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PubMed1993

Neonatal bacterial septicemia in a tropical area. Four-year experience in Guadeloupe (French West Indies).

During a four-year study (1987-1990) at the Neonatal Department, University Hospital Pointe-à-Pitre (French West Indies), blood culture was systematically performed on all admitted newborns. The incidence of septicemia was 48 of 1000 admissions and 8.9 of 1000 inborn live births. Among the 107 neonatal positive blood cultures, group B streptococcus accounted for 37% of blood culture isolates and was the most frequent cause of septicemia. The overall mortality rate was 8.4%. The incidence of neonatal bacterial septicemia was among the high rates reported in the literature. The incidence of neonatal bacterial septicemia is discussed as a public health problem in perinatology in Guadeloupe in spite of good medical care. A review of the literature on bacterial septicemia in tropical or developing countries compared to the Guadeloupean experience allows speculation that this problem might be underestimated in third world countries.

Escherichia coli Infections↗
PubMed1989

[Risk factors of ciguatera in the French West Indies in Saint-Barthélémy, Saint-Martin and Anguilla].

An epidemiological study on ciguatera fish poisoning in the French West Indies (St-Barthelemy, St-Martin and Anguilla) was conducted during the years 1985-1986. The investigation on intoxications shows a non seasonal significant prevalence. Though it was difficult to list the cases, the morbidity seems to vary between 7 and 30 per thousand. A study of fish toxicity was realised; 46 different species were tested (individually or by pools) by the mosquito bio-test. Observations of intoxications give the following results: High risk species: Caranx bartholomaei, C. lugubris, Seriola dumerili, Lutjanus apodus, L. jocu, Pristipomoides macrophtalmus, Gymnothorax funebris, G. moringa, Scomberomorus cavalla, S. regalis, Mycteroperca venenosa, M. tigris, Epinephelus morio, Sphyraena barracuda. Intermediate species: Caranx latus, C. ruber, Lachnolaimus maximus, Lutjanus analis, L. buccanella, L. griseus, Malacanthus plumieri, Scomberomorus maculatus. Low risk species: Balistes vetula, Alectis ciliaris, Haemulon album, Bodianus rufus, Halichoeres radiatus, Priacanthus arenatus, Alphestes afer. Many species are involved in the toxic food chain. New ones have been identified, but it is difficult to determine the toxic level range. A cartography is presented but no place is free of risk. A research of Gambierdiscus toxicus, the causal agent, on algal surface from dead corals was conducted around St-Barthelemy and St-Martin. The dinoflagellate is found in low or medium populations all around the islands with no difference between North and South. There is a maximal activity during the spring. A model of the epidemiology of the ciguatera in the area is proposed.

Animals↗
PubMed2002

Progression of visual field loss in untreated glaucoma patients and glaucoma suspects in St. Lucia, West Indies.

PURPOSE: A 1986-1987 survey found 8.8% prevalence of open-angle glaucoma in the black population of St. Lucia, West Indies. This follow-up study assessed visual field loss progression in untreated glaucoma patients and glaucoma suspects 10 years later. DESIGN: Cohort study. METHODS: Subjects were 205 glaucoma patients and suspects; 1987 data included age, sex, visual acuity, and visual fields measured by automated threshold perimetry (Humphrey C 30-2 test), and 1997 data included intraocular pressure, visual acuity, and visual fields measured by the same test. Exclusion criteria included field unreliability, field improvement due to vision improvement, nonglaucomatous vision deterioration, glaucoma treatment since 1988, and scoring of a visual field as end stage in 1987. Visual fields were scored by algorithms for the Advanced Glaucoma Intervention Study (AGIS) and Collaborative Initial Glaucoma Treatment Study (CIGTS). RESULTS: By AGIS criteria, 55% of 146 right eyes and 52% of 141 left eyes showed progression of visual field loss. In linear regressions, progression severity was unassociated with sex, intraocular pressure, or baseline visual field score, but was positively associated with age (P <.001, right; P =.002, left). The cumulative probability of reaching end stage in 10 years in at least one eye was approximately 16% by AGIS criteria. By CIGTS criteria, 73% of 146 right eyes and 72% of 141 left eyes progressed. CONCLUSIONS: These data provide a unique opportunity to study progression of untreated glaucoma. The percentage of eyes showing visual field loss progression and the percentage reaching end stage were considerably higher than in studies of visual field progression in treated eyes.

