Pharmacy practice in the diabetes care team - a quality and economic approach for the Caribbean

As the number of people with diabetes increases, the disease with it's complications takes an ever-increasing toll on health care budgets. It is projected to become one of the world's main disablers and killers by 2025. In the Caribbean the rates of diabetes are also projected to continue to climb rapidly. Immediate action is needed to prevent the rise of new diabetics and instill cost-effective interventions in patients with established diabetes. A multidisciplinary team approach is recommended in the provision of diabetes care. The benefits of this approach to diabetes management are well established globally. A "pharmacist-managed" diabetic clinic operating in collaboration with health care team has extended quality and cost-effective services to diabetic population. In the Caribbean, the multidisciplinary team needs an improved collaborative approach within which the vital role of pharmacy practitioner can be defined. The objective of this study is to recommend evidence-based approaches that Caribbean pharmacists as members of diabetes multidisciplinary team, can adopt in order to develop pharmacist-managed diabetes practice. A literature search was conducted from 1995 to present. Of the 49 studies identified only 14 met the inclusion criteria. There were no published studies on diabetes disease management by pharmacists in the Caribbean. The selected studies were reviewed to determine the primary care functions that Caribbean pharmacists should opt to introduce in a pharmacist managed diabetes practice and thereby assist with quality of care and cost effectiveness. Studies from several countries have confirmed the improved quality of health care and positive impact on costs that pharmacists' involvement had on the management of diabetic patients. A Caribbean pharmacist-managed diabetic practice can result in a meaningful and sustained impact on the diabetes epidemic and its escalating cost to regional health systems.

Clinical isolates of bacteria from domestic cats in Grenada, and their antimicrobial susceptibility

Of a total of 57 consecutive clinical samples from domestic cats in Grenada, 23 were culture positive for aerobic bacteria. Of 25 isolates from these samples, 13 were Gram-negative bacteria, the majority (54%) being Escherichia coli from urinary tract infections and wounds/ abscesses, followed by Pseudomonas aeruginosa. Of the 12 Gram-positive isolates, the majority (75%) were staphylococci, originating from various infections. Among the less common isolates were, an Enterobacter cloacae strain associated with otitis externa, an Enterococcus faecalis strain associated with urinary tract infection, and a Streptococcus pneumoniae strain associated with upper respiratory infection. Antimicrobial resistance was least to enrofloxacin, the rate being 5.2%, followed by gentamicin (12%), chloramphenicol (14.2%), amoxicillin-clavulanic acid (15%), cephalothin (20%), and tetracycline (38.1%). All Gram-negative isolates were susceptible to enrofloxacin, and all Gram-positives to amoxicillin-clavulanic acid.

Autofluorescent vesicular structures in hematoxylin and eosin stained duodenal mucosa of the domestic cat

Sections of formaldehyde-fixed, paraffin-embedded and routinely haematoxylin and eosin stained duodenal tissue of the domestic cat were inadvertently observed under blue excitation visible light of a fluorescence microscope, while undertaking histological studies on normal mammalian gastrointestinal tract. The sections revealed yellow fluorescing vesicular droplets in basally located cells within mucosal epithelium of the villi and the intestinal glands. The droplets had pink coloration under light microscopy, while with non-routine staining methods of Periodic acid – Schiff reagent and silver (Fontana method), they were negatively stained. An evaluation for similar structures in duodenal tissue of dogs, cattle and rats proved negative. A review of the literature indicates that these structures may be unique to the cat’s duodenum, and that they may represent serotonin secretory product of cells that can be classified as a member of the diffuse neuroendocrine system.

The application of PCR and reverse line blot hybridization to detect arthropod-borne hemopathogens of dogs and cats in Trinidad.

