Showing papers in "West Indian Medical Journal in 1995"

Tropical spastic paraparesis occurring in HTLV-1 associated infective dermatitis. Report of two cases.

Abstract: An association between HTLV-1 infection and infective dermatitis (ID) a relapsing eczematous condition of Jamaican children, was reported in 1990. These patients are at risk of developing other known HTLV-1 related diseases. We have observed the development of HTLV-1 associated myelopathy/tropical spastic paraparesis in two patients, ages 14 and 35 years, who were diagnosed with ID at ages 2 and 10 years, respectively. Infective dermatitis of children serves as an early marker of HTLV-I infection and may predict later development of either the malignant outcome, adult T-cell leukaemia/lymphoma or the neurologic manifestation HAM/TSP among adult carriers of HTLV-1 infection.

Testosterone deficiency and extreme retardation of puberty in homozygous sickle cell disease

Abstract: Homozygous sickle-cell (SS) disease is associated with retardation of physical and sexual development but most Jamaican SS children commence their adolescent growth spurt before 16 years of age. Analysis of growth data from children in the Jamaican Cohort Study noted extreme growth retardation, defined as absence of the adolescent growth spurt and pre-pubertal sexual development (Tanner stage 1 or 2) at age 16 years, in 8/52 (15%) SS boys. These and two boys from the general sickle-cell clinic with a similar growth pattern provided a study group of 10 boys who were investigated for a possible endocrine explanation for their extreme retardation of physical maturation. A sub-optimal testosterone response (< 10 nmol/l) to human chorionic gonadotrophin and an exaggerated gonadotrophin response to gonadotrophin hormone releasing hormone was consistent with poor testicular function in 5 boys. Retardation of adolescent growth and development is common in boys with SS disease but, when extreme, requires early investigation to identify potentially correctable mechanisms.

Acute carpal tunnel syndrome secondary to thrombosis of a persistent median artery

Abstract: An unusual case of thrombosis of a persistent median artery as a cause of acute carpal tunnel syndrome is reported. The sudden onset of numbness in the median nerve distribution and pain in the fingers were the main symptoms. The embryonic development of the median nerve vascular supply and the reported incidence of persistent median artery are reviewed.

Attitudes of medical students toward the acquired immune deficiency syndrome (AIDS).

Abstract: Several studies have reported negative attitudes toward AIDS patients, homosexuals and drug abusers among physicians, nurses, and health workers in training. To examine attitudes towards AIDS of a group who in the near future would be practising physicians in the Caribbean, medical students at the Cave Hill Campus of the University of the West Indies were surveyed regarding their attitudes toward AIDS. This paper analyses responses to 21 Attitude Items with reference to five primary areas related to AIDS: Testing for HIV, Homosexuality, Fear of Contagion, Comfort in Interacting with AIDS Patients, and Intention to care for Persons with AIDS. The analysis indicates that these students were all not comfortable with issues related to homosexuality, and there was wide variation and some inconsistency in opinions regarding controversial and contentious issues. Most of these students, regardless of their choice of specialty after graduating, will eventually come into contact with an HIV-positive individual or an AIDS patient. There is a distinct possibility that biases and misperceptions held during the period of training are at risk of being carried over into clinical practice, resulting in unwillingness, or even refusal, to treat certain types of patients. What has also become evident is that emphasis should be placed on ethical and attitudinal training within the Faculty of Medical Sciences. Our future doctors have to be trained to effectively manage the many psycho-social, ethical, and legal problems that will be generated by the AIDS epidemic. What is urgently needed, therefore, is relevant curriculum design and development in the area of AIDS Education directed at the region's future physicians.

Prevalence of antibodies to hepatitis C virus and other markers in Jamaica.