Adult↗
PubMed1986

Multiresistant Salmonella ohio infections at the University Hospital of the West Indies.

During 1982-83 there was a substantial increase in the number of S. ohio infections at the University Hospital of the West Indies, which coincided with the appearance of strains resistant to chloramphenicol, cotrimoxazole, ampicillin, neomycin and carbenicillin. Multiresistant strains of S. ohio accounted for 19.3% of all salmonella isolates during this period and all of 40 strains tested were able to transfer resistance determinants to E. coli K12 J 53-2. S. ohio was cultured from stool (60), blood (5), wounds and abscesses (4) and postmortem material (2). Eighty-six per cent of S. ohio infections occurred in children of 3 years old or less. There was a high incidence of gastroenteritis in malnourished children, a 14% incidence of localizing infections and a 7% incidence of septicaemia. Two infants with severe gastroenteritis and bronchopneumonia died. There were a number of unusual infections including two cases of septicaemia in children receiving chloramphenicol for Haemophilus influenzae meningitis, a scrotal abscess secondary to extravasation of urine and infected scabies in a child with marasmic kwashiorkor.

Adolescent↗
PubMed2002

Progression of visual field loss in untreated glaucoma patients and suspects in St Lucia, West Indies.

PURPOSE: A 1986-1987 survey found an 8.8% prevalence of open-angle glaucoma in the black population of St Lucia, West Indies. This follow-up study assessed progression of visual field loss in untreated glaucoma patients and persons with suspected glaucoma 10 years later. METHODS: Subjects were 205 patients with or suspected of having glaucoma. The 1987 data included age, sex, visual acuity, and visual fields measured by automated threshold perimetry (Humphrey C-30-2 test). The 1997 data included intraocular pressure, visual acuity, and visual fields measured by the same test. Exclusion criteria included field unreliability, field improvement due to vision improvement, nonglaucomatous vision deterioration, glaucoma treatment since 1988, and scoring of a field as end-stage in 1987. Visual fields were scored by algorithms for the Advanced Glaucoma Intervention Study (AGIS) and Collaborative Initial Glaucoma Treatment Study (CIGTS). RESULTS: By AGIS criteria, 55% of 146 right eyes and 52% of 141 left eyes progressed. In linear regressions, progression severity was unassociated with male or female sex, intraocular pressure, or baseline visual field score, but was positively associated with age (P < .001, right; P = .002, left). By CIGTS criteria, more eyes progressed. The cumulative probability of reaching end-stage disease in 10 years in at least on eye was about 16% by AGIS criteria and was 35% by CIGTS criteria. CONCLUSIONS: These data provide a unique opportunity to study progression of untreated glaucoma. A considerably larger percentage of eyes showed progression of visual field loss, and the rate of progression was greater than in studies of visual field loss in treated eyes.

Adult↗
PubMed1999

Medical admissions of oncology patients to the University Hospital of the West Indies.

A prospective study of 80 oncology patients (42 men, 38 women; mean age 50.3 years) admitted to the University Hospital of the West Indies, Jamaica, was conducted over a six month period (August 1, 1995 to January 31, 1996). There were 103 admissions representing 8.7% of total admissions to the medical wards. Solid tumours and haematological malignancies accounted for equal proportions of admissions. 62% were emergency admissions. Investigation of constitutional symptoms, abnormal physical findings, infection and chemotherapy were the commonest reasons for admission. Complications developed in 42.7% of admissions, the commonest being renal and/or hepatic impairment; anaemia, leukopaenia and thrombocytopenia; and nosocomial infections. 35% of the patients died during the study period. The mean length of stay was 12.9 days (SD 12.8). Mean hospital stay was significantly longer in admissions involving an initial diagnosis of cancer and in those resulting in complications (p < 0.001).

