PubMed Health⌕ Search

Biomedical subjects

C M Stein

Publications and source records attributed to C M Stein.

At least 73 records · Page 4Linked to original sources
PubMed1992

Antihypertensive effects of low doses of hydrochlorothiazide in hypertensive black Zimbabweans.

The antihypertensive effects of low doses of hydrochlorothiazide have not been examined in black African hypertensive patients although hydrochlorothiazide is commonly used as first-line therapy. The antihypertensive effects of hydrochlorothiazide in a daily dose of 6.25, 12.5, 25 and 50 mg were examined in 19 black Zimbabwean hypertensive patients in a double-blind, random order, placebo-controlled, cross-over trial. The mean systolic blood pressure on placebo was 170.2 mmHg (95% CI +/- 9.0 mmHg) and on daily doses of hydrochlorothiazide decreased to: 161.1 mmHg (95% CI + 10.0 mmHg) on 6.25 mg; 156.6 mmHg (95% CI +/- 8.6 mmHg) on 12.5 mg; 154.9 mmHg (95% CI +/- 8.5 mmHg) on 25 mg and 149.1 mmHg (95% CI +/- 9.2 mmHg) on 50 mg. The mean diastolic blood pressure on placebo was 101.4 mmHg (95% CI +/- 5.0 mmHg) and decreased to: 98.0 mmHg (95% CI +/- 5.7 mmHg) on 6.25 mg; 96.1 mmHg (95% CI +/- 4.5 mmHg) on 12.5 mg; 93.6 mmHg (95% CI +/- 5.3 mmHg) on 25 mg and 90.5 mmHg (95% CI +/- 3.9 mmHg) on 50 mg. Hydrochlorothiazide in doses of 25 mg and 50 mg decreased systolic and diastolic blood pressure and the 12.5 mg dose decreased systolic blood pressure significantly more than placebo. We conclude that in this population maximum antihypertensive effect is not seen with the lower doses of hydrochlorothiazide and 25 mg is an appropriate starting dose for most patients.

Adult↗
PubMed1992

Value of the history and stool occult blood test in selection of patients for upper endoscopy in Zimbabwe.

Patients with abdominal pain and no definite diagnosis referred for endoscopy were studied to define discriminating features in the history, and the value of a stool occult blood test, in predicting the presence of upper gastrointestinal disease. Endoscopy was performed in 116 patients; pathology was seen in 32 (duodenal ulcer 17, gastric carcinoma 4, gastric ulcer 3, miscellaneous 8) and no pathology was seen in 84 patients. Features that predicted upper gastrointestinal pathology were, in descending order of rank: a positive pointing sign, a positive stool Fecult test, a history of vomiting, loss of weight, and alcohol intake. Using these discriminating features together it was possible to correctly predict 95% of patients with abnormal endoscopy and 82% of patients with a normal endoscopy. The history and the stool occult blood test are useful predictors of the presence of upper gastrointestinal pathology and may aid rational selection of patients for endoscopy.

Endoscopy, Gastrointestinal↗
PubMed1991

A prospective analysis of patients with rheumatic diseases attending referral hospitals in Harare, Zimbabwe.

In a 10-month prospective study a research assistant identified 411 patients with rheumatic disease at the 2 referral hospitals in Harare. Rheumatic disease accounted for less than 1% of hospital admissions. Rheumatoid arthritis, the commonest condition, accounted for 18% of patients, many of whom had impaired functional capacity. Septic arthritis (16%) was common in younger patients, often affecting the hip or knee and often associated with other complications of disseminated staphylococcal infection. Osteoarthritis (9%), rheumatic fever (7%), gout (6%), human immunodeficiency virus associated musculoskeletal problems (6%) and systemic lupus erythematosus (5%) were relatively common while the spondyloarthropathies occurred less frequently. The spectrum of rheumatic disease seen in teaching hospitals in Harare, although significantly different from that seen in Europe and North America, approximates the pattern seen in developed countries more closely than previous studies from Africa would suggest.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Behçet's disease associated with HIV infection.

The cooccurrence of Behçet's disease and human immunodeficiency virus infection is described in a 33-year-old man who died. If this is not a chance occurrence, then either the constellation of signs that characterize Behçet's disease may be simulated by complications of HIV infection, or else HIV infection causes, or predisposes to, a Behçet's-like illness.

Adult↗
PubMed1990

Combination of a thiazide, a vasodilator and reserpine compared with methyldopa plus hydrochlorothiazide in the treatment of hypertension in Zimbabwe.