Arthropod-borne diseases are important causes of morbidity and mortality of companion animals in Trinidad. As clinical signs are vague, more sensitive methods to diagnose these diseases based on the polymerase chain reaction (PCR) followed by reverse line blot hybridization (RLB) of amplified products are being developed. An RLB of 14 oligonucleotide probes coupled with polymerase chain-amplified regions of 16S rRNA or 18S rRNA genes of hemoparasites from cats and dogs detected Ehrlichia canis, Anaplasma platys, Babesia canis vogeli, feline mycoplasmas ("Candidatus Mycoplasma haemominutum,"Mycoplasma haemofelis), and some unknown species within the Babesia/Theileria group and the Anaplasma/Ehrlichia tribe. Amplified products were obtained from blood samples collected from 348 dogs and 15 cats. Overall, hemopathogen DNA was detected in 92 (26.4 per cent) dogs and six (40.0 per cent) cats. E. canis (49, 14.1 per cent) and feline mycoplasma (5, 33.3 per cent) DNA were most frequently identified in dogs and cats, respectively. B. canis vogeli (1, 6.7 per cent) and E. canis (1, 6.7 per cent) were also detected in cats. Mixed infections of Anaplasma/Ehrlichia sp. and Babesia sp. were present in five (1.4 per cent) dogs, while mixed infections of the feline mycoplasmas were present in two (13.3 per cent) cats, one of which was also positive for E. canis. Pyrexia was significantly associated with a positive RLB result in dogs (P= 0.00, chi(2), 1 df). This is the first reported application of macro-arraying techniques to detect arthropod-borne hemopathogens of companion animals in the Americas and the first detection of DNA of B. canis vogeli and E. canis in cats in Trinidad.

Seroepidemiology of feline leukaemia and feline immunodeficiency virus in domestic and feral cats in Grenada.

The serological prevalence of feline leukaemia virus (FeLV) and feline immunodeficiency virus (FIV) infections in domestic and feral cats in Grenada was studied using serum samples collected from 237 cats. The serum samples were tested for antibodies to the two viruses with the IDEXX ninety-six well micro assay plate ELISA kits. For confirmation, positive samples were further tested with the IDEXX comb FIV and FeLV snap tests. The overall prevalence of FeLV and FIV in cats in this study was 0% (n=237) and 19% (45/237), respectively. The seroplrevalence of FIV was 6.7% (7/104) in domestic cats and 28.6% (38/133) in feral cats. Feral cats had a significantly (p<0.05) higher FIV seroprevalence than domestic cats, and there was a significantly greater FIV seroprevalence in males compared to females as well as in cats 1 year of age and older compared to cats under one year. This study establishes the prevalence of FIV infection in Grenada. The negative FeLV results in our study are probably a reflection of Grenada's relative isolation and lack of numerous amicable contacts that occur when many cats share a close living space.

Seroepidemiology of feline leukaemia and feline immunodeficiency virus in domestic and feral cats in Grenada.

The serological prevalence of feline leukaemia virus (FeLV) and feline immunodeficiency virus (FIV) infections in domestic and feral cats in Grenada was studied using serum samples collected from 237 cats. The serum samples were tested for antibodies to the two viruses with the IDEXX ninety-six well micro assay plate ELISA kits. For confirmation, positive samples were further tested with the IDEXX comb FIV and FeLV snap tests. The overall prevalence of FeLV and FIV in cats in this study was 0% (n=237) and 19% (45/237), respectively. The seroplrevalence of FIV was 6.7% (7/104) in domestic cats and 28.6% (38/133) in feral cats. Feral cats had a significantly (p<0.05) higher FIV seroprevalence than domestic cats, and there was a significantly greater FIV seroprevalence in males compared to females as well as in cats 1 year of age and older compared to cats under one year. This study establishes the prevalence of FIV infection in Grenada. The negative FeLV results in our study are probably a reflection of Grenada's relative isolation and lack of numerous amicable contacts that occur when many cats share a close living space.

Animal ownership and attitudes to feral cats on St. Kitts, West Indies

Of fifty randomly selected residents of St. Kitts surveyed (22 questions), 42 percent owned dogs and 12 percent had cats. Most residents (54 percent) liked cats mainly because they were friendly and provided companionship, but also because they removed vermin. Thirty eight percent disliked cats principally because cats fouled the environment or damaged furniture. Although most people (48 percent) knew cats were associated with human diseases (mainly allergies and asthma), 38 percent were unsure. Most respondents (52 percent) observed feral cats around their homes and thr majority (73 percent) thought there were not too many feral cats on St. Kitts.