Anemia↗
PubMed2004

Perceived competency at graduation among dental alumni of the University of the West Indies.

The aims of this study were to describe levels of self-rated competency of dental graduates from the University of the West Indies (UWI) and to investigate relationships with gender and the effect of curriculum change. A thirty-two item self-reported postal questionnaire was sent to UWI dental alumni (1994-2002). The questionnaire included twenty-eight competencies that could be rated on a 5-point scale: 1 (not at all competent) to 5 (very competent). Overall preparedness for practice could also be rated from 1 (not at all prepared) to 5 (very prepared). The response rate was 77.4 percent, with a mean age of 29.3 years. Items with the highest mean scores were taking an adequate medical history (4.49), recognizing and treating dental caries (4.46), oral examination (4.36), and giving dental health education (4.35). Those with the lowest rating were designing and undertaking clinical research (2.29), dealing with practice management issues (2.52), designing and delivering crown and bridge work (3.33), and recognizing pathologic occlusions (3.33). Overall preparedness for practice was rated as 3.27. Female graduates rated four competencies significantly higher than males. Graduates exposed to the new curriculum perceived greater overall preparedness for general dental practice, suggesting the change to a competency-based curriculum was effective.

Attitude of Health Personnel↗
PubMed1991

Appendicectomy at the University Hospital of the West Indies (1984-1988). A retrospective review.

The pathological records of appendicectomy specimens from patients with suspected acute appendicitis at the University Hospital of the West Indies during the 5-year period 1984-1988 were studied. The numbers of cases, their ages, sex and seasonal incidence were similar to those of other studies. The overall false positive diagnosis rate was 25% (16% in males, 38% in females). The main diagnostic difficulty was in young females in whom surgery for suspected appendicitis often proved unnecessary.

Acute Disease↗
PubMed2002

Integrating medical communication skills with library skills curricula among first year medical students at the University of the West Indies, St. Augustine.

A two-year study designed to integrate the medical communication skills and library skills curricula at the University of the West Indies, St. Augustine is reported. Given that an integrated approach to curriculum development offers benefits to learners and staff. The objective of this study was to explore the feasibility of implementing this approach among Year 1 pre-clinical students in 1997 and 1998. Student performance on an essay question that integrated the application of students' knowledge of written communication and library skills in a final examination performance was assessed. Pre- and post-test results of students' library skills were compared within each year. anova analysis indicated that there was a significant increase in mean scores from pre-test to post-test which suggests that students performed better on a test of their knowledge and application of library skills after instruction, but the unavailability of a control group made this finding inconclusive. The findings are discussed in relation to practical and intellectual issues in curriculum integration. It is concluded that this type of curriculum integration is feasible, creates linkages in the curriculum and does not increase demand on student time.

Cohort Studies↗
PubMed2005

The impact of the establishment of a neonatal intensive care unit on the outcome of very low birthweight infants at the University Hospital of the West Indies.

A retrospective analysis of the outcome of inborn very low birthweight infants admitted to the neonatal unit of the University Hospital of the West Indies pre- (period 1) and post- (period 2) establishment of a neonatal intensive care unit was conducted. During the study, 250 infants were admitted to the neonatal unit, 132 (53%) during period 1 and 118 (47%) during period 2. There was improved survival during period 2 when 81 (69%) infants survived compared to period 1 when 73 (55%) survived (p = 0.02). This increased survival was due to an increase in survival of infants weighing 750-999g in period 2 when 17 (65%) infants survived compared to 9 (29%) in period 1 (p < 0.05). There was an increase in the number of infants ventilated in period 2, 39 (33%) compared to 12 (9%) period 1 (p < 0.001). Infants who were ventilated in period 2 were less likely to die than those ventilated in period 1 (OR 0.05, CI 0.01, 0.66). After controlling for gender, weight, gestational age and ventilation, infants born in the second time period were less likely to die than those born in the first time period (OR 0.33, CI 0.14, 0.76). The establishment of a neonatal intensive care unit has resulted in improved survival of very low birthweight infants; further improvement in survival of these infants will be dependent on increased accessibility to surfactant therapy, initiation of total parenteral nutrition and availability of trained personnel.

