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PubMed2003

A comparison of Caribbean and non-Caribbean clients in a residential addiction treatment facility in Antigua, West Indies.

The first 50 Caribbean clients admitted to a private, multicultural, not for profit addiction treatment center in Antigua, West Indies, were compared with the first 100 non-Caribbean clients admitted. There was no significant difference in age, 38 years (18-61 years) versus 40 years (22-63 years), or gender, 74% versus 67% male. Caribbean clients were more likely to be Black, 68% versus 2%, P < .001. Caribbean clients were less likely to have a prior psychiatric diagnosis, 18% versus 43%, P < .01, or to have been in prior treatment program, 22% versus 64%, P < .001. Caribbean and non-Caribbean clients were equally likely to be polydrug users, 48% versus 50%, and to use alcohol as a primary drug, 52% versus 51%. Caribbean clients were more likely to use cocaine, 30% versus 11%, P < .01, and marijuana, 12% versus 0%, P < .001, but less likely to use heroin, 6% versus 30%, P < .001 or pills, 0% versus 8%, P < .05. Caribbean clients were less likely to have elevated MCV, 24% versus 57%, P < .001 or serum transaminases, 23% versus 46%, P < .01. Differences between groups in this multicultural setting warrant further investigation.

Adolescent↗
PubMed2006

Seroprevalence of Toxoplasma gondii in pregnant women and cats in Grenada, West Indies.

Prevalence of antibodies against Toxoplasma gondii was studied in 534 pregnant women and 40 domestic cats in Grenada, West Indies. Antibodies (IgG) for T. gondii were sought in human sera by an enzyme-linked immunosorbent assay and in cat sera by using the modified agglutination test (MAT). Antibodies were found in 57 % of pregnant women. Seroprevalence increased with age; 51% of 15- to 19-yr-old women (100 total) had antibodies versus 60% of 20- to 24-yr-old women (127 total). Antibodies to T. gondii (MAT, 1:25 serum dilution) were found in 35% of cats; titers were 1:25 in 7 cats, 1:50 in 4 cats, and 1:500 in 3 cats. Epidemiological data suggested that the ingestion of food or water contaminated with oocysts was an important mode of transmission of T. gondii to women.

Adolescent↗
PubMed1996

An assessment of stress among clinical medical students of the University of the West Indies, Mona Campus.

This study looks at sources of stress among the medical students of the University of the West Indies at the Mona campus. Students of the classes 1993 through 1995 were asked to fill out a questionnaire which had been developed for a similar study at the University of Texas in 1983. The return rate was 66%. The results were compared for differences between males and females and between the different year groups. The two most stressful items were rated the same by men and women, i.e., 1) the amount of material to be learned, and 2) examinations and/or grades. There was no statistically significant difference between stress levels by gender in this study. The penultimate clinical year was most stressful. It is hoped that the findings of this study will be the basis for discussion about whether the identified stressors are inherent and necessary to the medical training experience and, if so, how students can be better prepared to cope with them.

Adult↗
PubMed2000

Complete genomic sequence of a dengue type 2 virus from the French West Indies.

Severe forms of dengue fever, dengue haemorrhagic fever, and dengue shock syndrome, were not prominent in the Americas until the epidemic of Cuba in 1981. Since that time, they have spread to other countries in Central and South America, correlating with the spread of dengue type 2 viruses related to Southeast Asian strains. We report here the complete genomic sequence of a dengue type 2 virus isolated during the epidemic in La Martinique in 1998. This constitutes the first complete genetic characterization of a dengue virus strain from French West Indies, and also the first molecular identification in this region of a dengue 2 strain phylogenetically related to the emerging American type 2 dengue viruses.

Amino Acid Substitution↗
PubMed1978

Body size and form of children of predominantly black ancestry living in West and Central Africa, North and South America, and the West Indies.

