel-group study with 'dummy loading' of the medications. Thirty-one general practitioners entered 309 patients in the study. Of these, 139 patients on isoxicam and 137 on indomethacin completed the treatment. The most common sites of osteo-arthritis were the knee (100 patients) and the hip (79 patients). On examination at 7 days and 14 days there was a significant improvement in both treatment groups. After 7 days the reduction of pain and clinical symptoms of osteo-arthritis of the hip and knee was significant for both drugs at the P less than 0,001 level. There thus appeared to be no difference in clinical efficacy between the drugs. Eight patients in the isoxicam group experienced definite drug-related adverse reactions as against 19 in the indomethacin group. A total of 38 patients (18 on isoxicam and 20 on indomethacin) suffered probably drug-related effects. Isoxicam therefore appeared to be better tolerated than indomethacin.

Acute Disease↗
PubMed1978

Oxprenolol slow-release with cyclopenthiazide-KCl compared with methyldopa in the treatment of essential hypertension. A multicentre general practice trial.

Two hundred and thirty-eight patients with essential hypertension from 39 general practice centres were treated in a double-blind trial with either oxprenolol 160 mg in a slow-release (SR) formulation with cyclopenthiazide 0,25 mg and potassium chloride 600 mg given once daily, or methyldopa 250 mg 3 times daily. After a 2-week placebo washout period, each patient was treated for 10 weeks. Both treatments significantly reduced blood pressure. Oxprenolol SR plus cyclopenthiazide-KCl was shown to possess significantly superior antihypertensive activity to methyldopa. Pulse rate, as expected, was significantly decreased by the beta-blocker and virtually unaffected by methyldopa. The overall incidence of side-effects was low. The incidence of sleepiness and dry mouth was significantly higher in the methyldopa group, and erythema in the oxprenolol group. The principle of general practitioners conducting multi-centre double-blind trials for research purposes, on drugs which are predominantly given to ambulatory patients, has been established for the first time in South Africa. Virtually no difficulty was encountered in getting patients' consent in the general practice milieu.

Adult↗
PubMed1977

The basis of general practice, its content and relation to training.

The present status is the newly defined discipline of general practice is briefly outlined. The reasons for its worldwide upsurge in the past decade and the relative failure of South Africa to keep abreast are reviewed. A brief exposition is given of the knowledge and skills required for general practice, the consultation, the clinical process and the content of what in some countries is regarded as family medicine. The difference in ethos between 'doctor-orientated' and 'patient-orientated' medicine is discussed. The latter approach is essential to general practice, in which the attidudes of both doctor and patient and their interactions are known to have an effect on the clinical process. The non-directive educative approach is discussed in relation to undergraduate and postgraduate training, and the attempts to make postgraduate general practice examinations valid and reliable, so that they evaluate the actual day-to-day activities of the doctor, are alluded to. The content of general practice is as yet not clearly identified and the problems encountered in delineating these as well as suggested approaches are presented. It is concluded that in South Africa no serious attempts have been made by legislative bodies and most medical educational institutions to recognize general practice as a new displine in spite of pioneering work achieved by the Faculty of General Practice of the College of Medicine of South Africa.

Clinical Competence↗
PubMed1976

Myocardial infarction and the evolution of the intensive coronary care unit.

