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PubMed2002

Problem-based compared with traditional methods at the Faculty of Medical Sciences, University of the West Indies: a model study.

The University of the West Indies (UWI) comprises three campuses located on three different islands. Two of the Campuses, Mona in Jamaica and St Augustine in Trinidad & Tobago offer full medical programmes, i.e. both basic sciences and clinical training. At Cave Hill, where basic sciences courses are not offered, students are drawn from the traditional school at Mona or the Problem Based Learning (PBL) school at St Augustine to follow a common clinical programme. After 24 months of clinical training consisting of a minimum of 12 clerkships these students take identical examinations in Medicine & Therapeutics, Surgery and Obstetrics & Gynaecology. In this paper the results of the final clinical examinations at Cave Hill for the five-year period 1995-99 have been analysed, comparing the performances of students drawn from Mona with those from St Augustine. We found that, except for a few isolated cases, there were no significant differences in the performance of the two groups of students. These results suggest that the delivery of a significant component of a basic sciences programme by a well-planned PBL system is unlikely to produce substandard students at the end of their clinical training.

Clinical Clerkship↗
PubMed1982

Adult T-cell lymphoma-leukaemia in Blacks from the West Indies.

Six Black patients (five born in the West Indies and one in Guyana), aged 21-55 years, had adult T-cell lymphoma-leukaemia diagnosed in the U.K. This disorder is rare in Europe and the U.S.A., but is more common in Japan. Five patients had severe hypercalcaemia which correlated with disease activity, although osteolytic lesions were found in only one. Other clinical features were lymphadenopathy and a high white blood-cell count (range 27-67 X 10(9)/l) with a predominance of pleomorphic lymphoid cells with pronounced nuclear irregularities prominent at ultrastructural level. The cells in all cases formed rosettes with sheep red blood-cells and lacked terminal transferase. Analysis with OKT monoclonal antibodies in four cases confirmed a mature T-cell phenotype defined as helper/inducer (T4+, T6-, T8-) in three. Combination chemotherapy resulted in short-lived remissions; four patients died and two have survived 3-6 months. The disease in these patients is indistinguishable on clinical and pathological grounds from adult T-cell leukaemia/lymphoma in Japan. Geographical clustering among certain racial groups suggests common aetiological factors in the pathogenesis of this disease. The finding of high titre antibody against the structural core protein (p24) of a new human C-type leukaemia virus (human T-cell leukaemia/lymphoma virus) in all tested cases from this series and data from all but one case from Japan suggest that one such factor may be viral.

Adult↗
PubMed1993

Ethics and law in the medical curriculum--a university of the West Indies perspective.

The Faculty of Medical Sciences (FMS), University of the West Indies, recognizes that ethics and law are not currently given adequate importance in the training of health professionals. FMS also recognizes the rapid advancement of technology, such as transplants, artificial organs, in vitro fertilization, life-sustaining equipment and euthanasia, as well as the ever-increasing prevalence of malpractice. Thus, two conferences were held to consider the implementation of ethics and law in the medical curriculum. The conferences recommended an increased input into the curriculum of ethics and law, and that this programme be taught and examined in all the medical years. The article discusses implementation strategies.

Bioethical Issues↗
PubMed2004

[Rickettsia africae, the agent of African tick-bite fever: an emerging pathogen in the West Indies and Reunion Island (Indian Ocean)].

Rickettsia africae is the agent of African tick bite fever, an emerging disease transmitted by Amblyomma ticks in sub-Saharan Africa. In 1998, we reported the first documented case of R. africae in the New World, in a patient who had returned from Guadeloupe. In order to confirm the presence of R. africae in the West Indies, entomologic surveys were conducted from 1999 to 2003 to collect Amblyomma, which are considered as potential vectors and reservoirs of the bacteria. Ticks were used as epidemiological tools to detect R. africae by molecular tools and/or cultivate the bacteria in shell-vial cell culture. This paper summarizes the results obtained in the West Indies. R. africae was detected and isolated for the first time in Guadeloupe, and then detected by molecular tools in Martinique and St-Kitts and Nevis. These last results confirm our first hypotheses--that is R. africae is prevalent on all the Caribbean islands where A. variegatum ticks have been introduced from Africa in the 18th and 19th centuries. We also present the results of a study conducted on the Reunion Island, a French island in the Indian Ocean. For the first time there, R. africae was detected in A. variegatum ticks, which were probably introduced from the African mainland or Madagascar with the human colonization during the 17th century Thus, clinicians should be aware that patient presenting in the West Indies or on Reunion Island (or after a trip over there) with fever, eschar (often multiple), regional lymphadenopathy and a rash, might be infected by R. africae.