Abstract: Three population groups, 1500 blood donors, 513 antenatal women representing a normal population group and 250 sicklers representing a multiply transfused group were studied to determine the prevalence of hepatitis C viral (HCV) infection in Jamaica The relationship to liver enzyme levels, hepatitis B infection, syphilis and HIV infection was also investigated Sera were screened by enzyme-linked immunoassay (EIA) for anti-HCV C100-3 and subsequently tested by a supplementary second generation recombinant immunoblot assay (RIBA) In the blood donors, the prevalence of anti-HCV was low, 03%-04%, the same level as that reported by several European countries In the multiply transfused sicklers, the prevalence was more than seven times higher No HCV infection was detected in the antenatal group There was little correlation between HCV infection and surrogate markers alanine aminotransferase (ALT) and antibody to hepatitis B core antigen (anti-HBc) and no correlation with sexually transmitted diseases

Prevalence of exercise-induced asthma in schoolchildren in Kingston, St. Andrew and St. Catherine, Jamaica.

Abstract: A cross-sectional study was done, focusing on the prevalence of exercise-induced asthma in Jamaica and variables that may account for this rate. No previous study of this nature had been undertaken, and the investigators contend that there is a need to identify children who suffer from this condition but are unaware of it. A sample of 214 students from primary and secondary schools in the Corporate Area were chosen and given questionnaires to complete. Eighty-four of the children reported a history consistent with that of exercise-induced asthma and were further subjected to stress testing for a definitive diagnosis of this condition. A prevalence of 20.8% [C.I. +/- 5.35] was identified which reflected a rate comparable to that recorded in North America. There was a significantly higher prevalence in children of primary school ages, but all other variables considered for significance testing to determine associations between these and the prevalence of EIA proved not significant. A recommendation has been made for opportunity screening by medical practitioners.

A pilot study of alcohol and drug-related traffic accidents and death in two Jamaican Parishes, 1991

Abstract: This study is a preliminary effort to document the role of drugs in motor vehicle accidents as it examines the presence of alcohol, marijuana and cocaine in blood samples of thirty-one motor vehicle fatalities. The study identified that males (90.3%) and pedestrians (41.9%) were killed most often. Evidence of alcohol intake was found in 77.5% of the fatalities and 35.5% had alcohol levels above the legal acceptable limits. Traces of marijuana were found in 22.5% and a combination of alcohol and marijuana in 22.5% of the victims.

Congenital solitary non-parasitic cyst of the liver.

Abstract: Although non-parasitic cysts of the liver have often been described in adults, solitary non-parasitic cysts are rare in infants. We report a 17-month-old child with a large hepatic cyst.

Is under-reporting of AIDS a problem in Jamaica?

Abstract: A survey of physicians in Jamaica was conducted between March and September, 1993 in order to estimate the level of reporting of HIV and AIDS. A questionnaire was delivered to nearly all of approximately 1,200 physicians practising in Jamaica. Completed questionnaires were received from 418, a response rate of 35%. Of the physicians responding, 46% were in private practice only, 22% in the public sector only and 32% in both. Two-thirds (66%) of the physicians in private practice had not diagnosed a case of AIDS and 65% had not had a patient with a positive HIV test result. Half (54%) of the private physicians had reported all their AIDS cases, 8% had reported some and 38% (45 doctors) had reported none. The main reasons for not reporting were: "thought someone else had reported" (15 doctors), concern for confidentiality (11) and not knowing where to report (8). Only 9% of private practitioners were currently seeing an AIDS patient and 12% were seeing an HIV-infected person. Of physicians with current AIDS patients 16% preferred not to report, 21% intended to report and 63% had reported. Nearly one-third (29%) of private practitioners expressed reservations about treating persons with HIV/AIDS. Most (75%) public sector physicians had seen one or more AIDS patients. Sixty-four per cent of these physicians said that all of their AIDS cases were reported, 4% said some, 4% said none and 28% didn't know. Reporting of AIDS cases is better in the public sector than among private physicians.(ABSTRACT TRUNCATED AT 250 WORDS)

A scoring system for use in the diagnosis of acute abdominal pain in childhood.

