Skin: the largest organ you possess

Ranging in colours from the richest black to light pink and almost colourless is the most remarkable and largest organ we possess: our skin. It's easy to take the skin for granted - until we experience a problem. Most of us would pay little attention to the health of this all-important organ, until we suffer from any one of a myraid of disorders like skin cancer, psoriasis, warts, cold sores, or vitiligo (loss of pigmentation) - all of which, if left untreated, could significantly affect our quality of life. So it's important to understand how the skin works, as well as what it does for us.

Comparison of plants used for skin and stomach problems in Trinidad and Tobago with Asian ethnomedicine

This paper provides a preliminary evaluation of fifty-eight ethnomedicinal plants used in Trinidad and Tobago for skin problems, stomach problems, pain and internal parasites for safety and possible efficacy. Thirty respondents, ten of whom were male were interviewed from September 1996 toSeptember 2000 on medicinal plant use for health problems. The respondents were obtained by snowball sampling, and were found in thirteen different sites, 12 in Trinidad and one in Tobago. The uses are compared to those current in Asia. Bambusa vulgaris, Bidens alba, Jatropha curcas, Neurolaena lobata, Peperomia rotundifolia and Phyllanthus urinaria are possibly efficacous for stomach problems, pain and internal parasites. Further scientific study of these plants is warranted.

Systemic phaeohyphomycosis in pregnancy and the puerperium

Systemic fungal infections are rare. In pregnancy, treatment is problematic because of the risk of possible teratogenic effects of the antifungal drugs. We present the case of a 32 year-old woman who presented during pregnancy with a two-month history of painless subcutaneous nodules. Excision biopsy of one lesion showed dematiaceous fungal elements. Anti-fungal treatment was deferred and the pregnancy proceeded uneventfully. The remaining nodules were excised at the time of caesarean section delivery. Three weeks into the puerperium, she developed generalised seizures and investigations indicated systemic fungal infection with positive cultures for Aureobasidium spp which responded to appropriate antifungal therapy of flucytosine and itraconazole.(Au)

T cells and the skin

In addition to its role as a mechanical barrier, the skin plays an important role in temperature regulation, vitamin D synthesis and absorption of ultraviolet radiation. The importance of the skin as an immunological organ was not fully appreciated until the advent of immunosuppressive agents such as cyclosporin and tacrolimus, which have a predominant action against T lymphocytes and have been found to be effective in the management of common skin diseases such as atopic eczema and psoriasis. T lymphocytes are of fundamental importance to the immune system. Access from the vascular compartment into the skin is facilitated by adhesion molecules located on the endothelial of dermal blood vessels. Selective upregulation of adhesion molecules occurs in various inflammatory skin diseases and specific skin homing T lymphocytes preferentially enter the skin rather than other organs. T cell have recently been classified into Th1 and Th2 cells based on their cytokine profile. Th1 cells produce interleukin 2 (IL-2) and interferon gamma, important in macrophage activation and cytotoxity, and Th2 cells produce IL-4 and IL-5, important in B cell maturation and humoral immunity. Contact dermatitis and psoriasis are characterised by Th1 cells and atopic dermatitis by Th2 cells. The Th1/Th2 profile is also important in infectious diseases such as leprosy in which polarisation towards tuberculoid or lepromatous disease depends on a predominance of Th1 or Th2 cells, respectively. Future management of diseases affecting the skin is likely to depend on a greater understanding of the infiltrating T cell subsets and appropriate modulation of the Th1 and Th2 profile.(AU)

Prevalence and characteristics of Staphylococcus aureus strains isolated from bulk and composite milk and cattle handlers

The prevalence and characteristics of Staphylococcus aureus strains isolated from bulk and composite milk and from cattle handlers on dairy farms in Trinidad were determined. S. aureus strains isolated from all 175 bulk milk samples tested (100 percent) while 280 of 287 composite milk samples (97.6 percent) yielded S. aureus. The mean counts of S. aureus in bulk milk ranged from 5.9 x 10(3) to 1.2 x 10(5) CFU/ml compard with mean S. aureus counts in composited milk which ranged from 2.4 x 10(3) to 3.0 x 10(4) CFU/ml. Of the 105 strains of S. aureus from bulk milk tested, 45 (42.9 percent) were enterotoxigenic elaborating staphylococcal enterotoxin A (SEA), SEB, SEC, SED, or a combination compared to 69 of 146 strains (47.3 percent) recovered from composite milk which were enterotoxigenic but the difference was not statistically significant (P > = 0.05; chi 2). Twenty-two of 42 bulk milk samples containing enterotoxigenic S. auerus (52.4 percent) had counts of the organism which exceeded 10(4) CFU/ml. For S. aureus strains isolated from cattle handlers, 66 of 146 (45.2 percent) were enterotoxigenic. Prevalence of resistance to nine antimicrobial agents tested was 18.7 percent and 12.9 percent among bulk milk and composite milk isolates, respectively, compared to 49.3 percent and 69.5 percent among isolates from human anterior nares and hand swabs, respectively. Resistance to ampicillin and penicillin was highest among both milk (12.2 percent) and human (53.6 percent) isolates of S. aureus, and the difference was statistically significant (P < or = 0.001); chi 2). It was concluded that bulk milk containing relatively high counts of enterotoxigenic S. aureus may constitute a health hazard to consumers(AU)