Animals↗
PubMedDate not supplied

Incidence of inflammatory bowel disease in the French West Indies (1997-1999).

OBJECTIVES: To investigate the incidence of inflammatory bowel disease in the French West Indies. METHODS: From January 1st 1997 to December 31st 1999 all patients observed with clinical symptoms suggestive of inflammatory bowel disease attending gastroenterologists practicing in Guadeloupe and Martinique were included. Patients were interviewed with a standard questionnaire to record data used by an expert to establish the final diagnosis of definite, probable or possible Crohn's disease, ulcerative colitis, unclassifiable chronic colitis or acute colitis, according to the EPIMAD registry. RESULTS: Sixty-six cases of ulcerative colitis (47.48%) including 12 cases of ulcerative proctitis (18.18% of the ulcerative colitis cohort), 55 of Crohn's disease (39.57%), 11 of unclassifiable chronic colitis (7.91%), and 7 of acute colitis (5.04%) were recorded. The crude annual incidence (per 100,000 inhabitants) based on definite and probable cases only was 2.44 for ulcerative colitis and 1.94 for Crohn's disease. The female/male ratio and median age at time of diagnosis were 1.61 and 29 years for Crohn's disease and 1.46 and 34 years for ulcerative colitis respectively. The median time from symptom onset to diagnosis was 2 months for both diseases. CONCLUSIONS: The observed incidence of inflammatory bowel disease In the French West-Indies is lower than in metropolitan France. These data will serve as a basis to assess disease evolution.

Adolescent↗
PubMed1998

Helminths of six species of Anolis lizards (Polychrotidae) from Hispaniola, West Indies.

From Hispaniola, an island in the West Indies, 6 species of anoles, Anolis cristatellus, Anolis etheridgei, Anolis eugenegrahami, Anolis hendersoni, Anolis monticola, and Anolis olssoni were examined for helminths. Helminths representing 2 species of trematodes, Mesocoelium monas and Urotrema scabridum; 1 species of cestode, Oochoristica maccoyi; 11 species of nematodes, Atractis scelopori, Oswaldocruzia lenteixeirai, Parapharyngodon cubensis, Skrjabinoptera leiocephalorum, Trichospirura teixeirai, Ascarops sp., Physocephalus sp., Porrocaecum sp., Rhabdias sp., Acuariidae gen. sp. and Cosmocercidae gen. sp.; and 1 species of acanthocephalan, Centrorhynchus sp., were found. Skrjabinoptera leiocephalorum, Ascarops sp., and Physocephalus sp. from A. cristatellus and all helminths recovered from the other 5 anole species represent new host records.

Acanthocephala↗
PubMed2001

Kenneth Harrison Uttley (1901-1972). Historian to the diseases of Antigua, British West Indies.

Dr Kenneth Harrison Uttley (1901-1972) served as the Chief Medical Officer in Antigua, British West Indies, from 1955 until 1966. During this time, Dr. Uttley personally reviewed and tabulated an island-wide governmental demographic database of all births, deaths and causes of death during the preceding 100 years. This database was the result of a Compulsory Birth and Death Registration Ordinance enacted as one of several Colonial Poor Laws in 1856. His efforts resulted in the publication of a total of 30 papers in American and British medical journals. Many of these papers reviewed historical demographic trends in births, fertility rates, neonatal deaths, infant mortality and early childhood mortality rates. Others focussed on the historical epidemiology of specific diseases such as neonatal tetanus, leprosy, tuberculosis and malaria. This is the first complete bibliographical account of Uttley's contributions to the history of diseases in the West Indies in general and Antigua in particular. Dr Uttley also served as an ordained priest in the Anglican Church and, upon retirement from the Colonial Medical Services, returned to England to serve as the Vicar of Purton, Oxfordshire.