A nested-PCR with an Internal Amplification Control for the detection and differentiation of Bartonella henselae and B. clarridgeiae: an examination of cats in Trinidad

BACKGROUND: Bartonella species are bacterial blood parasites of animals capable of causing disease in both animals and man. Cat-Scratch Disease (CSD) in humans is caused mainly by Bartonella henselae and is acquired from the cat, which serves as a reservoir for the bacteria. A second species, B. clarridgeiae is also implicated in the disease. Diagnosis of Bartonellosis by culture requires a week or more of incubation on enriched media containing blood, and recovery is often complicated by faster growing contaminating bacteria and fungi. PCR has been explored as an alternative to culture for both the detection and species identification of Bartonella, however sensitivity problems have been reported and false negative reactions due to blood inhibitors have not generally been addressed in test design. METHODS: A novel, nested-PCR was designed for the detection of Bartonella henselae and B. clarridgeiae based on the strategy of targeting species-specific size differences in the 16S-23S rDNA intergenic regions. An Internal Amplification Control was used for detecting PCR inhibition. The nested-PCR was utilized in a study on 103 blood samples from pet and stray cats in Trinidad. RESULTS: None of the samples were positive by primary PCR, but the Nested-PCR detected Bartonella in 32/103 (31%) cats where 16 were infected with only B. henselae, 13 with only B. clarridgeiae and 3 with both species. Of 22 stray cats housed at an animal shelter, 13 (59%) were positive for either or both species, supporting the reported increased incidence of Bartonella among feral cats. CONCLUSION: The usefulness of a single PCR for the detection of Bartonella henselae and B. clarridgeiae in the blood of cats is questionable. A nested-PCR offers increased sensitivity over a primary PCR and should be evaluated with currently used methods for the routine detection and speciation of Bartonella henselae and B. clarridgeiae. In Trinidad, B. henselae and B. clarridgeiae are the predominant species in cats and infection appears highest with stray cats, however B. clarridgeiae may be present at levels similar to that of B. henselae in the pet population.

Short communication: concomitant malaria and filariasis infections in Georgetown, Guyana

Lymphatic filariasis and malaria are endemic in Guyana, South America. To determine the prevalence of concomitant infections, we conducted a 1-year survey of febrile patients attending the malaria (day) and filariasis (night) clinics in Georgetown. In all, 1278 thick blood smears were collected; 769 for filariasis, of which 103 were positive for Wucheria bancrofti, and three for both W. bancrofti and malaria parasites; and 509 for malaria, 21 of which tested positive for malaria and 17 for both malaria and filariasis. The age groups and sex of the infected persons with malaria and W. bancrofti are descibed. These results suggest that the incidence of concomitant infections in Guyana may be quite low but efforts should be made to reduce the disease burden in Georgetown, Guyana (AU)

Seroepidemiology of Helicobacter pylori infection in a Jamaican community

We researched epidemiologic associations between environmental and demographic factors and prevalence of Heliobacter pylori infection in a suburban Jamaican community. Using a clustered sampling technique, 22 domestic yards enclosing 60 separate households were randomly selected from a local community. All household members (n=346) were invited to participate following informed consent; the overall compliance rate ws 58.9 percent. A detect IgG antibodies raised against H. pylori. Environmental and demographic information was obtained by questionnaire. The seroprevalence of H. pylori was 69.9 percent (n=202). Analysis of the independent variables revealed three major components: Component 1 described, collectively, good personal hygiene and sanitation, indoor water supply and absence of straying animals in the peridomestic area; Component 2 included older age, good personal hygiene and large yard size; Component 3 the presence of domestic animals (cats and dogs) and again, large yard size. These three complexes explained 42.2 percent of the variability in the data set. Logistic regression showed that Components 2 and 3 were independently associated with H. pylori seropositivity, indicating that a combination of demographic, environmental and zoonotic factors is involved in the spread of H. pylori infections at the tropical community level. (AU)

Cutaneous larva migrans infection in the pediatric foot: a review and two case reports

Cutaneous larva migrans is the result of infestation of human skin by helminth larvae, which burrow through the epidermis. This route of infestation makes the foot a typical site for origination of this infection. Children, who frequently play barefoot in locations where the most common the helminth larvae, the dog and cat hookworms, are endemic, are at particular risk of this disorder. This article reviews the differential diagnosis of cutaneous larva migrans and current concepts in management. Two cases of related children who presented to their pediatricians with this condition are reported(AU)

A case of feline haemobartonellosis (feline infectious anaemia) and opisthorchiasis in Trinidad

A ten-year old cat showing signs of anaemia, inappetence, salivation and muscular twitching was diagnosed as having a mixed infection with the blood parasite Haemobartonella felis and the liver fluke Opisthorchis felineus. Opisthorchis felineus can infect man and is therefore considered a zoonosis. Neither disease has been previously reported in Trinidad. (AU)