Confidence Intervals↗
PubMed1999

Trauma aetiology and cost in the Accident and Emergency Unit of the University Hospital of the West Indies.

Trauma accounted for 37% of 22,311 patients seen in the Accident and Emergency Unit (A&E Unit) at the University Hospital of the West Indies (UHWI) during 1996. Thirty-nine per cent of injuries were intentional and 18% were due to motor vehicle accidents. Knives, machetes and rocks accounted for 75% of the injuries compared with 5% for gunshot wounds. Passengers were injured in about 40% of motor vehicle accidents and pedestrians in 19%. The admission rate was 16% and the orthopaedic clinic received 75% of the patients referred to specialist clinics. Victims of motor vehicle accidents made up a greater proportion of admissions (24%) than those of intentional violence (13%). The average cost of caring for each patient in the A&E unit was US$70 resulting in an annual cost of US$578,000.

Adolescent↗
PubMed1990

Multiple sclerosis among United Kingdom-born children of immigrants from the Indian subcontinent, Africa and the West Indies.

Multiple sclerosis (MS) is very uncommon among ethnic Asians in the Indian subcontinent, among Asians and Africans resident in the New Commonwealth countries of Africa and in the West Indies. It is also very uncommon among those who have migrated to England from those countries. In contrast, the children born in the United Kingdom of Asian, African and West Indian immigrants have, in the age groups available for study, a high prevalence of MS of a similar order to that occurring in the general population of England.

Adolescent↗
PubMed1989

Seroepidemiological study of the transmission of the mumps virus in St. Lucia, West Indies.

A seroepidemiological study of the prevalence of mumps virus specific antibodies reveals a pattern of endemic persistence on the island of St Lucia in the West Indies. In the unvaccinated population the proportion seropositive rose rapidly in the child age classes to attain a stable plateau close to unity in value in the teenage and adult age groups. The average age at infection was estimated to be between 3 and 4 years of age and the average duration of detectable levels of maternally derived antibodies was approximately 3 months. Analyses based on mathematical models of the transmission dynamics of the virus suggest that in excess of 75% of each cohort of 1- to 2-year-old children must be effectively immunized to eliminate mumps virus transmission. A mumps radial haemolysis test, developed for quantitative measurements of antibody, is discussed.

Adolescent↗
PubMed2002

Necropsy request practices in Jamaica: a study from the University Hospital of the West Indies.

AIM: To investigate necropsy request practices at the University Hospital of the West Indies, Jamaica, to determine the extent to which these might influence the declining necropsy rates. This is the first such study from a developing country. METHODS: The necropsy service was audited prospectively over a six month period, and data relating to non-coroner's (hospital) necropsy requests, including the clinical service and post of the clinician involved, were documented. The reasons for non-request were recorded for deaths in which a necropsy was not requested, in addition to the reasons given by pathologists for not performing necropsies in cases that were requested but not done. The overall, non-coroner's, and coroner's necropsy rates in addition to the non-coroner's necropsy request and success rates were calculated. RESULTS: There were 364 deaths comprising 323 non-coroner's and 41 coroner's cases. The overall, non-coroner's, and coroner's necropsy rates were 29.2%, 20.2%, and 38.7%, respectively. The non-coroner's necropsy request rate was 35.3% with a success rate of 65%. Seventy five per cent of the requests were made by non-consultant clinicians and on the internal medicine service, which accounted for most of the non-coroner's deaths; necropsy requests were biased towards younger patients (p < 0.0001). Confident clinical diagnosis was the main reason for not requesting a necropsy, and the primary reason for refusing to perform a necropsy was that the request had been made too long after death. CONCLUSIONS: These findings show a relatively high necropsy success rate in the face of a comparatively low necropsy request rate, and indicate that necropsy rates can be increased if clinicians make more necropsy requests in a timely manner in patients of all ages.

Adolescent↗
PubMed1994

Clustering of human T lymphotropic virus type I seropositive in Montserrat, West Indies: evidence for an environmental factor in transmission of the virus.