Brinerdin (Sandoz), a combination of a diuretic (clopamide 5 mg), a vasodilator (dihydro-ergocristine 0.5 mg) and reserpine (0.1 mg) (CDR) was compared with methyldopa (MD) plus hydrochlorothiazide (HCT) for antihypertensive effect, adverse reactions, compliance and patient preference in an open cross-over trial. Eighteen patients completed both arms of the trial and 5 patients who completed the CDR arm were withdrawn while on the MD arm because of adverse effects in 4 and poor control in 1. On HCT 50 mg daily the mean baseline systolic blood pressure was 163.9 +/- 16.3 mmHg and the diastolic blood pressure was 105.9 +/- 6.7 mmHg. On CDR these were reduced to systolic blood pressure 140.3 +/- 15.1 mmHg and diastolic blood pressure 87.8 +/- 9.3 mmHg. On MD + HCT the systolic blood pressure was reduced to 138.5 +/- 16.9 mmHg and the diastolic blood pressure to 88.9 +/- 10.3 mmHg. The differences between the two treatment periods in systolic blood pressure (1.8 mmHg; 95% confidence interval (CI) - 4.1 + 7.7 mmHg) and diastolic blood pressure (1.1 mmHg; 95% CI - 4.6 + 2.4 mmHg) were not significant with P values of 0.6 and 0.7 respectively. Compliance was 98.2% for CDR and 94.7% for MD + HCT (P = 0.02). Unusual sleepiness occurred more frequently in the MD arm (P less than 0.01). Thirteen patients chose to continue on CDR, 2 on MD + HCT and 3 had no preference (P = 0.005). CDR is similar in antihypertensive effect to MD + HCT but is better tolerated with fewer withdrawals, fewer adverse effects, better compliance and has more patients electing to continue taking it.

Adult↗
PubMed1990

Chemoprophylaxis of bacterial endocarditis--a survey of current practice in Zimbabwe.

There is no information about the use of antibiotics in the prevention of bacterial endocarditis in a developing country. A questionnaire was posted to 73 dentists, 233 general practitioners and 43 physicians. Completed questionnaires were received from 31 (42%) dentists, 59 (25%) general practitioners and 15 (35%) physicians. Prophylactic practice differed from the current published recommendations in the choice of drugs, dosage regimens, and a longer duration of use before and after invasive procedures. Wider dissemination of authoritative recommendations would simplify current practice.

Anti-Bacterial Agents↗
PubMed1990

Therapeutics review: the use of parenteral drugs for falciparum malaria.

Recent studies on the pharmacokinetics of parenteral chloroquine and quinine have resulted in safer regimens for the treatment of severe falciparum malaria. In this article we summarise these regimens, and discuss the emergence of chloroquine resistance and the implications for treatment.

Animals↗
PubMed1989

Self-medication in urban and rural Zimbabwean communities.

1. A questionnaire examining the use of, and knowledge about over-the-counter (OTC) drugs was administered verbally to representatives from 200 urban and 200 rural households. Self-medication was common in both groups but there were more drugs present in rural (336 items) than urban homes (231 items) with the differences largely due to the more frequent presence of traditional medicines in rural homes. 2. Analgesics were the commonest items in the homes of both groups. A positive urine screening test for aspirin, chloroquine, or antibiotics was found in 25% of urban and 27% of rural samples tested. Respondents who elected to use an OTC drug for a particular symptom usually chose an appropriate drug. 3. Rural respondents were more likely to use traditional medicines particularly for the treatment of cough, abdominal pain, and diarrhoea. 4. Knowledge about dosages, the possibility of adverse reactions, and the seriousness of potential poisoning with OTC drugs was inadequate and needs to be corrected for more efficient self-medication.

Adult↗
PubMed1989

Lack of effect of paracetamol on the pharmacokinetics of chloramphenicol.

The effect of oral paracetamol (1 g) on the pharmacokinetics of oral chloramphenicol (500 mg) was examined in five adult male Zimbabwean patients with normal hepatic and renal function. No significant alteration of half-life, area under the concentration-time curve or peak concentration of chloramphenicol was observed. The previously reported, potentially serious interaction between chloramphenicol and paracetamol administered intravenously was not observed with the more commonly used oral preparations.

Acetaminophen↗
PubMed1989

Extreme elevation of the erythrocyte sedimentation rate in patients admitted to a general medical ward in Harare, Zimbabwe.