Tinea capitis in Trinidad

Characteristics of clinically diagnosed cases of tinea capitis from Trinidad are discribed. Tinea capitis comprised 29. percent of all dermatophytoses seen at one general hospital out-patient dermatology clinic during a one-year period. Males were more often affected than females and there was a predominance of patients of African descent. Among the dermatophytes cultured Trichophyton tonsurans was the most prevalent (52.9 percent), followed by Microsporum canis (20.0 percent) and M. audouin ii (18.6 percent). Less frequent isolates included M. gypseum (1.9 percent), T. mentagrophytes var granulare (1.4 percent) and T. rubrum (1.4 percent) (AU)

Supporting evidence for the use of cassava (manihot esculeta) products instead of wheat flour products in the diet of the diabetic

The extent of blood glucose increases produced by products of cassava and wheat flour were compared in experiments performed in cats and rats. In normal anaesthetized cats, a meal of 500 mg grated cassava preparation produced a mean maximum blood glucose increase which is 200 percent less than the mean maximum blood glucose increase produced by a meal of 500 mg wheat flour preparation. In diabetic rats, a 20 gm homogenous mixture, consisting of 50 percent cassava bammmy and 50 percent rat chow that was eaten within a 24-hour period, produced a mean blood glucose increase which is 221 percent less than the blood glucose increase produced by a 20gm homogenous mixture, consisting of 50 percent wheat flour bread and 50 percent rat chow and eaten over a similar period of time. The lower glycaemic reponses of the cassava preparations therefore represent significant advantages over wheat flour preparations, for its (cassava preparation) inclusion in the diet of the diabetic (AU)

A pharmacological study of the hypotensive and anticurare effect of Anacardium occidentale

The bark of the cashew tree, Anacardium occidentale, is known to exert various therapeutic effects in the folklore medicine. However, there is little exiperimental evidence to substantiate these claims. West, Garvey and Ling in 1973 reported hypotensive action. Present investigations were carried out to find the possible mode of its hypotensive and anticurare effects. It is now well known that most of the clinically used antihypertensive drugs exert their pharmacotherapeutic effect via a common mode of action in spite of their different origins. Bhargava proposed that the central adrenergic, dopaminergic, cholinergic and tryptaminergic mechanisms in the central nervous system regulate the cardiovascular system, but the existence of such a central mechanism does not rule out the possibility of a peripheral component in the antihypertensive action of the drugs. The pathways followed by the central adrenergic and serotonergic nerves in the central nervous sytem are well suited for the regulation of the blood pressure. Most animals which received Anacardium occindentale showed an initial hypotensive response following the administration. This was marked and was not influenced by several experimental procedure or the drug pretreatments. The delayed hypotensive response occurred in most of the animals between 60 to 120 min after its administration and once set, remained below the basal level all throughout the duration of the experiment. The experimental manoeuvres and drug designs did not influence the delayed hypotensive response. The hypotensive action occurred in rats, cats and dogs and did not show any initial rise in blood pressure. (au)

Leptospirosis in dogs and cats on the island of Trinidad: West Indies

Concerning previous observations on dog populations in other parts of the world, notably Japan, the Phillippine Islands, and some countries in South America, we found that a high percentage of dogs in Trinidad are infected with organisms from many serogroups of Leptospira. Serogroups Canicola and Icterohaemorrhagiae were most commonly found. Ten isolates obtained from 50 kidneys from stray dogs (20 percent infectivity rate) were typed as portland-vere (six) and canicola (two) of the Canicola serogroup, copenhageni of the Icterohaemorrhagiae serogroup (one), and georgia in the Hebdomadis serogroup (one). To the best of our knowledge, this is the first record of a serotype in the Hebdomadis serogroup being isolated from a dog. A cat isolation was identified as canicola. Serological results show that 55 percent or more of stray dogs had been exposed as opposed to only 12.5 percent of the cats examined. Serogroups Canicola, Icterohaemorrhagiae and Hebdomadis are found most frequently in dogs, cats, mongooses, and man in Trinidad. (AU)

Ten years of rabies surveillance in Grenada, 1968-1977

During the period 1968-1977 there were nearly 700 recorded cases of animal rabies on Grenada and one human death. The mongoose is the major reservoir of the disease (AU)

The antiarrhythmic property of myoinositol isolated from the bark of Jamaican anacardium occidentale (cashew) - abstract

