ABSTRACT
Following the discovery of a high school student with communicable tuberculosis, the Tulsa City-County Health Department skin tested 1,005 persons in the family, community, and school. Of the 931 persons tested at the school, 10 were reactors in March and 33 more were reactors in May. All 5 family members and 4 community contacts were tuberculin reactive. In all, 52 new tuberculin reactors were identified, evaluated, and considered for treatment or prophylaxis. This situation illustrates the conundrum that tuberculosis remains an important public health issue because of the possibility of transmission from small pockets of diseased persons to the larger community, especially in institutions of all kinds. Physicians and public health agencies must be vigilant and identify new cases for treatment and begin contact tracing to minimize the spread of tuberculosis.
Subject(s)
Tuberculosis, Pulmonary/epidemiology , Adolescent , Adult , Child , Contact Tracing , Humans , Middle Aged , Oklahoma/epidemiology , Tuberculosis, Pulmonary/transmissionSubject(s)
Histoplasmosis/diagnosis , Adult , Anti-Bacterial Agents/therapeutic use , Chronic Disease , Diagnosis, Differential , Drug Therapy, Combination , Histoplasma/isolation & purification , Histoplasmosis/drug therapy , Histoplasmosis/epidemiology , Histoplasmosis/microbiology , Humans , Lung/microbiology , Lung Diseases, Fungal/diagnosis , Lung Diseases, Fungal/drug therapy , Lung Diseases, Fungal/microbiology , Male , Mouth/microbiology , Mouth Diseases/diagnosis , Mouth Diseases/drug therapy , Mouth Diseases/microbiology , United States/epidemiologyABSTRACT
A case of disopyramide-associated cholestatic jaundice is presented, and all reported cases of disopyramide-associated liver dysfunction are reviewed. Manifestations of liver dysfunction usually appear during the first week of treatment. Discontinuing administration of the drug often results in prompt clinical resolution, although in rare instances, laboratory abnormalities persist up to 18 months. Physicians should be aware of this rare but serious complication of disopyramide therapy.
Subject(s)
Cholestasis/chemically induced , Disopyramide/adverse effects , Pyridines/adverse effects , Adult , Aged , Chemical and Drug Induced Liver Injury , Cholestasis/diagnosis , Humans , Male , Middle AgedABSTRACT
The use of clonidine in the management of opiate abstinence is presented in a patient dependent upon levorphanol tartrate given for chronic pain. Use of levorphanol was abruptly discontinued, and the patient was monitored for signs and symptoms of opiate withdrawal. He manifested a significant increase in pulse and blood pressure and had perspiration, agitation, and opiate-seeking behavior. Clonidine effectively abolished these signs and symptoms. The mechanism by which clonidine prevents the opiate abstinence syndrome is discussed. Clonidine is a safe and inexpensive means of achieving rapid opiate withdrawal.
