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PubMed2002

Ultrasonography of the lower limbs for deep vein thrombosis at the University Hospital of the West Indies. A five-year analysis.

A study was conducted on all patients referred to the ultrasound service of the radiology department of the University Hospital of the West Indies, Kingston, Jamaica, for evaluation of a clinical diagnosis of thrombosis of the deep veins of the lower limb, during the period January 1, 1995, to December 31, 1999. The calf veins were not routinely examined; this study was limited to the popliteal, superficial and deep femoral veins. Two hundred and seventy-four females and 104 males were referred. Seventy females and 32 males had ultrasound findings of deep vein thrombosis (DVT). The significant findings were that the male:female ratio for confirmed DVT was approximately 1:2; 26% of referrals had DVT on ultrasound; DVT was more common on the left and the popliteal vein (48%) and the superficial femoral vein (47%) accounted for most documented cases of DVT but thrombosis of the profunda femoral vein was unusual accounting for only 5% of cases.

Adolescent↗
PubMed2002

A case-control study of risk factors associated with human T-cell lymphotrophic virus type-I seropositivity in blood donors from Guadeloupe, French West Indies.

BACKGROUND AND OBJECTIVES: An age- and gender-specific distribution characterizes human T-cell lymphotrophic virus type-I (HTLV-I) seropositivity in Guadeloupe (French West Indies). Further epidemiological studies are required to identify other possible risk factors associated with this retroviral infection. MATERIALS AND METHODS: A nested case-control study was conducted between 1997 and 1999 among blood donors. A total of 102 HTLV-I-positive subjects were matched (at a ratio of 1 : 3) by gender, age (+/-5 years) and donor status (new or regular) to 306 HTLV-I-negative controls. Information was obtained through a questionnaire assessing both environmental and behavioural variables. RESULTS: Factors independently associated with HTLV-I infection included a low level of education [odds ratio (OR) 6.61, confidence interval (CI) 2.89-15.15], black ethnicity (OR 3.28, CI 1.01-10.65), two or more sex partners in the previous 3 years (OR 2.43, CI 1.16-5.10), early age at first sexual intercourse (0.84 risk reduction per additional year, CI 0.76-0.93), a history of sexually transmitted diseases (OR 2.29, CI 1.0-5.34) and positive Chlamydia serology (OR 1.95, CI 1.03-3.68). CONCLUSION: These data provide a wide spectrum of features associated with HTLV-I seropositivity, especially sexual risk factors. It strongly suggests that heterosexual intercourse is an important route of HTLV-I transmission in Guadeloupe, even among low-risk populations such as blood donors.

Adult↗
PubMed1982

[Demonstration of a liposoluble ciguateric toxin in Caranx bartholomaei caught in the French West Indies].

This report deals with some of the biological and chemical properties of a liposoluble poison extracted from Caranx bartholomaei (yellow jack), a toxic fish from the French West Indies (St Barth's island). Within a single fish, poison concentration is higher in the viscera; toxicity level is uniform throughout the flesh. In the few specimens tested, liver toxicity variations parallel those of flesh. The poison is heat stable so that cooking does not impair the toxicity. It is soluble in acetone, diethyl ether, chloroform, benzene, methanol and ethanol, but insoluble in n. hexane. Crude toxin injection or ingestion induces ciguateric disease in cats, mice or newly born chicken. Crude toxin stability is good after 30 minutes at 90 degrees C in a 0,5 N solution of a weak acid but not of a weak base. In the same conditions, loss of activity is nearly complete with a strong acid or a strong base. Moreover, rapid alkali treatment at room temperature destroys more than 50 per cent of the toxicity. The toxin is eluted by chloroform-methanol (9:1) from a silicic acid column and by acetone-methanol (9,5:0,5) from a Florisil column. DEAE cellulose column chromatography clearly separates the toxin into two lethal components; but thin layer chromatography of crude or fractionated toxin indicates only one toxic band in three different solvent systems. As a conclusion, in spite of a few differences related to instability in alkalin medium and elution from DEAE cellulose, this poison is quite similar to those carried by ciguatoxic fishes from the Pacific area. The differences noted above could be accounted for either by a specific metabolism of the species studied or by differences in the causative agent due to geographical location, or both.