Prevalence and characteristics of Staphylococcus aureus strains isolated from bulk and composite milk cattle handlers

The prevalence and characteristics of Staphylococcus aureus strains isolated from bulk and composite milk and from cattle handlers on dairy farm all 175 bulk milk samples tested (100 percent) while 280 of 287 composite milk samples (97.6 percent) yielded S. aureus. The mean counts of S. aureus in bulk milk ranged from 5.9 x 10(3) to 1.2 x 10(5) CFU/ml compared with mean S. aureus counts in composite mild which ranged from 2.4 x 10(3) to 3.0 x 10(4) CFU/ml. Of the 105 strains of S. aureus from bulk milk tested, 45 (42.9 percent) were enterotoxigenic elaborating staphylococcal enterotoxin A (SEA), SEB, SEC, SED, or a combination compared to 69 of 146 stains (47.3 percent) recovered from composite milk which were enterotoxigenic, but the difference was not statistically significant (P > 0.05; chi 2). Twenty-two of 42 bulk milk samples containing enterotoxigenic S. aureus (52.4 percent) had counts of the organism which exceeded 10(4) CFU/ml. For S. aureus strains isolated from cattle handlers, 66 of 146 (45.2 percent) were enterotoxigenic. Prevalence of resistance to nine antimicrobial agents tested was 18.7 percent and 12.9 percent among bulk milk and composite milk isolates, respectively, compared to 49.3 percent and 69.5 percent among isolates from human anterior nares and hand swabs, respectively. Resistance to ampicillin and penicillin was highest among both milk (12.2 percent) and human (53.6 percent) isolates of S. aureus, and the difference was stastically significant (P < or in 0.001; chi 2). It was concluded that bulk milk containing relatively high counts of enterotoxigenic S. aureus may constitute a health hazard to consumers(AU)

Clinical, pathologic, and immunologic features of human T-lymphotropic virus type I- associated infective dermatitis in children

Objectives: To define the clinical and laboratory features associated with infective dermatitis (ID) and confirm its association with human T-lymphotropic virus type 1 (HTLV-I). Design: A case series of patients with ID were compared with patients with atopic dermatitis (AD) which is an important disease in the differential diagnosis of ID. Setting: Patients were recruited from dermatology and pediatric clinics at the University Hospital of the West Indies and the Bustamante Children's Hospital, Kingston, Jamaica. Main Outcome Measures: Clinical and laboratory features of patients with AD were compared with those of patients with ID. Patients: Consecutive patients older than 1« years diagnosed as having ID (n=50) and AD (n=35) were enrolled based on clinical findings. Results: The mean age of patients with ID and AD were 6.9 and 7.8 years, respectively. Histologically, both disease were predominantly chronic dermatitis... Conclusion: Infective dermatitis is a distinct clinical entity associated with HTLV-I, which plays a role in the pathogenesis and immune perturbations observed.(AU)

A comparison of the use of plain catgut, skin tapes and polyglactin sutures for skin closure: a propsective clinical trial

A prospective clinical trial was carried out to compare the effect, on wound healing, of the use of polyglactin, plain catgut sutures, or skin tapes, in the closure of 190 groin crease incisions in children. The final outcome variable analysed was uneventful healing, defined as the absence of wound erythema, four successive observation periods, up to 11 months post-operatively. Wounds closed with polyglactin (P=<0.5). This association diminished over subsequent observation periods. Skin tapes were cheapest of the skin edges. Patient age (P=<0.01 to <0.05) and sex (P<0.01) also exercised an effect on wound outcome, particularly at the final observation point. The reason for this was not determined. The results of this trial favour the use of polyglactin sutures over plain catgut and skin tapes in the closure of groin crease incisions in the population studied (AU)

Postural vasoconstriction and leg ulceration in homozygous sickle cell disease

Chronic leg ulceration is a major cause of morbidity in patients with homozygous sickle cell disease; the ulcers commonly resolve on bed rest. We have therefore compared the cutaneous vascular response to dependency in three groups of eight patients with sickle cell disease (those with an active ulcer, with an ulcer scar and with no history of ulceration) and in eight subjects with normal haemoglobin and no history of leg ulceration. We monitored with a laser Doppler flowmeter, the change in red cell (erythocyte) flux induced in the skin of the leg, at two sites proximal to the malleoli, with the leg horizontal and 5 and 10 min after moving the leg to the dependent position. With the leg horizontal, mean cutaneous red cell flux was was substantially higher in normal cells of patients with sickle cell disease than in normal subjects and was higher still at the site of the ulcer scar. On dependency, red cell flux fell not only in normal subjects but also in the patients with the sickle cell disease. The fall in red cell flux in normal skin of patients with sickle cell disease was smaller than in normal subjects when considered as a percentage of the control values, but in absolute terms the falls in red cell were similar in sickle cell patients normal subjects. By contrast, the fall in red cell flux at the ulcer/scar site was greater than in normal skin from sickle cell patients. We propose that high resting perfusion is important in patients with sickle cell disease to maintain normal integrity of cutaneous tissue and that pronounced vasoconstriction on dependency hinders the healing and encourages recurrence of the leg ulcers (AU)