Stature, sitting height, hip width, arm and calf circumferences and body weight have been measured in black children of Richland County, South Carolina. Lower limb height and three indices of body shape were obtained from the measurements. Sample size exceeded 200 for each of five age-sex groups representing girls and boys aged 6 years, girls and boys aged 9 years, and boys aged 11 years. Comparisons are made with findings from previous research on children of predominantly black ancestry living in west and central Africa, the West Indies, and North, Central and South America. Black children of Richland County measured during 1974--77 are taller than black children studied since 1960 in Angola, Chad, Ghana, Liberia, Nigeria, Senegal, Uganda, Anguilla, Barbados, Cuba, Guyana, Jamaica, Nevis, St. Kitts, St. Vincent, and Surinam. Children of well-to-do black families in Accra and Ibadan are no taller or heavier than black children of Richland County taken without regard to socio-economic status. In hip width, averages for Richland County black children are larger than those for children of the Hutu and Yoruba tribes; in arm girth they are larger than children of the Hutu and Tutsi tribes. Age changes and group differences are reported for hip width relative to lower limb height, and lower limb height relative to sitting height. During childhood, the hip/lower limb index decreases, and the lower limb/sitting height index increases. Almost identical hip/lower limb indices characterize black populations in Africa, Cuba, and the United States.

Africa↗
PubMed2005

Anaesthesia for operative deliveries at the University Hospital of the West Indies: a change of practice.

There has been an increasing trend worldwide to use regional anaesthesia for operative deliveries. The Confidential Enquiry into Maternal Deaths in the United Kingdom has demonstrated a steady decline in the anaesthesia-related deaths since the introduction of regional anaesthesia. There are lower morbidity profiles in mothers delivering under regional anaesthesia as well as better infant Apgar scores. In 1997, a decision was taken to have at least 60% of all elective Caesarean sections done at the University Hospital of the West Indies (UHWI) performed under spinal anaesthesia. This is a review of the anaesthetic technique for Caesarean sections at the UHWI since 1996. The Deliveries and Anaesthetic Books on the labour ward were reviewed and the type of anaesthesia for elective and emergency Caesarean sections recorded for the period January 1996 to December 2001. At the beginning of the period under study, more than 90% of the Caesarean sections were being done under general anaesthesia. By the middle of 1998, spinal anaesthesia was more commonly employed than general anaesthesia for Caesarean sections and by December 2001, more than eight out of every ten Caesarean sections were being done under spinal anaesthesia. The main reasons for the successful change of practice were that it was consultant-led, there was good communication between relevant departments, the junior staff were properly trained, there was a consistent supply of appropriate drugs and there was a high level of patient satisfaction.

Anesthesia, Conduction↗
PubMed2004

Fatal poisoning in Jamaica: a coroner's autopsy study from the University Hospital of the West Indies.

This study reviewed cases of fatal poisoning in a coroner's autopsy series at the University Hospital of the West Indies and represented the first such study reported from Jamaica. The autopsy protocols of all coroner's autopsies performed over the 20-year period January 1980 to December 1999 were reviewed retrospectively; 22 (1.0%) cases were identified and relevant clinical and pathological data analysed. There were 13 males and nine females (M:F ratio 1.4:1) with an age range of 2 - 69 years (mean +/- SD = 27 +/- 16.1 years). The 20 - 29 year group was most commonly affected and five patients (22.7%) were children (< 18 years of age). Pesticides (herbicides/ insecticides) were implicated in nine (41%) cases: paraquat was the most common, found in six (27%) cases. Prescription drugs were the next most prevalent group with six (27%) cases, followed by anti-psychotic drugs in four (18%) cases. Cocaine and ackee were each implicated in two (9%) cases. The manner of death was suicidal in 14 (64%) cases and accidental in eight (36%) cases. Seven patients had documented psychiatric illnesses, six of whom committed suicide. Autopsy findings were largely non-specific. The relatively small number of cases was consistent with the low incidence of fatal poisoning in Jamaica.

Adolescent↗
PubMed2006

Epidemiology of coagulase-negative Staphylococci isolated from clinical blood specimens at the University Hospital of the West Indies.

The prevalence and significance of coagulase negative staphylococci (CoNS) isolated from blood cultures at the University Hospital of the West Indies (UHWI) during a six-month period were investigated. Standard and automated microbiological procedures were used to process 3001 blood culture specimens received from 2363 patients and 658 (21.9%) of the blood cultures yielded 854 bacterial isolates. The highest prevalence of positive blood cultures (60%) and the lowest prevalence of blood isolates of CoNS (12%) were found in the intensive care unit (ICU). The blood isolates of CoNS were most frequent in the surgical wards (13%) and lowest in obstetrics and gynaecology (2%). High rates of resistance to methicillin, other anti-staphylococcal penicillins, and cephalosporins used in the treatment of CoNS were observed All blood isolates of CoNS (100%) were susceptible to vancomycin. In conclusion, the results show that coagulase-negative staphylococci are the most prevalent bacterial isolates in blood cultures at the UHWI occurring mostly as contaminants. The practice of proper venepuncture and hand-washing techniques by medical staff are recommended to facilitate appropriate antibiotic usage.