Abstract: A statistical analysis was undertaken of 1158 children admitted to a surgical ward for the management of acute abdominal pain. Over two-thirds (40%) of the children had non-specific abdominal pain while 29.7% had appendicitis. The remainder were found to have had urinary tract infections (11.7%), constipation (7.5%), gastroenteritis (5.8%) or intussusception (5.3%). A stepwise discriminant analysis of the data collected during their evaluation was performed, using the BMDP statistical software package. Demographic and clinical features, as well as the results of ancillary investigations, were included in the data. The programme generated a classification function of a sub-set of 18 variables which best discriminated among the diagnostic groups. The coefficients of the classification functions were then combined with the rank order of selection of the variables to derive a scoring method for predicting the diagnosis. The results of urine culture were excluded since these would be unavailable during early clinical assessment. The scores for the diagnostic groups fell within the following ranges:-1-23 Non-specific abdominal pain; 20-48 appendicitis; 35-84 Gastroenteritis; 75-88 Constipation and 89-140 Intussusception. It is suggested that this scoring method be evaluated by a prospective study to test its validity.

Socio-biological associations of bacteriuria in pregnancy.

Abstract: The prevalence and socio-biological relations of bacteriuria in Trinidadian pregnant women were investigated. The prevalence of bacteriuria was found to be 16.7% and it was more common in the 30-39 year age group, among parous women, among Negroes, and in patients with a low family income and overcrowded living conditions. Symptoms were present in 19% of bacteriuric patients and almost one-third gave a past history of urinary tract infection. Only 10% had been previously exposed to sexually transmitted diseases such as syphilis, gonorrhea and herpetic genital infections. Because of the serious consequences to mother and foetus, we advocate quantitative urine cultures for all antenatal patients, especially those coming from disadvantaged socio-economic conditions.

Genital tract infections in sexually active women in Barbados.

Abstract: Ninety-eight women attending three different clinics were prospectively studied for the presence of genital tract infections, including Chlamydia trachomatis. Of these 98 women, 35 were presenting to a polyclinic with symptoms of genital tract infection, 55 were attending an antenatal clinic for their first visit, and 8 referred to a colposcopy clinic because of an abnormal Papanicolaou smear were included. Gonorrhoea was detected in one patient, syphilis in two, and Trichomonas vaginalis in six. Candida albicans and Chlamydia trachomatis were each detected in 18 patients, while the most common condition was bacterial vaginosis, detected in 35 patients. The prevalence of these infections was lowest in patients referred for colposcopy and highest in the women attending the antenatal clinic. Chlamydia trachomatis was the most common sexually-transmitted pathogen detected in this population. These data emphasise the need for an aggressive approach to the diagnosis and treatment of chlamydial infection in females.

Systemic lupus erythematosus, rheumatoid arthritis and HLA phenotypes in Jamaicans.

Abstract: The HLA phenotypes were investigated in 30 Jamaican patients with Systemic Lupus Erythematosus (SLE), 30 with Rheumatoid Arthritis (RA) and 40 healthy controls. HLA phenotypes were determined by the microcytoxicity technique, using commercially prepared typing trays. In this study, the HLA phenotypic associations with SLE (HLA-B14, RR 4.3: HLA-A28, RR 4.3) were not statistically significant. However, a statistically significant lack of HLA-A9 (p < 0.01; CP < 0.1) was observed in SLE patients compared to healthy controls. In RA patients, a statistically significant association was noted with HLA-A2 (RR 5.1; CP < 0.01). No HLA class II associations were noted with SLE. Class II associations with RA did not achieve statistical significance but included those previously established in other populations. The preliminary data obtained from this study indicate differences in the patterns of HLA phenotypes in Jamaican patients with SLE and RA compared to those observed in such patients elsewhere. Further studies involving larger groups of patients and typing at the serological, cellular and molecular levels are clearly warranted.

Asymptomatic cardiac involvement in systemic lupus erythematosus.

