Dental services and oral health.
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Biomedical subjects
Publications and source records attributed to B Bloom.
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Information was obtained from a survey of a representive sample of 8% of the medical practitioners in South Africa in 1985. Each practitioner recorded all reasons for contact, diagnoses, whether a contact was new or a repeat, and demographic details of the patients over a 1-week period. Tables are presented only for general practitioners for contact rates of 70 causes of morbidity (ICD abridged list) as well as a chronicity index for each condition (the ratio of repeat to new contacts for that condition). Acute respiratory infections and diseases of the genito-urinary system were the most common reasons for contact, while diabetes mellitus was the condition with the highest chronicity.
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A pilot survey of morbidity patterns reflected in general practice was undertaken by a panel of physicians in Cape Town during 1984-1985. Acute upper respiratory tract infections, bronchitis and bronchiolitis were the commonest reasons for contact. A definite pattern of contacts by day of week was noted. The age distribution of the contacts closely matched that of the suburb in which the practice was situated.
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In a randomised trial a combination vaccine consisting of live BCG together with killed leishmania promastigotes was compared with a standard antimonial regimen in 94 patients with localised cutaneous leishmaniasis. Three vaccinations over 32 weeks gave a similar cure rate (94%) to three 20-day courses of meglumine antimonate. In the immunotherapy group side-effects were few (5.8%) and slight whereas in the chemotherapy group they were frequent (52.4%) and often serious. Immunotherapy is a low-cost, low-risk alternative to chemotherapy in localised cutaneous leishmaniasis, applicable by primary health services in rural areas.
Data from the 1973 and 1982 National Health Interview Surveys reveal increased use of routine medical examinations between the two survey dates. The proportion of adults age 40 or older who ever had a glaucoma test increased by 50 per cent. Other large increases were in the proportion of adults age 40 or older who ever had an electrocardiogram and in the proportions of women age 17 or older who ever had breast examinations or Pap smears.
Pulmonary effluent from infants who received exogenous human surfactant for severe respiratory distress syndrome was evaluated for inflammatory changes previously identified with lung injury during the first 2 weeks after birth. The number of pulmonary effluent inflammatory cells was higher only on day 1 in infants given surfactant. No other evidence of enhanced inflammation was detected in cytologic assessment of tracheal secretions. The classical pathway of complement was not activated in infants given surfactant or in control infants 2 weeks after birth. Albumin content of airway secretions was higher on the first day but not significantly altered on subsequent days. Human surfactant treatment was not associated with increased proteolytic activity, measured as neutrophilic elastase per milligram of albumin in lung effluent, but was associated with significantly higher alpha 1-proteinase inhibitor levels than in control infants from days 2 to 7 after birth. These findings provide evidence that exogenous human surfactant instilled into the lungs of preterm infants with severe respiratory distress syndrome is not associated with enhanced lung inflammation, compared with conventional mechanical ventilation alone. These data support additional clinical trials using human surfactant.
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Macrophages in culture secrete a variety of products including neutral protease activities such as plasminogen activator(s) (P.A.), collagenase and elastase. These products are not made by unstimulated macrophages, but only after induction by inflammatory stimuli, phagocytosis and lymphokines. Phagocytosis induces the prompt release of high levels of P.A. by endotoxin-primed macrophages and prolonged secretion follows uptake of non-degradable particles. Stimulation of lymphocytes results in the release of a supernatant product which enhances P.A. secretion by unstimulated mouse macrophages up to 5-fold. The production of the P.A. inducer (P.A.I.) is immunologically specific and is found in allogeneic mixed leukocyte culture (MLC) reactions, but not in syngeneic controls. The P.A. is also induced in activated macrophages from animals infected with BCG of T. cruzi and challenged with specific antigen. Production of the P.A.I. in MLC reactions depends on the presence of thymus-derived (T) lymphocytes and is closely correlated with the appearance of macrophage migration inhibition factor (MIF). The induction of macrophage P.A. and other proteases provides an important pathway for activating macrophages in delayed hypersensitivity reactions and could contribute significantly to tissue destruction in chronic inflammatory diseases in joints.
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