Antigua and Barbuda↗
PubMed2004

[Causes of death among HIV infected adults in French Guyana and the French West Indies in the era of highly active antiretroviral therapy (HAART)].

OBJECTIVE: The survey "Mortality 2000" had for aim to describe the distribution of causes of death in HIV-infected adults in France. METHOD: Hospital wards involved in the management of HIV infection prospectively reported deaths occurring in 2000. The causes of death were documented using a standardized questionnaire. RESULTS: In French Guyana and the French West Indies the five referent wards reported 81 deaths. The main underlying causes of death were AIDS-related (67%), non-AIDS and non-hepatitis related cancer (9%), cardiovascular disease (7%), bacterial infections (5%), and end stage liver disease (4%). Among AIDS-related deaths, the more frequent diseases were histoplasmosis and toxoplasmosis in Guyana and atypical mycobacterial infection, tuberculosis, and cytomegalovirus disease in the West Indies. Median age was 43 years, transmission of HIV infection was heterosexual in 79%; 56% lived in poor socio-economic conditions, and 30% were born abroad. One out of five had been recently diagnosed with HIV infection and one out of three had never received antiretroviral treatment. CONCLUSION: In 2000, two in three death cases in HIV-infected adults were AIDS-related in French Guyana and the French West Indies. Improved strategies for screening HIV infection before the occurrence of AIDS are still needed taking into consideration poor socio-economic and migrant conditions.

Adult↗
PubMed1983

Hypertension in the West Indies.

Hypertension is the most common chronic disease in the West Indies, and is a major health problem today being among the 10 most common causes of death in the English-speaking territories of the region. Most patients have essential hypertension. Renal failure, stroke, and cardiac failure are the most common complications, myocardial infarction being relatively uncommon in black patients. While an earlier report from the Caribbean suggested that beta-blockers were not effective for treating black hypertensives, recent experience with these drugs show that they are useful particularly when administered along with a diuretic. Beta-blockers may be required in higher doses than those commonly recommended for patients in Europe and North America, but even small doses of thiazide diuretics are effective in lowering the blood pressure of West Indian hypertensives. West Indians show a combination of personalistic, naturalistic, and modern medical beliefs, which need to be understood in order to mount effective programmes for the management of hypertension in the community.

Adolescent↗
PubMed1982

Population study of blood pressure and associated factors in St Lucia, West Indies.

A population survey of blood pressure in St Lucia, West Indies has confirmed that high blood pressure constitutes an important public health problem. In common with other studies blood pressure was found to be significantly correlated with body weight, possibly by a primary effect on diastolic pressure. Blood pressure was also significantly correlated with casual urinary sodium/potassium and potassium/creatinine ratios in those under 45 years of age. This unexpected finding suggests that casual urinary electrolyte estimations may in some circumstances be a useful guide to intake, perhaps especially in populations with more stable intakes. An independent role of potassium in the aetiology of high blood pressure would have important public health implications.

Adolescent↗
PubMed2006

Rickettsia africae in the West Indies.

Rickettsia africae is the agent of African tick-bite fever, a mild but common disease of local persons and tourists in Africa. The major vector of this spotted fever group rickettsia is most likely Amblyomma variegatum, the tropical bont tick, which has become widely distributed through the West Indies in the last 30 years. This report reviews all available information on R. africae in the West Indies.

Animals↗
PubMed1993

An attempt to correlate cattle breed origins and diseases associated with or transmitted by the tick Amblyomma variegatum in the French West Indies.