In the West Indies a wide variety of local plants are used in the treatment of several illnesses (folk medicine). The aqueous extract of anacardium occidentale is used in Jamaica to treat diabetes mellitus. It has reported that intravenous administration of a tincture or the bark lowered the blood sugar level for several hours; however our preliminary experiments in this study revealed no antidiabetic property. On the other hand the aqueous extract of the bark possesses cardiac antiarrhythmic properties. The antiarrhythmic agent was isolated and shown to be identical with myoinositol which constitutes about 25 percent of the extract material. The cardiovascular studies were conducted on adult mongrel dogs and adult cats of either sex. Only in the dog was left ventricular contractile force measured. Cardiac arrhythmias were induced by the infusion of adrenaline at 3 ug/kg/min and were easily maintained. This does caused multiple atrial or ventricular extrasystoles, or ventricular tachycardia within two minutes of starting the infusion. Myoinositol was injected intravenously before and during the adrenaline infusion in doses of 1-2 mg/kg. In cases where myoinositol was given before adrenaline, five to ten minutes were allowed before the infusion of adrenaline was started. The results indicated that myoinositol at this dose level had no significant effect upon pulsatile blood pressure. E.C.G. (lead 11) heart rate and contractile force in the normal animal. After the above dose of myoinositol was given the animal could withstand infusions of adrenaline as high as 6 ug/kg/min for up to 60 minutes without arrhythmias. Myoinositol does not interfere with the bet-adrenergic effect of adrenaline on the heart, hence this antiarrhythmic effect might not be mediated through a beta-adrenergic mechanism. On the other hand, since the compound has no local anaesthetic effect and does not depress the myocardium at the dosage that protects against adrenaline induce arrhythias, this effect cannot be due to a myocardial action. It is well known that myoinositol is found in various tissues of the mammalian body with the highest concentration in cardiac muscle (1.6 percent) but its exact physiolodical role is uncertain. Further work is being carried out using other types of arrhythmias with a view to elucidate the mechanism of this antiarrhythmic action (AU)

Analysis of respiratory response patterns following electrical stimulation of the medulla oblongata - abstract

The exact location of the "Respiratory Centre" and its possible demarcation into anatomically distinct "inspiratory" and expiratory half centres" have remained the subject of much controversy. In this study the medulla oblongata of 105 cats (1.65-3.40 kg, choralose-urethane anaesthesia) was exposed from the ventral surface, and the effect of the submaximal stimulation (40/sec., 1m sec., 1-4V) on respiration was investigated. The respiratory response pattern was analysed, and group according to the qualitative characteristics into (a) Inspiratory (4 types), (b) expiratory (two types) and (c) Mixed (3 types) effects. The observed response types were then charted on the medullary sections at the points where they were elicited. Taken together, inspiratory responses in the medullary cros sections are seen to be concentrated about three zones: (a) 10mm rostral (pontomedullary border) to the Obex level, (b) from the Obex level up to 4mm rostral of it, and (c) 4-9 mm caudal from the Obex. Expiratory reactions may be elicited in a region extending from 8 mm rostral to 2 mm caudal from the Obex. Expiratory effects were constantly 4-6mm rostral to the Obex on the ventrolateral aspect, even at the surface. Inspiratory and expiratory zones are in close contact forming together a rostrocaudally orientated semispiral, suggesting perhaps a functional interaction. The "respiratory centre" (defined here as structures, the stimulation of which results in respiratory arrest in the inspiratory or expiratory positions) may be demarcated into "inspiratory" and "expiratory" half centres, in agreement with Pitts et al. (Am. J. Physiol. 126, 673-688, 1939). It is located laterally in the formatio reticularis at the Obex level. At the transition between these two half centres there is a high degree of overlapping, explaining thereby the findings of Liljestrand (Acta. Physiol Scand. 29 suppl. 106, 321-393, 1953) of an intermingling pool of inpiratory and expiratory neurones. Mixed effects showing an increase in amplitude involving both inspiration and expiration were found concentrated ventrally in both rostral and caudal superficial chemosensitive zones (J. Appl. Physiol. 18, 523-533, 1963 and Pflugers Arch. 312, 189-205, 1969). Extending caudally from the caudal chemosensitive zone, the response is characterized by an inspiratory shift from the end-expiratory position. Ablation studies indicate that this type of response is representative, not of intrinsic respiratory centre activity, but of efferent pathway activity from the respiratory centre (AU)