Coagulase↗
PubMed2002

Abdominal obesity in type 2 diabetic patients visiting primary healthcare clinics in Trinidad, West Indies.

OBJECTIVE: To compare the blood pressure and metabolic parameters of type 2 diabetic patients with high waist circumference (WC) with those of type 2 diabetic patients with normal WC. DESIGN: After 10-14 h overnight fasting, weight, height, waist and hip circumferences and blood pressure were measured, and blood samples taken for glucose, glycated haemoglobin, total cholesteroL triglyceride, HDL-cholesterol, LDL-cholesterol and insulin determinations. Insulin resistance was calculated using the homeostatic model assessment (HOMA) method, while high WC was considered as WC > 102 cm and 89 cm for males and females, respectively. SETTING: Two primary care clinics in Trinidad, West Indies. PATIENTS: 190 confirmed type 2 diabetic patients with mean duration of 9.2 years were studied. RESULTS: About 75% and 17% of female and male patients, respectively, had high WC. Although blood pressure and lipid levels did not differ (p > 0.05) between patients with high and normal WC, the former group of patients had significantly higher mean levels of basal insulin and insulin resistance in each gender group (p < 0.001). However, female patients had an overall higher prevalence rate of hypercholesterolaemia (75% vs 52%) and higher LDL-cholesterol (84% vs 68%) than male patients (p < 0.001). CONCLUSIONS: Although there was similarity in the control of blood pressure and metabolic parameters irrespective of WC, patients with high WC might be at a comparatively higher risk of cardiovascular disease owing to greater basal insulin resistance. Early detection and treatment of abdominal obesity should therefore be encouraged in the primary healthcare setting.

Abdomen↗
PubMed1985

Bacteraemia at the University Hospital of the West Indies--a report of 222 cases.

A total of 222 cases of septicaemia was recorded at the University Hospital of the West Indies between June 1982 and June 1983. This gave an overall incidence of 16.1 per 1000 admissions. The 233 bacterial strains isolated comprised 100 Gram-positive and 133 Gram-negative organisms with Klebsiella pneumoniae, Streptococcus pneumoniae and Staphylococcus aureus being the most frequent. Highest rates of septicaemia were recorded in patients less than 1 year and over 50 years of age. Septicaemia caused by Gram-positive organisms was predominantly a disease of children whereas that caused by Gram-negative organisms arose more often in neonates and in patients over 50 years of age. A predisposing factor was noted in 104 patients of whom 42 had neoplastic disease. The most frequently identified initial sites of infection were the respiratory tract, the gastro-intestinal tract and the meninges. Most blood stream infections were community-acquired, three quarters of all septicaemic patients being admitted to the departments of medicine or paediatrics. There were 11 cases of polymicrobial septicaemia caused predominantly by Gram-negative organisms in patients with underlying disease. Appropriate antimicrobial drugs were administered to 57% of septicaemic patients whereas 17% received superfluous antimicrobial therapy. In those patients who received inappropriate antimicrobial therapy there was a marked increase in mortality. Forty of 61 deaths were attributed to septicaemia. Mortality from septicaemia caused by Gram-negative organisms was 21% compared with 13% for that caused by Gram-positive organisms. The organisms associated with the highest case fatality rates were Escherichia coli, 53%; Enterobacter sp., 27%; and beta-haemolytic streptococci 24%. There were no deaths from septicaemia caused by Haemophilus influenzae, Salmonella sp. or Serratia sp. The highest mortality rates were associated with neoplastic disease, diabetes, polymicrobial septicaemia, urinary tract infections and old age.

Adolescent↗
PubMed1999

Drug resistance mutations among HIV-1 strains from antiretroviral-naive patients in Martinique, French West Indies.