By using biological data and historical research, we have tried to explain the difference between resistance and susceptibility to the diseases transmitted (cowdriosis) or associated (dermatophilosis) with the tick Amblyomma variegatum, in two cattle breeds of the French West Indies: the Creole crossbred cattle of Guadeloupe and the Brahman zebu cattle of Martinique. Have been studied the polymorphisms of 5 independent genetic systems (erythrocytic haemoglobin, serum albumin and transferrin, the class I region of the BoLA complex and the gamma S crystallin gene) in different breeds comprising Bos taurus cattle of Europe and Africa, Bos indicus of West and East Africa, as well as the Brahman of Martinique and the Creole crossbred of Guadeloupe. By comparing the different allele frequencies of these 5 non related polymorphic loci and by using the two different mathematical matrices of NEI and of CAVALLI-SFORZA, have been established the genetic distances between these breeds. It appears clearly that the Creole cattle of Guadeloupe are in an intermediate position between the Bos taurus N'Dama breed of West Africa and two Bos indicus zebu breeds, namely the West African Sudan zebu and the Brahman. Thanks to studies of different archieves in the Caribbean and in Europe, historical evidence have been accumulated on the geographical origins and on the chronology of the establishment of Creole and Brahman cattle in the French West Indies. The high resistance of the Creole cattle of Guadeloupe to diseases associated with or transmitted by the "Senegalese" tick Amblyomma variegatum seems to be due to the inheritance of a pool of genes from West African cattle and more particularly from the N'Dama breed.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2003

Utility of rapid staining of fine needle aspiration smears at the University Hospital of the West Indies.

In a prospective study at the University Hospital of the West Indies, 187 fine needle aspiration cytology (FNAC) specimens, comprising 100 breast, 75 head and neck, and 12 miscellaneous specimens, were subjected to rapid Papanicolaou staining and immediate assessment. Inadequate aspirates were repeated, and all cases were also evaluated after routine Papanicolaou staining. Histologic and clinical follow-up data were obtained. The overall concordance between rapid and routine cytologic diagnoses ranged from 79% to 87% for the three specimen cohorts. Sensitivity and specificity values were similar for rapid and routine-stained slides and ranged from 80% to 100%. There were no false positive or false negative diagnoses in the cases for which the outcome was known. Rapid staining of cytologic smears is a useful adjunct to the evaluation of aspirated material, improving adequacy rates and overall performance of the FNAC service, and should also result in significant savings in time and cost to patients.

Biopsy, Needle↗
PubMed1992

Ciguatoxic fish in the French West Indies.

An epidemiological study on ciguatera fish poisoning in the French West Indies on St-Barthelemy, St-Martin and Anguilla was conducted in the years 1985-1986-1987 and 1991-1992. A study on the toxicity of coral fish was realized. The toxicity of 700 fish belonging to 57 species was evaluated by bio-assays. 430 mosquito-bio-assays were performed on individual fish (flesh or liver) and 19 on pools (flesh or liver; with 4 to 24 fish). A second group was evaluated on liver by the chick feeding-test (33 individual and 64 on pools with 2 to 24 fish). The results showed that many species are involved in the toxic food chain. At least 25% may have a high level of toxicity, 32.5% are intermediate and 10% are doubtful. Major results concern: (1) high risk species (Caranx bartholomaei, C. lugubris, Lutjanus apodus, L. jocu, Gymnothorax funebris, G. moringa, Mycteroperca venenosa, M. tigris, Epinephelus morio, Sphyraena barracuda); (2) intermediate species (Caranx latus, C. ruber, Lutjanus buccanella); (3) low risk species (Balistes vetula, Haemulon album, Priacantus arenatus, Alphestes afer). Occasionally other species or new species are involved Etelis oculatus, Lutjanus analis, Pristipomoides macrophtalmus, Rhomboplites aurorubens, Haemulon album, Scarus vetula.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1982

Public health training programs at the University of the West Indies.

The Department of Preventive Medicine of the University of the West Indies was established in 1957 with the idea of improving undergraduate teaching facilities to enable medical students to study patients in their homes and social environment. The authors describe the two public health diploma programs available at the University and cite pertinent enrollment and geographic distribution statistics. Candidates for the Diploma in Public Health are registered medical practitioners who take a series of compulsory and elective subjects and have a period of supervised field training and research during the 12-month course. The Diploma in Community Health trains students in the health and diseases of man in his total environment. Students choose among three program options: the general program, specialization in health education, or specialization in health services administration/hospital administration. The general program is the most popular because it gives the student a rounded education suitable to the needs of small states. The 12-month diploma course features the interdisciplinary approach where students from various fields discuss important issues in community health. Comprehensive courses in these areas include health services administration, social sciences, environmental health, epidemiology and biostatistics, family health, communication science, and community mental health. The authors state that the candidate for the Diploma in Community Health is assessed on the basis of course and field work, a special project report, and a final written and oral examination.