A community survey of human T cell lymphotropic virus type I (HTLV-I) in Montserrat, West Indies, identified 22 instances in which 2 HTLV-I-seropositive adults lived within 60 m of each other (close pairs), compared with 7.8 expected (P < .001). Five of these close pairs were mother-offspring or husband-wife. The remaining 17 pairs were of unrelated members in separate households. The percentages of male-female (41%), female-female (41%), and male-male (18%) types in these 17 pairs were very similar to those among the 1377 similarly defined pairs in which neither or only 1 member was seropositive, affording no support for extramarital heterosexual activity as an explanation for the clustering observed. Thus, the demography of HTLV-I was not accounted for completely by sexual and mother-to-offspring transmission. The predominance of clustering of unrelated HTLV-I-seropositive individuals in locations with high mosquito infestation raised the possibility of sporadic transmission of HTLV-I by hematophagous insects.

Adolescent↗
PubMed2006

The neonatal intensive care unit at the University Hospital of the West Indies: The first few years' experience.

A retrospective analysis of neonates admitted for ventilatory support to the neonatal intensive care unit at the University Hospital of the West Indies between August 2001 and December 2004 was conducted. One hundred and thirty-eight neonates fulfilled criteria for admission into the study. Ninety-eight (71%) were inborn, 88 (64%) survived and 50 (36%) died. The median age at death was 72 hours and 72% of non-survivors died within one week of life. The main reasons for admission into the unit were respiratory distress syndrome 87(63%), followed by hypoxic ischaemic encephalopathy 15 (11%), surgical indications 13 (9%) and meconium aspiration syndrome 11 (8%). Babies with meconium aspiration syndrome and surgical problems had the best survival 82% and 85% respectively. Survival rates increased with increasing birthweight and gestational age. The most common complication seen was air leaks. The judicious use of neonatal intensive care measures in a developing country can result in a reduction of morbidity and mortality. However to maximize on benefits versus cost in an atmosphere of budgetary constraint evidence based management policies and protocols must be developed and implemented

Birth Weight↗
PubMed2003

Surface reactivity of volcanic ash from the eruption of Soufrière Hills volcano, Montserrat, West Indies with implications for health hazards.

The fine-grained character of volcanic ash generated in the long-lived eruption of the Soufrière Hills volcano, Montserrat, West Indies, raises the issue of its possible health hazards. Surface- and free-radical production has been closely linked to bioreactivity of dusts within the lung. In this study, electron paramagnetic resonance (EPR) techniques have been used, for the first time, on volcanic ash to measure the production of radicals from the surface of particles. Results show that concentrations of hydroxyl radicals (HO*) in respirable ash are two to three times higher than a toxic quartz standard. The dome-collapse ash contains cristobalite, a crystalline silica polymorph that may cause adverse health effects. EPR experiments indicate, however, that cristobalite in the ash does not contribute to HO* generation. Our results show that the main cause of reactivity is removable divalent iron (Fe2+), which is present in abundance on the surfaces of the particles and is very reactive in the lung. Our analyses show that fresh ash generates more HO* than weathered ash (which has undergone progressive oxidation and leaching of iron from exposed surfaces), an effect replicated experimentally by incubating fresh ash in dilute acid. HO* production experiments also indicate that iron-rich silicate minerals are responsible for surface reactivity in the Soufrière Hills ash.

Electron Spin Resonance Spectroscopy↗
PubMed1981

Studies on an isolated West Indies population: I. Analysis of HLA genotypes.

The transmission of HLA genes was studied in an isolated population of French origin on the lesser Antilles islands in the West Indies. The study of 74 unrelated individuals, 44 of whom were genotyped, was carried out for the alleles of HLA loci: A, B, C and Bf (proactivator factor of properdin). As a result of the founder effect and the inbreeding process, the HLA haplotypes were noted to be less polymorphic than in a French continental population. Two haplotypes: A2, Cw5, B12, BfS and A3, C-, B14, BfF represent 24% of the observed haplotypes, and only 2% of the reference haplotypes in France. No significant excess or deficit of homozygotes was observed at the A and B loci.

Deafness↗