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[Cough caused by angiotensin-converting enzyme inhibitors. A series of cases collected by spontaneous notification of adverse reactions].

Cough is one of the possible untoward adverse drug effects of angiotensin converting enzyme inhibitors. We describe the available information on 50 cough episodes attributable to captopril and 18 episodes attributable to enalapril reported to the Spanish Drug Surveillance System. Cough represented 37% and 39% of the reports of side effects of captopril and enalapril, respectively. There was a remarkable female predominance among the patients with cough. Cough developed at very low doses (15 mg of captopril and 5 mg of enalapril daily), although the patients on captopril who developed cough were receiving higher doses than those who presented other side effects. A high proportion of patients (29%) continued with the drug for more than six months after cough had developed, suggesting the need for a wider knowledge of this side effect.

Aged↗

[Decrease in notifications of AIDS dementia complex in 1989-1990 in Italy: possible role of the early treatment with zidovudine].

We evaluated the incidence of AIDS dementia complex (ADC) in groups of patients who acquired infection through different risk behaviours, and attempted to evaluate the possible role of zidovudine (AZT) treatment in preventing or delaying the onset of ADC. The Italian National AIDS Registry was used to study patients with AIDS for whom ADC was reported as an index disease. Relative risk of presenting ADC between different patient categories has been determined. Logistic regression was used to analyse temporal trends in the proportion of AIDS cases presenting with ADC. Of the 6466 cases reported between August '87 and August '90, ADC was seen in 640 (9.9%). I. V. drug addicts had twice the risk (estimated odds ratio: 1.9; 95% confidence interval: 1.5-2.6, p less than 0.001), compared to homo/bisexuals, of presenting with ADC. There is significant evidence (p less than 0.0001) that after a progressive increase in the period '87-'89, it began a definite decrease in the monthly proportion of ADC cases, starting August '89. AZT was introduced in Italy in July 1987 for patients with AIDS or advanced ARC. The incidence of AIDS dementia complex at the moment of AIDS diagnosis in our population of patients, began to decline 24 months after the introduction of systematic AZT treatment in Italy. This could have been due to inhibition of HIV replication in the Central Nervous System among patients who initiated AZT-treatment before developing full-blown AIDS.

AIDS Dementia Complex↗

Critical limits for urgent clinician notification at US medical centers.

A national survey determined critical limits used by trauma and medical centers in the United States. Mean low and high critical limits for the most frequently listed tests were the following values: glucose, 2.6 and 26.9 mmol/L; potassium, 2.8 and 6.2 mmol/L; calcium, 1.65 and 3.22 mmol/L; sodium, 120 and 158 mmol/L; hematocrit, 0.18 and 0.61; hemoglobin, 66 and 199 g/L; platelets, 37 x 10(9)/L and 910 X 10(9)/L; and white blood cell count, 2.0 X 10(9)/L and 37.0 X 10(9)/L. The high critical limit for prothrombin time was 27 seconds. Critical limits for PCO2 were 19 and 67 mm Hg; and for pH, 7.21 and 7.59. The low critical limit for PO2 was 43 mm Hg; no high critical limit was listed. The noncritical span for free calcium was 0.80 mmol/L. Important qualitative critical results included the presence of blasts on the blood smear, a Gram's stain or culture from blood or cerebrospinal fluid with positive results, and an elevated white blood cell count in the cerebrospinal fluid. A product of 15 years of collective medical judgment, these data should help physicians improve the quality and efficiency of acute patient care.

Blood Gas Analysis↗

[The sick leave notification II system. From the project Evaluation of follow-up of long-term sick leave patients].

In 1988 the National Insurance Administration in Norway introduced a compulsory sickness certificate to be issued by the doctor after eight weeks of incapacity of work (sickness certificate II). The form contains 25 specified items to be filled in by the doctor. We registered and analysed the sickness certificates received by the local National Insurance offices in five municipalities during the last three months of 1988 (n = 735). The patients included a slight majority of males. 1/3 of the patients were younger than 30 years old and 2/3 younger than 50. 1/4 of the items had not been filled in by the doctors. The most frequent diagnostic groups were musculo-skeletal/connective tissue diseases (46.4%), mental disorders (11.2%), and complications related to pregnancy and birth (9.6%). Sickness certificate II included a five-level prognosis scheme. 68.3% of the patients were allocated to prognosis A, i.e. full recovery as a result of medical treatment only. Few doctors noted that cooperation with other health and social welfare personnel was desirable. The level of unemployment was reported as being higher in patients who were certified sick for greater than or equal to 8 weeks than in the general population of the countries included in the study. The extra costs of introducing sickness certificate II are estimated to equal one day's sickness allowance for each of the 735 patients.

Absenteeism↗

Community notification of child sexual abuse.

There has been a heightened awareness of sexual abuse of children in Ireland in the past four years. One-hundred and forty seven cases of alleged sexual abuse notified to the Director of Community Care in 1986-1987 were reviewed retrospectively from the medical and social work notes. In 81 (55%) cases, sexual abuse was either confirmed or strongly suspected and these were analysed further. Victims were twice as likely to come from an urban as from a rural background. Girls were more likely to be abused at all ages, and this was particularly marked in the teenage years. Abusers were either intra-familial or known to the family in most cases. A surprising number were under 16 years of age. The study highlights the time commitment needed to manage this problem in the community and the need to develop services directed towards the young perpetrator. It also raises concern at the sizable percentage of children who, following investigation, are found not to have been abused.

Adolescent↗