A morbidity survey of South African primary care.

Background: Recent studies have described the burden of disease in South Africa. However these studies do not tell us which of these conditions commonly present to primary care providers, how these conditions may present and how providers make sense of them in terms of their diagnoses. Clinical nurse practitioners are the main primary care providers and need to be better prepared for this role.

Antihypertensive and metabolic effects of concomitant administration of terazosin and methyclothiazide for the treatment of essential hypertension.

The efficacy and safety of once-daily 2.5- or 5.0-mg methyclothiazide (MCTZ) added to once-daily 5.

Prazosin versus captopril as initial therapy. Effect on hypertension and lipid levels.

A randomized, parallel group study evaluated the safety, efficacy, and effect of the alpha blocking agent prazosin and the angiotensin converting enzyme inhibitor captopril on serum lipid levels in patients with mild to moderate hypertension. Baseline evaluations were performed on 31 patients after a four-week placebo washout period. Patients were randomly assigned to receive either prazosin (n = 15) or captopril (n = 16).

Management of hypertension in patients with concomitant diseases.

The treatment of hypertension in patients with diabetes, obstructive airway disease, impaired renal function, or congestive heart failure (CHF) is discussed. Specifically, the value of alpha 1-adrenoceptor blocking agents in such patients is reviewed. An individualized approach to therapy is required, with careful consideration of the effects of different drugs on the existing metabolic and hemodynamic situation.

A comparison of prazosin versus nadolol in combination with a diuretic.

The comparative efficacy and effects on total body potassium of prazosin and polythiazide vs nadolol and polythiazide in the treatment of patients with mild to moderate essential hypertension unresponsive to diuretic alone were compared in an open, crossover trial involving 20 male patients. Both prazosin and nadolol reduced blood pressure to goal values in both study phases. Side effects were minor, and only 1 patient dropped out of treatment for reasons unrelated to the study drugs.

Effectiveness of prazosin as initial antihypertensive therapy.

After nearly 10 years in clinical use, prazosin has been shown in numerous studies worldwide to be an effective antihypertensive agent over the entire range of hypertension (mild, moderate, and severe), when used alone or in multitherapy. In addition to its general effectiveness, prazosin is particularly useful in specific subpopulations of hypertensive patients, such as those with impaired renal function, those on hemodialysis, and those with concomitant heart block, bronchospasm, diabetes mellitus, or disturbed carbohydrate metabolism, hyperlipidemia, or hyperuricemia. The side effects of prazosin are usually mild and transient and seldom require discontinuation of the drug.

Analgesic effects of oral nalbuphine and codeine in patients with postoperative pain.

Efficacy and safety of oral nalbuphine in doses of 15 and 45 mg were compared with those of the standard oral analgesic codeine in single doses of 30 and 90 mg in 153 patients with acute postoperative pain; data on 20 more patients were excluded because they received potentially interfering medications. All patients had pain ranging from moderate to severe in intensity and most had severe pain related to orthopedic procedures or trauma. Estimates of relative potency showed that nalbuphine was three times as potent as codeine.

National Cooperative Gallstone Study: nonprimate toxicology of chenodeoxycholic acid.

A program involving acute, subacute, and chronic toxicity as well as reproduction studies was performed to evaluate the potential toxicity of chenodeoxycholic acid in rats, hamsters, and dogs. Acute oral toxicity studies showed that there were some species differences and that female hamsters were more sensitive to toxic doses than male hamsters. Subacute and chronic studies in hamsters showed the toxicity to be limited to effects on the liver, including proliferation of intrahepatic bile ducts in portal areas with elevations of serum glutamic-pyruvic transaminase and glutamic-oxaloacetic transaminase.

Validation of a computer-assisted method for estimating the number and volume of gallstones visualized by cholecystography.

It is likely that in the near future there will be widespread use of medicinal therapy to dissolve gallstones. The efficacy of medicinal therapy can best be determined by attempting to relate the total surface area of a collection of gallstones to the composition of bile in patients undergoing therapy. Surface area, in turn, can be directly related to gallstone size and number.

Long-term antihypertensive therapy with prazosin plus a diuretic.

Prazosin was administered to 21 diuretic-treated mild hypertensives for intervals of 1 month to 1 year. Three patients dropped out of the study, one from side-effects, one from noncompliance and the third for relocation. At 1, 6, and 12 months of follow-up therapy, blood pressures were reduced by 9--12%.

An analgesic comparison study of indoprofen versus aspirin and placebo in surgical pain.

Single oral doses of 100 and 200 mg indoprofen were compared with 600 mg aspirin and placebo in a double-blind, completely randomized study of hospitalized patients with postoperative, post-fracture, or musculoskeletal pain. The patients evaluated their pain for 5 hours after administration of the study drug. Each of the three active treatments performed significantly better than placebo.

A double-blind study of tienilic acid with two year follow-up of patients with mild to moderate essential hypertension.

In a double-blind study, thirty patients having mild to moderate essential hypertension were randomly assigned to a six week regimen of either tienilic acid, hydrochlorothiazide, or placebo. Blood pressure was significantly reduced with tienilic acid and hydrochlorothiazide although more so with tienilic acid. Serum uric acid declined strikingly with tienilic acid and increased significantly with hydrochlorothiazide.

Ticrynafen and hydrochlorothiazide in hypertension.

In a double-blind study, 28 patients having mild to moderate essential hypertension were randomly assigned to a 6-week regimen of ticrynafen, hydrochlorothiazide, or placebo. Blood pressure fell after ticrynafen and hydrochlorothiazide. Serum uric acid fell strikingly with ticrynafen whereas it rose with hydrochlorothiazide.

Feasibility of low-dose and intermittent chenodeoxycholic acid therapy of gallstones.

Chenodeoxycholic acid, by reducing the concentration of biliary cholesterol relative to that of bile acid and phospholipid, dissolves cholesterol gallstones. This bile acid, however, has potential dose-related hepatotoxicity and causes dose-related diarrhea. Therefore, the feasibility of low-dose and intermittent therapy was assessed by studying the induction and persistence of chenodeoxycholic acid-induced biliary lipid changes.

Double-blind comparison of triamterene plus hydrochlorothiazide and spironolactone plus hydrochlorothiazide in the treatment of hypertension.

The results from this double-blind, multi-investigator study showed that a combination of 50 mg triamterene plus 25 mg hydrochlorothiazide and a combination of 25 mg spironolactone plus 25 mg hydrochlorothiazide were equally efficacious in lowering blood pressure in hypertensive outpatients, and that they produced the same type and incidence of adverse effects. Likewise, the two drug combinations produced similar effects on blood chemistry and hematology. There were no significant differences between the two combination drugs in efficacy laboratory studies, or adverse effects.

Long-term efficacy and safety of prazosin in essential hypertension.

The long-term efficacy and safety of prazosin plus a thiazide diuretic in severe hypertension has been evaluated in an open trial that is now in its fifth year. The combination is consistently effective in reducing diastolic blood pressure to 90 mm Hg or less. No side effects or adverse reactions have been observed except a "first-dose" fall in blood pressure, and there is no evidence of development of tolerance to the agent.