Animals↗
PubMed2003

Hepatic abscesses at the University Hospital of the West Indies. A 24-year autopsy review.

A retrospective review of all hepatic abscesses identified at autopsy over the 24-year period 1977-2000 at the University Hospital of the West Indies (UHWI), Kingston, Jamaica, was conducted. Post mortem and microbiology records were reviewed. Data collected included age, gender, predisposing factors, organisms isolated, number of abscesses and associated conditions, such as diabetes mellitus. Data for the adults was analyzed separately. Thirty-nine cases of pyogenic abscesses were identified from 7480 post-mortems. Thirty-three occurred in adults of mean age 59.5 years. Sixty per cent of the abscesses were solitary. Biliary tract disease was the predisposing factor in 33% of cases. Six per cent were cryptogenic: 11/33 patients were diabetic and these were significantly older than non-diabetics (p < 0.014) Klebsiella pneumoniae was the most common organism isolated from diabetics (6.9). Only 2/33 abscesses were diagnosed ante-mortem. The abscesses in children were more frequently multiple and associated with extra-abdominal infection. Gram positive cocci were the commonly isolated organisms in children. There were no cases of amoebic abscess. The prevalence of hepatic abscess was low. Diabetes mellitus was a significant contributing factor. A high index of clinical suspicion is therefore warranted particularly in elderly diabetics.

Abdomen↗
PubMed2004

Endoscopic retrograde cholangiopancreatography use at the University Hospital of the West Indies.

All patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) at the University Hospital of the West Indies (UHWI) were entered into a prospective database. Parameters included demographics, indication for the procedure, success of the ERCP and any immediate complications noted. Retrospectively, the patients' case notes were analyzed for complications developing after 24 hours, and outcome. During the period March 1999 to December 2002, a total of 120 consecutive patients were subjected to 123 ERCPs, all being performed by a single gastroenterologist. Of these 120 patients, eight had ERCP as outpatients and were transferred back to their referring hospitals. These patients were excluded from further analysis. Of the 115 UHWI patients, the case notes of 96 were available for analysis and this group formed the basis of this review. ERCP had successful cannulation in 95% of patients. There were 70 females and 26 males with a female to male ratio of 2.7:1. Age ranged from 13 to 85 years (mean +/- SD, 43 +/- 17), males being an average six years older than females. The most common indication for ERCP was a patient with cholelithiasis and abnormal liver function tests scheduled for laparoscopic cholecystectomy. This made up 33% of patients and in this subgroup, sickle cell disease accounted for 50% of cases. Patients with common bile duct stones preoperatively and post-cholecystectomy accounted for 13% and 17% respectively while gallstones pancreatitis accounted for 13% of cases, including three patients with severe pancreatitis. While 64% of the patients had normal cholangiogram, 66% of them had sphincterotomy. Common bile duct stones were seen in 23 cases and complete removal was successful in 48%. There were ten cases (10%) of ERCP pancreatitis and this was severe in three patients and the direct cause of death in one. One patient had ascending cholangitis post ERCP and there were no cases of post-sphincterotomy bleeding or duodenal perforation. Endoscopic retrograde cholangiopancreatography at the UHWI has high diagnostic yield but its therapeutic use needs further development.

Adolescent↗
PubMed2005

Triage decisions and outcome among the critically ill at the University Hospital of the West Indies.

The worldwide scarcity of intensive care therapy leads to the rationing of this expensive resource. This prospective study investigates the rationing of intensive therapy at the University Hospital of the West Indies (UHWI) by recording triage decisions for intensive care unit (ICU) admission and the impact of these decisions on patient outcome. Between June 2001 and May 2002, all patients triaged for admission to a multidisciplinary ICU were studied For each patient, data were collected including APACHE II score, ICU resource availability and patient survival. There were 356 eligible requests, and 285 (80%) were admitted to the ICU, with 73 (26%) of these admitted patients receiving intensive care outside of the ICU due to space limitations. The APACHE II score was the strongest predictor of ICU admission, with admission more likely as the score decreased (odds ratio = 0.94, 95% confidence interval 0.91, 0.98, p = 0.001). Of 311 requests considered suitable for admission, 26 (8%) were refused admission due to resource limitations. Mortality among these eligible refusals was 81%, compared to 34% among admitted patients (p < 0.001). Although triage decisions are based predominantly on a patient's disease severity, the demand for ICU space exceeds supply, and patient care is negatively impacted by this imbalance.