Abstract: Cardiologic and laboratory parameters were studied in 21 patients with systemic lupus erythematosus (SLE) with cardiopulmonary symptoms (CPS), 20 SLE patients without CPS and 45 age- and sex-matched healthy controls. The most frequent cardiac abnormalities in patients with CPS included pericardial effusion (24%), ventricular enlargement (20%), mitral regurgitation (19%) and tricuspid regurgitation (14%). No structural abnormalities were observed in SLE patients without CPS. Mean calculated and derived echocardiographic values in both groups of SLE patients differed significantly from those observed in normal controls (p < 0.004). Patients with CPS had significantly lower mean values of ejection fraction (p < 0.05) and fractional shortening (p < 0.03). However, the frequencies of functional abnormalities in patients with CPS did not differ significantly from those observed in patients without CPS. There were no remarkable laboratory findings in SLE patients with CPS compared to those without. The finding that some SLE patients may have functional cardiac abnormalities in the absence of CPS is an important one. It raises the question as to whether asymptomatic cardiac involvement in SLE is a separate entity or whether it heralds symptomatic cardiopulmonary involvement.

Management of penetrating abdominal injuries.

Abstract: One hundred and twelve patients with penetrating abdominal injuries seen at the Kingston Public Hospital, Jamaica, over a twelve month period from January 1 to December 31, 1992 were reviewed. Seventy-five (67%) patients had stab wounds and thirty-seven (33%) sustained gunshot wounds. There were 10 deaths (27%) from gunshot wounds, and seven deaths (9%) due to stab wounds. Using a protocol of selective conservatism for stab wounds, 41 (60%) were observed, 27 (40%) explored and 5 (12%) patients had negative laparotomy. The male to female ratio was 10:1 with 88% in the age group 16-35 years. A decision to perform laparotomy was based entirely on clinical diagnosis of peritonitis. In gunshot wounds a policy of mandatory laparotomy was used and is recommended.

Aetiology of vaginal infections in pregnant and non-pregnant women in Barbados.

Abstract: The aetiology of vaginal discharge was studied in 175 Barbadian women. Pregnant women accounted for 52% (91) of the population studied. Candida albicans was detected in 45% of the women, bacterial vaginosis in 28% and Trichomonas vaginalis in 8.6%. Bacterial vaginosis was more common in non-pregnant women (33% vs 23%) whereas C. albicans was more common in pregnant women (49% vs 39). T. vaginalis was found with almost equal frequency in pregnant and non-pregnant women. Mixed infections were found in 10 women and an aetiological agent was detected in 75% of the women studied. These data emphasize the need for laboratory investigation of vaginal discharge since each of these infections can be treated effectively with specific agents.

Primary aortoenteric fistula.

Abstract: One hundred and thirty-eight patients with abdominal aortic aneurysms were treated by aneurysmorrhaphy over an eleven-year period. Six patients, all male and aged 60-74 years, were found to have developed primary aortoenteric fistulae. Four patients presented with bleeding into the gastrointestinal tract in association with a tender abdominal swelling. In the other two cases, the aneurysm was discovered at emergency laparotomy for gastrointestinal haemorrhage. The presence of the fistula was confirmed at operation in five patients and at autopsy in one. Two patients died, one from a massive gastrointestinal haemorrhage prior to surgery, the other from sepsis complicated by Adult Respiratory Distress Syndrome and renal failure following operation.

Cutaneous furuncular myiasis in a Jamaican resident.

Abstract: Data are presented on a case of cutaneous furuncular myiasis in a Jamaican resident. This condition is virtually unknown in the Caribbean, but is endemic in Central and South America. The infection, which was caused by Dermatobia hominis, was acquired in Belize and was misdiagnosed and treated as infected insect bites. Cutaneous furuncular myiasis should be considered in patients with sub-acute inflammatory nodular skin lesions with a history of recent travel to endemic countries.

Amniotic fluid index in the management of the postdates pregnancy.

Abstract: This is a prospective evaluation of the relationship between the amniotic fluid index (AFI) and perinatal outcome in 55 postdates pregnancies. The gravid abdomen was divided into four quadrants, using real-time ultrasound with a 3.5 mHz transducer, the largest pocket of amniotic fluid in each quadrant was measured and their sum totalled to arrive at the amniotic fluid index. AFI in this study ranged from 2.8 cm to 22.6 cm. The mean for 41 weeks was 13.52 +/- 4.6 cm and for 42 weeks, 9.93 +/- 4.37 cm. Oligohydramnios was noted in four patients, AFI less than 5.3 cm. Two of these cases developed intrapartum foetal distress and had Caesarean Section. All four babies were admitted with meconium aspiration and one died from this complication.