We report on the frequency of genetic mutations associated with drug resistance in antiretroviral treatment-naive patients from Martinique (French West Indies), where zidovudine (ZDV) has been available since 1987 and where combination therapy developed simultaneously with its use in continental France. Genotypic resistance was studied in plasma HIV RNA from samples collected between 1988 and 1998 from 70 antiretroviral-naive study subjects, half presenting with either primary infection or documented seroconversion. A line probe assay (LIPA) was used to detect substitutions on the reverse transcriptase (RT) codons 41, 69, 70, 74, 184, and 215. Direct sequencing was used to complete the data for RT codons which were uninterpretable by LIPA. Of these patients, 17 harbored mutated viruses with one or more mutations in the RT gene codons analyzed. ZDV resistance mutations T215Y/F, M41L, and K70R were found in 2, 5, and 12 individuals, respectively. Mutant strains L74V (didanosine [ddI] and dideoxycytidine [ddC]) were detected in 3 patients and M184V (lamivudine/ddI/ddC) in 4 patients. However, pure mutant results at one or more codons of interest were observed in only 5 (7%; 95% confidence interval [CI], 1%-13%) patients, all involving ZDV resistance. One carried both mutations T215Y and M41L known to confer a high degree of phenotypic resistance to ZDV. Among a subgroup of 28 patients with a timepoint of infection after 1995, 24 [86%; approximately 95% CI, 73%-99%) presented with a wild-type pattern. The significance of the high prevalence of mixed patterns observed in drug-naive patients remains unclear. However, the frequency of primary mutant genotypes associated with high levels of drug resistance is low in Martinique and in this study we did not observe any currently increased tendency in this frequency.

Anti-HIV Agents↗
PubMed2005

Clinicopathologic profile of gastric carcinomas at the University Hospital of the West Indies.

The objective of this study was to examine the clinicopathologic features of gastric cancer seen at the University Hospital of the West Indies (UHWI) and to compare the findings with other studies. A retrospective study was conducted using data obtained from the surgical pathology reports of all gastrectomies and gastric biopsies during the period January 1993 and December 2002. Additional cases were identified from the Department of Surgery's audit database. Demographic, clinical and pathological features were analyzed. Two hundred and sixteen patients were identified, 126 males and 90 females. One hundred and thirty-six underwent biopsy procedures but no definitive surgery aimed at cancer eradication, while 70 had gastrectomy. The peak age prevalence in both males and females was the 70-79-year age group. While the antrum was the commonest site, there was an overall increase in tumours of the gastro-oesophageal junction and tumours of the entire stomach in the latter five-year period of the review especially in the 50-59-year age group. Epigastric pain and constitutional symptoms were the common presenting features, and the most common gross tumour characteristic was an ulcerating mass, while histologically, the intestinal variety was most common. Lymph node metastases were common. Helicobacter pylori (Hpylori) were present in 16.7% while chronic multifocal atrophic gastritis was present in 40%. This study indicates that the gastric cancer pattern is typical of developing countries. However, the low prevalence of H pylori in the resected specimens may indicate the importance of other risk factors for gastric cancer development in this population. This warrants further study.

Adult↗
PubMed1991

Infectious mononucleosis in the University Hospital of the West Indies.

The clinical features and laboratory parameters in sixteen confirmed cases of Infectious Mononucleosis (IM) seen at the University Hospital of the West Indies between 1975 and 1989 were reviewed. The common presenting features were lymphadenopathy (14/16), fever (13/16) and pharyngitis (7/16). Atypical lymphocytosis was present in 10 cases and heterophile antibodies (HA) in 9 cases. The aetiology and laboratory diagnosis of IM are briefly discussed.

Adolescent↗
PubMed1998

Tungiasis among five communities in south-western Trinidad, West Indies.

The prevalences of Tunga penetrans Linn. within the five townships of Granville, Fullerton, Icacos, Coromandel and Cedros in south-western Trinidad, West Indies, as determined by physical examination of all inhabitants present during the survey, were 17.0% (38/223 subjects), 15.7% (36/237), 31.4% (102/325), 17.4% (42/242) and 17.9% (50/280), respectively. The rate in Icacos was significantly higher than in the other four sites (P < 0.001). Not only were males more likely to be infected than females in all five study sites (P < 0.0007) but chigoe-flea burdens were also higher in males than in females (P < 0.012), with mean (S.D.) burdens of 5.44 (2.54) fleas/male infected subject and 2.38 (2.00) fleas/female infected subject. Feet were significantly more infected than other areas of the body (P < 0.001). Analysis of variance revealed that the interactions between prevalence of chigoe-flea infection and geographical location (P = 0.0058) and between sex of infected subject and site of infection (P = 0.0109) were highly significant but that between geographical location and sex of infected subject was not significant (P > 0.30). At least seven species of bacteria, with varying sensitivities to antibiotics, were isolated from 16 patients with sepsis associated with their T. penetrans infections: Streptococcus pyogenes, beta-haemolytic Streptococcus (not group A), Klebsiella aerogenes, Enterobacter agglomerans, Staphylococcus aureus, Escherichia coli and a Bacillus species. Closteridium tetani was not isolated.