APACHE↗
PubMed2006

Predictors of poor outcome in neonates with bacterial sepsis admitted to the University Hospital of the West Indies.

To determine factors that affect outcome in neonates with culture-proven sepsis, the charts of all neonates with culture-proven sepsis admitted to the University Hospital of the West Indies between January 1995 and December 2000 were reviewed retrospectively. Neonates who survived without developing any complications (favourable outcome group) were compared with those who died and/or developed severe complications during the course of treatment (poor outcome group). Chi-square tests were done to determine factors associated with poor outcome; univariate and multivariate logistic regression analyses were also performed. One hundred and thirty-five neonates had culture-proven sepsis, of which 89 (66%) were term infants and 46 (34%) were preterm. Male to female ratio was 1.6:1. One hundred and twenty-six (93%) survived and 9 (7%) died. Case fatality rates were higher for premature infants (15%) than for term infants (2%). Twenty-four (18%) of the neonates with culture proven sepsis had a poor outcome. Gram negative organisms accounted for 19 (70%) of the cases with poor outcome. Prematurity (p < 0.001), very low birthweight (p < 0.001) and female gender (p < 0.05) were factors associated with poor outcome. Strategies aimed at decreasing morbidity and mortality in neonates with sepsis must include measures that will decrease the incidence of prematurity and low birthweight.

Analysis of Variance↗
PubMed2003

First record of Aedes albopictus from Trinidad, West Indies.

This is the 1st report of the occurrence of Aedes albopictus in Trinidad, West Indies. Eggs collected in 2 ovitraps, 1 in November and 1 in December 2002, were hatched and reared to adults at the Insect Vector Control Division laboratory. Three female Ae. albopictus emerged, whereas 6 females were collected by human-bait collections. The implications of these findings are discussed.

Aedes↗
PubMed2001

Colonic lipomas at the University Hospital of the West Indies.

Lipomas of the colon are uncommon but cause diagnostic difficulty when they are symptomatic. The clinical and pathological features of 17 cases of colonic lipomas diagnosed at the University Hospital of the West Indies between 1970 and 1999 are reported. Ten cases were symptomatic, two of these being diagnosed with adult intussusception. Six patients had incidental lipomas in bowel resected for other pathology while one lipoma was diagnosed on sigmoidoscopy. Increased awareness of these lesions will enhance pre-operative diagnostic accuracy.

Aged↗
PubMed1981

[Antenatal diagnosis of sickle-cell anaemia by DNA analysis of amniotic fluid cells. A preliminary study in the French West-Indies (author's transl)].

The genetic polymorphism previously reported to be associated with the sickle-cell (beta S) gene in black U.S.A. citizens was studied in the population of two French West-Indies islands in order to evaluate its potential application to the antenatal diagnosis of sickle-cell anaemia. The polymorphism consists of a change in the DNA sequences located near the 3' end of the beta globin gene. The change can be detected by means of the restriction endonuclease Hpa I. When cellular DNA is digested with this enzyme, the beta globin gene is contained in a DNA fragment measuring either 7.6 or 13.0 kilobases (kb). In 70% of SS homozygous subjects in Martinique and 57% in Guadeloupe the beta S gene was carried by a 13.0 kb DNA fragment, whereas the normal beta A gene was carried by a 7.6 kb DNA fragment. This polymorphism would make it possible to detect the foetal beta S gene in the DNA of amniotic fluid cells by linkage analysis.

Amniotic Fluid↗
PubMed2002

The Postgraduate Diploma in Primary Care and Family Medicine at the University of the West Indies, St Augustine, Trinidad and Tobago.

This paper is a descriptive one and provides the background and programme description of the Postgraduate Diploma in Primary Care and Family Medicine at The University of the West Indies, St Augustine, Trinidad and Tobago. This time-efficient model, built on the principles of adult learning, draws on the participants' past and present work experiences and uses their present work experiences as a source for reflection and change in a student-friendly, academic, educational setting. Core courses within the programme include medical education, biomedical ethics, evidence-based medicine and communication skills. There is also a strong clinical component to the programme.