Writing a scientific paper.

Abstract: There are many varieties of medical writing. This paper suggests a sound, practical approach for writing up a research project in the conventional format for a medical or scientific journal. The structure of a scientific paper is well established, to accommodate the "Why" of the project (the Introduction), the "Who, when, where and how" (the Methods) and the "What" (the Results). The Discussion (the "So what") should be in three parts--discussion and explanation of results, disputation, and disquisition (implications for practice and for future work). Guidelines are given for getting started and for producing a paper that will, hopefully, be published and read.

Sertoliform variant of endometrioid carcinoma of the ovary.

Abstract: Although endometrioid carcinoma constitutes the second most common type of primary ovarian adenocarcinoma, the sertoliform variant is rarely encountered. We describe a case of this rare ovarian carcinoma which mimics a Sertoli cell tumour in its pathological appearance.

Ultrastructure of voluntary muscle in childhood malnutrition.

Abstract: This paper is part of a study on the electron microscopy of protein-energy malnutrition, using a rapid autopsy protocol. Samples of voluntary muscle, obtained from eight children dying of severe oedematous malnutrition, were fixed in glutaraldehyde within 75 minutes of death. Atrophy of myofibres, increased prominence of satellite cells, and segmental necrobiosis were seen by light microscopy. Electron microscopy showed variable depletion of myofibrils. In the most severe case, there was focal absence of myofibrils, also disorganized Z lines, and absent M bands. Residual atrophic myofibrils measured less than 0.1 micron in width. Other specimens showed sarcomere disorganization, mitochondrial swelling, glycogen depletion, sarcoplasmic oedema, and focal contractions of sarcomeres. Though non-specific, rigor may be accelerated by free radical damage, calcium release into the cytosol, and low supplies of high-energy phosphates. These conditions may exist in severe malnutrition, complicated by terminal infection and metabolic disturbances.

Malignant triton tumour of the spine: a case report.

Abstract: A malignant triton tumour is a malignant schwannoma with rhabdomyoblastic differentiation, and is a very rare occurrence. We describe the case of a 33-year-old man with neurofibromatosis type 1 who presented with paraplegia. Pathological examination of an intradural, extramedullary tumour excised at lumbar laminectomy demonstrated a malignant schwannoma with rhabdomyoblastic differentiation. We believe this is the first documented case of a malignant triton tumour of the spine.

Pharmacoeconomics of intravenous antibiotic use in serious infection

Abstract: A pharmacoeconomic study of 15 antibiotics available in Barbados was performed. The antibiotics studied were amoxycillin/clavulanate, ampicillin, ampicillin/sulbactam, cefazolin, cefotaxime, ceftazidime, ceftriaxone, clindamycin, cloxacillin, cotrimoxazole, gentamicin, imipenem, metronidazole, piperacillin, piperacillin/tazobactam, and vancomycin. The costs of use of these compounds were calculated for a five-day course using a formula comprising eight categories: antibiotic purchase cost, maintenance of intravenous access, drug delivery cost, drug monitoring cost, dose readjustment, general monitoring cost, 'sharps' disposal cost and adverse effects. The costs of adverse effects were not included in this study due to lack of accurate data. The total cost of antibiotic use (in U.S. dollars) ranged from $42.52 to $463.73 per five-day course. Generic compounds were less expensive ($45.52 - $98.23) than brand-name compounds ($106.18 - $106.18 - $463.73). Antibiotic purchase costs accounted for proportions of total costs ranging from 7 to 93%. Non-drug costs represented a much greater proportion of total costs of generic compounds. For most compounds the non-drug costs were related to the frequency of dosing, but for gentamicin the non-drug costs were relatively higher because of the need for monitoring of serum gentamicin levels. Efficacy and freedom from side-effects will remain the most important determinants in the choice of antibiotic therapy. However, pharmacoeconomic analyses can provide prescribers with the information required to make cost-effective choices for treatment of their patients.