A prospective, 1-year study was performed to determine the causes of an ESR greater than or equal to 100 in patients admitted to a general medical ward in Harare, Zimbabwe. An ESR greater than or equal to 100 was found in 101 (12%) patients. Infection (46 patients) was the commonest cause, followed by malignancy (25), connective tissue disease (17), renal disease (8) and liver disease (5). The frequency of an ESR greater than or equal to 100 in these diagnostic groups was infection (28%), malignancy (44%), connective tissue disease (71%), renal disease (30%) and liver disease (24%). Pneumonia was the commonest infection diagnosed and the commonest cause of a markedly elevated ESR. Although myeloma was only the second commonest malignancy diagnosed it was the commonest malignancy causing an ESR greater than or equal to 100. In the largest group, infection, there was a significantly increased mortality in patients with an ESR greater than or equal to 100.

Bacterial Infections↗
PubMed1988

Clinical effect of admission chest X-rays in Zimbabwe.

The independent effect of admission chest X-rays on clinical management of 432 consecutive patients admitted to general medical wards was prospectively evaluated. Diagnosis, investigations, and treatment were recorded on the basis of clinical findings alone. A chest X-ray was then taken and clinical effect measured by the resultant changes. Although 226 (53%) admission chest X-rays were abnormal, only 9% changed management. In patients with no clinical evidence of cardiorespiratory disease ("routine" X-rays, n = 214) the clinical effect was slight; management was changed in 5% and patient benefit resulted in 1.4%. Clinical effect was greatest in patients (n = 172) with definite signs of new cardiorespiratory illness (altered management 14%, patient benefit 6%) and patients (n = 34) with "possible" chest disease (altered management 9%, patient benefit 9%). Omission of admission chest X-rays in patients with no clinical evidence of chest disease, those with clinically stable, known chest disease, and those with isolated cardiomegaly or hyperinflated lungs would result in a 60% reduction in the number of admission chest X-rays.

Adult↗
PubMed1988

Drug use before hospital admission in Zimbabwe.

Drug use before hospital admission was studied prospectively in 284 consecutive patients admitted to general medical wards in Zimbabwe. Drugs were used by 84% of patients. Self-medication was used by 143 (50%) patients, aspirin (54%) and chloroquine (17%) being the most commonly used drugs. Traditional medicines were used by 55 (19%) patients. Drugs dispensed from orthodox medical sources were taken by 128 (45%) patients. Analgesics (22%), antibiotics (18%), and chloroquine (13%) were the commonest drugs dispensed. Urine screening tests were performed and were positive for aspirin in 37% of cases, chloroquine (33%), and antibiotics (20%). Adverse drug reactions requiring hospital admission occurred in 14 patients (10 orthodox medicines, 4 traditional medicines). Drug use before hospital admission, which is often poorly documented, is a source of potential drug toxicity and may obscure a diagnosis of infective illness.

Analgesics↗
PubMed1988

Self-medication with chloroquine for malaria prophylaxis in urban and rural Zimbabweans.

Representatives of 200 urban and 200 rural households were interviewed to determine the extent and appropriateness of the use of chloroquine obtained over-the-counter for malaria prophylaxis. Malaria prophylaxis was taken by 38 urban and 65 rural respondents. Chloroquine was the only drug used and was found in 7 urban and 40 rural households. The presence of chloroquine was detected in 4/130 urban and 11/136 rural urine samples tested. Knowledge about chloroquine was unsatisfactory with 6 urban and 10 rural respondents aware that chloroquine could have harmful adverse effects. The doses of chloroquine taken for prophylaxis varied widely, and of the 103 respondents who took prophylaxis only 16% (urban) and 31% (rural) were taking the correct dose. Self-medication accounts for a substantial, little acknowledged, portion of chloroquine use. To limit appropriate use of a powerful, potentially dangerous antimalarial drug and perhaps extend the useful therapeutic life of chloroquine clear recommendations and population education are needed.

Adolescent↗
PubMed1987

Acute tropical polyarthritis in Zimbabwe: a prospective search for a gonococcal aetiology.

Fifteen consecutive patients with acute arthritis were studied. Careful culture and microscopy of swabs from mucosal sites were performed to examine the hypothesis that the acute tropical polyarthritis commonly seen in Zimbabwe is due to undiagnosed gonococcal infection. Rheumatic fever and Reiter's disease accounted for two cases each. Gram negative intracellular diplococci were found in three patients who would otherwise have been diagnosed as having tropical polyarthritis. Except for two of the remaining eight patients, who had raised anti-streptolysin O titres suggesting recent streptococcal infection, no explanation for the arthritis was found. The clinical entity of tropical polyarthritis may not be due to a single aetiological agent.

Acute Disease↗