Curriculum↗
PubMed2004

Student evaluation of an OSCE in paediatrics at the University of the West Indies, Jamaica.

BACKGROUND: The Faculty of Medical Sciences, University of the West Indies first implemented the Objective Structured Clinical Examination (OSCE) in the final MB Examination in Medicine and Therapeutics during the 2000-2001 academic year. Simultaneously, the Child Health Department initiated faculty and student training, and instituted the OSCE as an assessment instrument during the Child Health (Paediatric) clerkship in year 5. The study set out to explore student acceptance of the OSCE as part of an evaluation of the Child Health clerkship. METHODS: A self-administered questionnaire was completed by successive groups of students immediately after the OSCE at the end of each clerkship rotation. Main outcome measures were student perception of examination attributes, which included the quality of instructions and organisation, the quality of performance, authenticity and transparency of the process, and usefulness of the OSCE as an assessment instrument compared to other formats. RESULTS: There was overwhelming acceptance of the OSCE in Child Health with respect to the comprehensiveness (90%), transparency (87%), fairness (70%) and authenticity of the required tasks (58-78%). However, students felt that it was a strong anxiety-producing experience. And concerns were expressed regarding the ambiguity of some questions and inadequacy of time for expected tasks. CONCLUSION: Student feedback was invaluable in influencing faculty teaching, curriculum direction and appreciation of student opinion. Further psychometric evaluation will strengthen the development of the OSCE.

Attitude of Health Personnel↗
PubMed1992

Human T lymphotropic virus (HTLV) type I and II DNA amplification in HTLV-I/II-seropositive blood donors of the French West Indies.

To confirm the presence of DNA from human T lymphotropic virus type I (HTLV-I), HTLV-II, or both in individuals found HTLV-I/II-positive through systematic screening of blood donations in Guadeloupe (French West Indies), 42 blood donors repeatedly positive for HTLV-I/II by ELISA were studied by polymerase chain reaction (PCR). Three primer pairs (env, pol, tax) targeted on conserved regions of HTLV-I or -II sequences (or both) and six probes (two generic, two HTLV-I-specific, two HTLV-II-specific) were used in a multiplex PCR. HTLV-I sequences were detected in 31 individuals (74%). All 31 subjects positive by Western blot (WB) harbored HTLV-I sequences. Fifteen individuals (48%) were positive with the three primer pairs used, 10 (32%) with two, and 6 (20%) with one. Subjects indeterminate or negative by WB were all negative by PCR. No HTLV-II sequences were detected with specific probes. The results indicate the absence of HTLV-I and -II infection in individuals with indeterminate WB, the presence of HTLV-I DNA in individuals positive for WB in the French West Indies, and the absence of HTLV-II infection in the cohort.

Adult↗
PubMed2005

Pathogenic Acanthamoeba strains from water sources in Jamaica, West Indies.

In 2004, samples of tap water and of river and sea water associated with human activities were collected in Jamaica, West Indies, and checked for free-living Acanthamoeba. The morphologies of the cysts and trophozoites observed and the results of PCR-based amplifications with a genus-specific primer pair were used to identify the Acanthamoeba isolates. The potential of each isolate as a human pathogen was then evaluated using thermotolerance and osmotolerance assays and two PCR-based assays for Acanthamoeba pathogenesis. Acanthamoeba were identified in 36.1%, 26.4% and 49.6% of the tap-, river- and sea-water samples collected, respectively. Pathogenic potential was shown by 60.0% of the Acanthamoeba strains isolated from tap water, 68.4% of the strains from river water, and 40.4% of the seawater strains. Sequencing of ribosomal DNA revealed the T1, T2, T4, T5, T7, T9 and T11 genotypes. Isolates of the T4 genotype were collected from tap, rain and sea water and, as expected, exhibited the most pathogenic traits; most were osmotolerant, thermotolerant and expressing extracellular serine protease. This is the first study of the occurrence and distribution of Acanthamoeba in water in the West Indies, and the results confirm the presence of potentially pathogenic strains in Jamaica.

Acanthamoeba↗