Pre-operative autologous blood donations. A five-year experience in Trinidad and Tobago.

Abstract: A pre-operative autologous blood donation programme was started in 1988 and made available to all doctors offering elective surgical procedures. Two hundred and seventy-seven (277) patients presented for autologous donation over a five-year period. Nine point four per cent were rejected because of low haemoglobin ( < 10.5 g/dl). The single biggest user of the programme was the Princess Elizabeth Hospital for handicapped persons. Patients undergoing orthopaedic procedures gave 50% of the donations, and ranged in age from 10 to 73 years. The oldest donor was a 73-year-old man who had an abdominal aortic aneurysm replaced. Gynaecological surgeons in the public and private sectors together provided 43.9% of donors, 3.6% of these underwent elective Caesarean Section, each donating one unit of blood at 36 weeks. Patients undergoing general surgical procedures comprised 10.4% of donors. Autologous donors contributed 1.3% of the total number of donations over this period.

Cytomegalovirus infection in renal transplantation.

Abstract: Three case reports of Cytomegalovirus (CMV) disease in seronegative renal transplant recipients of seropositive donor kidneys are presented. Clinicians need to have a high index of suspicion for CMV disease in such patients. Early diagnosis and treatment are essential to decrease morbidity and mortality. Prophylaxis with antiviral and/or CMV-hyperimmunoglobulin may decrease the incidence of serious infection.

Peptic ulcer disease and Jamaican patients' awareness of their disorder.

Abstract: In the management and prevention of recurrence of peptic ulcer disease, patients' awareness of their disorder is essential. Fifty-one patients with peptic ulcer disease were studied regarding their awareness of their disorder and compliance with medications. There were 30 women and 21 men with a mean age of 45 years. Thirty-five per cent had secondary school education; 22% had tertiary training and 10% had no formal education. Sixty-three per cent of patients knew their ulcer location but 37% were unaware of their diagnosis. Twenty-nine per cent received most of their information from their pharmacists. Twenty per cent of patients smoked cigarettes; 31% drank alcohol, and 14% took non-steroidal analgesics. Seventy-six per cent thought that poor eating habits were a contributory cause of their ulcer; 39% thought that stress was a cause and 16% implicated heredity. Seventy-six per cent of patients took their medications daily, and 24% only when symptomatic. Jamaican patients' awareness of their ulcer disease is inadequate. There is a need for more physician education of their patients as well as public health promotion about peptic ulcer disease.

The ageing of the population--a time for action. The role of public health.

Abstract: The past two decades have witnessed the growth of the over-60, "elderly" population both in numbers and life expectancy. Similarly, there has been a shift in overall morbidity from acute to chronic causes and associated lifestyle factors. The increasing elderly population provides health care planners with new challenges at a time of decreasing resources. The public health approach, which equally stresses the responsibility of the individual, the family, the community and health care providers, is suggested as the starting point for addressing the issue.

Plexiform neurofibroma: a rare cause of obstructive jaundice.

Abstract: A case of obstructive jaundice secondary to a neurofibroma in the common hepatic duct is presented. The histological appearance was that of a plexiform neurofibroma. The clinicopathological features are discussed.

Electron microscopy in Jamaica: applications and techniques.

Abstract: Although the electron microscope was developed about 60 years ago in Germany, its arrival and subsequent use in Jamaica are of considerably more recent date. In this paper, the principles of scanning and transmission electron microscopy (SEM & TEM) are briefly explained, and examples are given of the research done with the electron microscopes at the University of the West Indies (UWI), Mona Campus, Jamaica, especially over the last three years. Detailed descriptions of specimen preparation are provided for both SEM and TEM and particular emphasis is placed on the methodology used in our laboratory, as it sometimes differs from the routine followed in electron microscopy units of temperate countries.