From the start of the 1960s it became increasingly evident that sudden death with acute myocardial infarction was owing to reversible derangement in heart rhythm rather than to gross myocardial damage. Patients at risk were placed in specialised areas, intensive coronary care units (ICCUs), and their heart rhythms were continuously monitored. Initially, the prime function of the ICCU was to resuscitate a patient who had suffered cardiac arrest. Since the survival rate after resuscitation was low, no obvious reduction in mortality was noted in the early ICCU. As intensive care evolved, better resuscitation techniques became available, understanding of the terminal arrhythmic mechanism improved, and the prevention of cardiac arrest by aggressive and prompt treatment of the minor warning arrhythmias became feasible. With these developments, the ICCU appeared to show a reduction in the mortality of acute myocardial infarction. It is argued that the 'supposed' decrease represents a 'real' decrease. This is on the basis of the consistency and similarity of all ICCU results throughout the world over a period of 7 years, coupled with the fact that cardiac arrests (which were initially reported to occur in 10%-20% of patients) had been eliminated. The principles of modern intensive coronary care have been equally well utilised in small community hospitals and in large academic hospitals. Thus, the extension of soundly-based management can have application in situations which, by force of circumstances, are far from ideal. An outstanding feature which emerged early on, was the high incidence of arrhythmias recorded by continuous monitoring. The percentage frequently quoted was 80% and above. Emphasis was placed on the dangerous ventricular arrhythmias, including the ventricular premature systole. The atrial arrhythmias were considered to be of lesser clinical significance.

Arrhythmias, Cardiac↗
PubMed1976

Emergency management of acute myocardial infarction by the general practitioner.

In the Cape GP Emergency Coronary Care Project, 129 general practitioners (GPs) collaborated over a 14-month period. The objectives were to reach all patients with symptoms of acute myocardial infarction as promptly as possible, and to institute therapy according to a simple protocol, where the emphasis was on the prophylactic administration of antidysrhythmic drugs. The results showed that 38% of a total of 333 patients received treatment within 1 hour of the onset of their symptoms, and 75% within 4 hours. The mortality at the end of 1 month was 15% in 333 patients of all ages, and 10,7% for 272 under the age of 70 years. The over-all community death rate from coronary heart disease in the patients of the participating GPs was 28,3% in 445 patients of all ages, and 23,3% in 356 patients under 70 years of age. These death rates are well below those reported in other comparable series. There was a low incidence of arrhythmic death, and only 1 death among patients who had received appropriate antidysrhythmic therapy. No ill-effects of complications occurred after the routine prophylactic administration of antidysrhythmic drugs. It is concluded that in the prehospital phase of acute myocardial infarciton, the Cape GPs were able to administer a service which compared favourably with that of a mobile intensive coronary care unit, at almost no extra cost to the community, and with very little extra strain on their practices.

Acute Disease↗
PubMed1976

A research project as a means for continuing education.

A project designed to encourage general practitioners to provide care in the earliest phases of coronary heart disease is reported from South Africa. A total of 129 general practitioners were actively involved and over 3,000 practitioners showed interest and attended at least one meeting.

Critical Care↗
PubMed1975

Historical perspective of myocardial infarction.

The history of myocardial infarction ('coronary thrombosis'), a condition which was only recognised as a clinical entity in the 20th century, is reviewed up to the time of the introduction of the intensive coronary care units. Early observations of presentations, complications, diagnosis and treatment of the disease are emphasised. The increase in incidence of myocardial infarction, real or relative, is discussed and the remarkable variation shown in earlier reports on the mortality rate of myocardial infarction is explained. Many of the important principles which revolutionised the management of the disease through coronary care units, are evident in the earlier reports.

Adult↗
PubMed1975

An evaluation of tilidine hydrochloride in the treatment of pain requiring immediate analgesia.

Problems relating to analgesia in various situations are briefly discussed. A simple working classification for analgesic administration is given. The results of a trial, in which 50 mg of a new analgesic, tilidine, was given sublingually, are presented. The drug was evaluated in cases where immediate analgesia was indicated. The majority of patients had injuries to the hand or head. It was found that tilidine provided a marked analgesic effect in 27 of the 30 patients. The onset of action was rapid, 25 of the 30 patients obtaining complete relief within 6 minutes. It is concluded that tilidine is a powerful analgesic, with a rapid onset of action when it is give in the sublingual drop form. Moreover, it is a drug of choice, in this form, for acute, moderately severe situations (those which require immediate analgesia, but where opinates are not thought to be necessary).

Acute Disease↗