Non-operative management of stab wounds to the abdomen with omental evisceration

A consecutive series of 12 patients with anterior abdominal stab wounds and omental evisceration treated at the Kingston Public Hospital Jamaica over a 3-year period is presented. During this period 223 patients with abdominal stab wounds were seen of which 66 had omental evisceration. Conservative surgical management was the approach followed in 14 patients who presented without signs of peritonitis. There were no late complications or missed visceral injuries necessitating laparotomy. Serial physical examination was the method used to select patients for conservative surgical management with the exclusion of patients with deteriorating clinical signs or peritonitis. Omental evisceration through an abdominal stab wound in a patient with stable clinical signs and without evidence of peritonitis is not an absolute indication for exploratory laparotomy. (AU)

Adult T-cell leukemia/lymphoma in Jamaica: 1986-1995

Adult T-cell leukemia/lymphoma (ATL) is the commonest lymphoid malignancy in adult Jamaicans, reflecting the role of the causative agent, human T-cell lymphotrophic virus type I (HTLV-I), in altering the pattern of non-Hodgkin lymphoma in an endemic area. A total of 126 cases of ATL were registered in Jamaica between January 1985 and July 1995. There were 65 male and 61 female patients (male-female ration, 1:1), with a mean age of 43 years (17-85 years). The majority of cases were acute subtype (46.8 percent), followed by lymphoma (27 percent), chronic (20.6 percent), and smoldering (5.6 percent) types. The disease is associated with a high mortality, with only five of the 126 patients currently alive. The median survival rate is 20 weeks. The epidemiologic, clinical, and laboratory features are similar to those reported in Japan and Brazil, except that the mean age of patients, identical in Jamaica and Brazil (43 years), is 11 years younger than that in Japan (54 years). Given the theory that ATL develops after a long incubation period after early life exposure to HTLV-I facilitated by mother-to-child transmission via breast milk, and the fact that mothers of ATL patients have a higher incidence of HTLV-I seropositivity, it would appear that reduction in the incidence of this disease could be achieved by methods aimed at preventing this mode of transmission.(AU)

Daily variability in resting levels of cardiovascular variable in normal subjects and those with homozygous sickle cell disease

Measurements were made of cardiovascular variables and oral temperature in 16 male subjects with homozygous sickle cell disease (SS) and in 17 matched controls (AA) at 10.00 a.m, 1.00 p.m and 4.00 p.m. All subjects were in a rested state throughout. At 10.00 a.m. mean arterial pressure was lower, while heart rate, total forearm blood flow and cutaneous red cell flux in the forearm were higher in SS than AA. Vascular resistance in total forearm and forearm skin, calculated by dividing arterial pressure by blood flow or red cell flux, were lower in SS but hand cutaneous red cell flux and vascular resistance were not significantly different in SS and AA. In both SS and AA, there were parallel increase over the three sessions, in mean arterial pressure (by approximately 12 and 10 percent respectively) forearm vascular resistance (by approximately 17 and 27 percent) and hand cutaneous vascular resistance and hand cutaneous resistance (by approximately 2240 and 350 percent) whereas forearm blood flow and hand cutaneous red cell flux fell. By contrast, forearm cutaneous resistance showed no change during the day in SS, but increased progressively in AA (by approximately 75 percent). These results indicate that, during the day, there is progressive vasconstriction in forearm muscle and hand skin in SS and AA and also in forearm skin of AA that contributes to a progressive rise in the resting level of mean arterial pressure. We suggest this daily variability should be considered in studies of cardiovascular function: within a given study they should be performed at the same time of day.(AU)

Angioid streaks in Jamaican patients with homozygous sickle cell disease

Angioid streaks were observed in 21 of 242 patients with homozygous sickle cell disease. Two morphological types were observed. There is no evidence that angioid streaks in Jamaican patients are related to pseudoxanthoma elasticum (AU)

Tropical acute rheumatic fever and associated streptococcal infections compared with concurrent acute glomerulonephritis

Ninety-three patients with acute rheumatic fever and 195 patients with acute glomerulonephritis were observed in Trinidad during an outbreak of scabies with a high incidence of secondary streptococcal infections. Clinical and laboratory manifestations of ARF were the same as those seen in temperate zones, except that antistreptolysin O titers were less markedly increased. The patients with ARF were similar to those with AGN in respect to sex, race, location of residence, and living conditions, but were older and had markedly fewer skin infections. Currently prevalent nephritogenic streptococcal strains never were isolated from patients with ARF even when M55 streptococci appeared and led to an epidemic of AGN.(AU)

Leg ulceration in sickle cell anaemia

In Jamaica, leg ulcers are a major manifestation of sickle cell disease. The chronicity of the lesions is such that education and consequent work potential are seriously affected. Although these lesions rarely cause mortality, they are a major determinant of the morbidity of the disease. (AU)