Education, Medical, Graduate↗
PubMed1989

Pasture populations of cattle nematode larvae in Guadeloupe (French West Indies).

The development of numbers of third-stage (L3) larvae of gastrointestinal nematodes after pat (faeces) deposition by heifers is described, using a mathematical model, for seven experiments carried out in Guadeloupe (French West Indies). A dramatic rise in L3 population size occurred on herbage near pats, 17-25 days after pat deposition. There was no clear relationship between climatic data and L3 population dynamics. However, 5 successive days of rainfall induced the resumption of larval migration in two experiments. Changing the unit of expression of L3 population size (100 L3 m-2 vs 1000 L3 per kg DM) did not alter estimates of the model parameters. The evolution of L3 population of Haemonchus and Cooperia were similar.

Animals↗
PubMed2001

A clinico-pathological study of Cushing's syndrome at the University Hospital of the West Indies and a review of the literature.

Cushing's syndrome is an uncommon but important disease. Twenty-one confirmed cases of spontaneous Cushing's syndrome were documented at the University Hospital of the West Indies over a 21-year period. They were predominantly young females (F:M ratio of 17:4; mean age 25 years and 3 months). The commonest presenting symptoms were amenorrhoea (41%) and obesity (19%). Common clinical features were cushingnoid features (95%), hypertension (76%) and hirsutism (82%). Twenty-nine per cent had frank hyperglycaemia. Cushing's syndrome was due to Cushing's disease in 10 cases, adrenal adenoma in 3 and adrenal carcinoma in 2 cases. In 4 cases with presumed adrenal hyperplasia, the histology was either unavailable or was not consistent with the diagnosis. Two cases appear now to have had the ectopic ACTH Syndrome. Adrenalectomy was the commonest treatment offered. There were no intra-operative or post-operative deaths but recurrence was common after subtotal adrenalectomy in Cushing's disease. Twenty-seven per cent of the patients developed Nelson's syndrome, which was fatal in 50%. Long-term hormone replacement therapy was unnecessary after surgery for adrenal adenomas. Treatment of Cushing's syndrome was well tolerated by the patients.

ACTH Syndrome, Ectopic↗
PubMed1999

Tick-borne rickettiosis in Guadeloupe, the French West Indies: isolation of Rickettsia africae from Amblyomma variegatum ticks and serosurvey in humans, cattle, and goats.

Twenty-seven rickettsiae were isolated and/or detected from 100 Amblyomma variegatum ticks collected on Guadeloupe in the French West Indies. In this study, the polymerase chain reaction procedure appeared to be more sensitive in detecting rickettsiae in ticks than the shell-vial technique. Sequencing a portion of the outer membrane protein A-encoding gene showed that these rickettsiae appeared to be identical to Rickettsia africae, a member of the spotted fever group rickettsiae recently described as an agent of African tick-bite fever occurring in sub-Sahelian Africa. A high seroprevalence of antibodies to R. africae was demonstrated among mammals, particularly humans, cattle, and goats. These results and a recently reported case of an infection due to R. africae on Guadeloupe demonstrate that R. africae is present on this island. Although this disease has been underdiagnosed there, it may be frequent and may exist on other Caribbean islands where A. variegatum has propagated dramatically over recent years.

Adolescent↗
PubMed1994

Effect of acaricide treatment of cattle on Amblyomma variegatum (Acari: Ixodidae) infestation of mongooses (Carnivora: Viverridae: Herpestes auropunctatus) in Guadeloupe, French West Indies.