Adolescent↗
PubMed1989

An assessment of the doctorate of medicine (internal medicine), University of the West Indies.

The outcome is described of 48 entrants to a postgraduate degree course (DM) in Internal Medicine established at the University of the West Indies in 1974. Contact by postal questionnaire was established in 96% of 26 graduates and 82% of 22 non-graduates. 22 of 25 DM graduate responders have remained in the Caribbean, working in six Caribbean territories. All graduate responders developed a subspecialty interest. The graduates' primary employers are the University (9) and the Government (12). However, failure to graduate did not necessarily preclude qualification as consultant physician (7 of 18 responders). Major difficulties with the DM programme included: (1) in practice, lack of recognition by contributing territories of individual DM (Internal Medicine) graduates; (2) incomplete regional coverage; (3) lack of adequate funding for the programme; (4) an inadequate research training input; and (5) difficulties with seniority for staff who trained in Jamaica to go to work in another territory. All these problems have solutions. Overall, the international recognition of the new degree programme has been satisfactory and the graduates' own assessment of the training was complimentary. At last a system has been devised that enables postgraduates to train as internal medicine specialists in the Caribbean to practise effectively within the Caribbean health system.

Adult↗
PubMed2006

[Intestinal parasitosis in French West Indies: endemic evolution from 1991 to 2003 in the University Hospital of Pointe-a-Pitre, Guadeloupe].

Guadeloupe is one of the French West Indies, where, until 1960, intestinal parasitic infections were endemic. In the microbiological laboratory of the university hospital of the island, we carried out a retrospective study of the 17,660 stool examinations received from 1991 to 2003. All the stool specimens were examined using at least a wet mount preparation and a concentration method (Bailenger). Specific techniques such as Ziehl-Neelsen modified acid fast stain, chromotrope staining procedure or Baermann's technique were used when indicated. A parasite considered as really pathogenic is detected in only 5.6% of the cases of the 17,660 stool examinations. The intestinal protozoa count for 10.8% of them, G. intestinalis (60%) is the most common, followed by Cryptosporidium sp (26%) and Isospora belli in AIDS patients while Entamoeba histolytica/dispar rarely appears (2.3%). Among the parasitic intestinal helminths, Strongyloïdes stercoralis is seen as the most prevalent (82%) whereas hookworms and Trichuris trichuria count respectively for 9.8% and 5.6%. Schistosoma mansoni appears as an exception. This epidemiological change for intestinal parasitic infections results from the improvement of socio-economic and sanitary way of living of the population. However the persistence of the strongyloidiasis constitutes the outstanding fact in a area of strong prevalence of the HTLV1 infection.

Endemic Diseases↗
PubMed1994

Outcome of stage I carcinoma of the breast at the University Hospital of the West Indies (1982-1988).

The 5-year survival data for 62 patients with Stage I breast cancer treated at the University Hospital of the West Indies (UHWI) between 1982 and 1988 were evaluated to determine which factors were affecting outcome. The overall survival rates (66.7%) were below those quoted from large multicentre studies from North America, Western Europe and Australasia. The most significant survival differences emerged in the subset of postmenopausal patients with clinically staged disease who fared worse than those with pathologically staged disease. These data suggest that clinical staging is inadequate for the management of Stage I breast cancer. Consistent pathological staging, utilization of other prognostic predictors, and systemic therapy on a more widespread scale may help to improve the clinical outcome.

Breast Neoplasms↗
PubMed1998

Epidemiology of cutaneous melanoma in the French West Indies (Martinique).

The epidemiology of melanoma in populations of African-European descent has rarely been reported. The authors studied melanoma in the French West Indies (Martinique), where black Caribbeans and whites represented 96% and 4% of the population, respectively. Among the 85 cases of melanoma collected from 1976 to 1995, blacks represented 75% and whites, 25%. The average incidence rates were 1.48 and 0.9 per 100,000 per year in females and males, respectively. The sole of the foot represented 72% of the primary sites in blacks. Breslow's tumor thickness was > 1.5 mm in 68% of the cases. The 5-year survival was 44%.

Age Distribution↗