The effect of acaricide treatment of cattle on the infestation of the small Indian mongoose (Herpestes auropunctatus Hodgson) by Amblyomma variegatum (F.) was determined during a field evaluation of selected acaricides in Guadeloupe, French West Indies. From April 1990 to April 1991, cattle at one site were treated every 14 d with pour-on formulations of deltamethrin, flumethrin, or permethrin; and cattle at a second site were treated as per a local standard treatment using a spray formulation of coumaphos every 30 d. The protocol was then reversed, and from April to July 1991 cattle at the original standard treatment site were treated using the pour-on treatment. Mongooses were examined for ticks during February-March and July 1990 and 1991. The mean prevalence of infestation of mongooses by A. variegatum larvae was reduced from 41 to 27% during the February-March to July periods at the pour-on treatment sites but increased from 29 to 43% during the same periods at the standard treatment sites. The mean relative density of infestation by larvae decreased from 2.15 to 0.65 at the pour-on treatment sites and increased from 0.7 to 1.95 at the standard treatment sites during the same periods. Data on nymphal infestations were inconclusive, and mongooses were not infested by adult ticks. The infestation of mongooses by A. variegatum may be of importance as a short-term alternative host system for immature stages of this tick during an eradication program.

Acari↗
PubMed2004

The emergence of Stenotrophomonas maltophilia as a significant nosocomial pathogen at the University Hospital of the West Indies.

Stenotrophomonas maltophilia is emerging worldwide as a nosocomial pathogen. It is associated with certain risk factors and a wide range of infections. This study was done to document its emergence at the University Hospital of the West Indies and to determine the incidence, distribution and risk factors associated with it. A retrospective study was conducted over the period April 1997 to December 2000. Clinical records were available for 46 of the 66 patients identified over the study period. Fifty-five per cent of the cases came from the Intensive Care Unit (ICU) and the rest from other wards. There was a slight increase in the prevalence of infection with increasing age. The surgical service accounted for the largest number of isolates. Of the cases presented, 95.7% were exposed to a wide range of antibiotics and had some form of instrumentation. Underlying disease was found in 71.7% of the patients. S maltophilia was found most often in the sputum of ICU patients whereas it was most often isolated from wound swabs in the ward patients. The organism was isolated from blood more often in ICU patients (23.3%) than in ward patients (9.5%) and there was a 44% mortality rate among the cases in ICU compared with those on the wards (4.8%). Stenotrophomonas maltophilia is an important nosocomial pathogen and occurs in a wide cross-section of patients. The risk factors must be addressed and infection control measures implemented to restrict the spread of this organism.

Adolescent↗
PubMed2001

Six cases of cervical ligamentum flavum calcification in Blacks in the French West Indies.

OBJECTIVE: Calcification of the ligamentum flavum at the cervical spine is an uncommon condition reported mainly in Japanese patients. We describe the clinical manifestations, imaging study findings, and outcomes in six cases seen in the French West Indies. MATERIAL AND METHODS: We retrospectively reviewed the medical charts of six patients admitted to an orthopedics department for spinal cord compression shown upon computed tomography to be caused by calcification of the ligamentu flavum. There were five women and one man, mean age at admission was 71.7 years (range, 64-79 years) and all six patients were Black. RESULTS: Five patients had cervical myelopathy and one was asymptomatic. All five symptomatic patients had cervical spinal stenosis, explaining the rapid symptom onset (within six and a half months) and severe motor loss. Computed tomography reconstruction in the sagittal plane ruled out ossification of the ligamentum flavum. Magnetic resonance imaging of the neck failed to demonstrate the calcifications but was useful in evaluating the severity of the spinal cord compression. One patient had articular chondrocalcinosis in both knees and another had calcifications in the basal ganglia. Surgical decompression by the posterior route was performed in two patients and was effective in both, whereas two of the three symptomatic patients who did not have surgery experienced worsening neurological loss. Analysis of the operative specimens from the two surgically treated patients showed a mixture of calcium pyrophosphate dihydrate crystals and apatite microcrystals. CONCLUSION: Calcification of the ligamentum flavum is probably underrecognized in blacks. This condition causes severe neurological loss. Imaging studies provide the diagnosis. The pathogenesis remains unclear.

Aged↗
PubMed2005

Oesophageal foreign bodies at the University Hospital of the West Indies.

A retrospective study was conducted of 97 patients with oesophageal foreign bodies (EFB). The patients were admitted to assess characteristics of EFB, modes of presentation and radiological and endoscopic findings. The patients were from the University Hospital of the West Indies and most (42%) were over the fourth decade of life. The commonest EFB were bones. A negative radiological finding was not a reliable means to select patients for endoscopy. Oesophagoscopy is a reliable method in the treatment of EFB impaction. There were no major complications or deaths.

Bone and Bones↗