Belize SARSCOV2 Lab Screenings 23rd April 2020

This document is an infographic of COVID-19, detailing Belize SARSCOV2 Lab Screening relating to Tests Done, Negative Tests, Positive Tests, Recovered, Deaths, and the cases Under Investigation for the period 23rd April 2020 (AU)

Comorbid disease in asthma: the importance of diagnosis

William Osler's comprehensive definition of bronchial asthma as "a neurotic affection characterized by hyperemia and turgescence of the mucosa of the smaller bronchial tubes … a peculiar exudate of mucin attacks … due to direct irritation of the bronchial mucosa or induced reflexly, by irritation of the nasal mucosa, and indirectly by reflex influences from stomach, intestines or genital organs" has been chiseled away to a chronic inflammatory disorder of the airways [1]. Asthma’s sharp climb in developing countries parallels their growing urbanization and westernization, eclipsing its rising prevalence in developed nations. Disease morbidity and mortality is higher in low- and lower–middle-income countries [101] particularly among the elderly, where atypical presentations and comorbidities render it likely to be underdiagnosed [2]. Common comorbidities associated with frequent exacerbations in difficult-to-treat asthma include hiatus hernia with or without associated gastroesophageal reflux disease (GERD), rhinosinusitis, recurrent respiratory infections, psychological disturbances and obstructive sleep apnea (OSA) [3,4]. Undiagnosed comorbid disease influences diagnosis, treatment response, disease management and control of asthma.

Acute respiratory disorders in the newborn: a survey at the Mt. Hope Women's Hospital, Trinidad

This retrospective study was undertaken to determine the incidence of acute respiratory disorders (ARD) in newborns delivered at the Mount Hope Women's Hospital [MHWH] from January 1st to December 31st, 1994. The study also examined the relationships between incidence rates and maternal and neonatal parameters. Hyaline membrane disease (HMD)m trabsuebt tachypnea of the newborn (TTN), meconium aspiration syndrome (MAS), persistent foetal circulation (PFC) and pulmonary infection (PI) were identified as ARDs among 5,062 live newborns using standard diagnostic criteria. Overall, 174/5,062 neonates were diagnosed with ARD to give an incidence of 3.4 percent (104 males and 70 females). The commonest ARD was PI (39 percent) followed by HMD (48/4363) in full term neonates. HMD occurred mainly in the preterm and low birth weight babies. TTN and PI were found in all gestational age groups. Asphyxia was present in 9.8 percent (17/174) at 1 minute and in 10.9 percent (19/174) at 5 minutes. It was more common in babies who developed HMD and PFC. Forty one percent of babies with ARD required assisted ventilation. There were 58 (33 percent) deaths. More than one half of those ventilated died (55 percent), 2/3 of those with asphyxia at both 1 and 5 minutes of age. There was significantly greater mortality among neonates with HMD as compared to the other ARDs. (AU)

Respiratory conditions, including asthma, and height in primary school

The National Study of Health and Growth (NSHG) of primary school children has examined the relationships between height and each of six separate respiratory conditions, one of which was asthma, in children aged 5-11 years, allowing for a number of genetic and enviromental confounding factors, in particular for parental height. The relationships were investigated in a 'representative' sample of 4974 Caucasian English children in 1984 and in an 'ethnic/inner city' sample of 3419 Afro-Caribbean/Indian and Pakistani/Caucasian English children in 1985. None of the respiratory conditions was found to be related to height except for wheeze most days', whether or not it was accompanied by an asthma attack in the last 12 months. The Caucasian children in the 'representative' sample who had 'wheeze most days', were 0.17 height standard deviation score (95 percent confidence interval 0.03 to 0.31) less (approximately 1cm) than those with no wheeze. Comparisons with previous results for NSHG 'representative' Caucasian English children in 1973 showed good agreement except for children with three or more asthma attacks who were found to be shorter in 1973, but not in 1984, which may reflect improved treatment, or milder asthma being reported in 1984. It was concluded that, in the 1980s, the respiratory conditions were not related to height. The exception was 'wheeze most days'. It is suggested that this is an indicator of sickness, most likely asthma, which is being experienced with sufficient severity to affect growth slightly (AU)

The management of asthma in general practice

The mortality and morbidity of asthma are unacceptably high worldwide given that there is an effective treatment for this condition. The recognition that asthma is an inflammatory disease has led to use of anti-inflammatory medication as a first line treatment, with the use of bronchodilators on an as required basis. A stepwise approach to treatment based on the severity of the condition is now accepted as the best way to treat the disease. The general practitioner is usually the first contact the asthmatic makes with the health services. Therefore, if asthma is to be treated effectively it is at the primary care level that improvement in management must take place (Summary)

Child morbidity in the Kingston metropolitan area, Jamaica 1983

The case reports of all children admitted to public and private hospitals in the Kingston metropolitan area were examined for an analysis, by special areas, of spatial variations in child morbidity. A poison probability test was applied in order to determine areas of significant excesses in admission rates and three special areas selected for a child health survey. At the 0.025 significance level 20 of the 72 special areas had significantly higher and three significantly lower levels of admission. The survey confirmed the pattern revealed by hospital admissions and suggested that the children of young, unemployed and single women may be particularly vulnerable.(AU)

Bed utilization study in paediatric medical patients at the Queen Elizabeth Hospital, Barbados

Details of a bed utilization study of 1,654 paediatric medical ward admissions to the Queen Elizabeth Hospital, Barbados, during 1983 are analysed. Forty-one per cent of admissions had a respiratory problem, 14 percent had infectious diseases, 9 percent central nervous system conditions, and 36 percent had diseases of other systems. Analysis of hospital stay revealed that 20 percent of patients spent less than 24 hours and these mostly for bronchial asthma (31 percent, respiratory tract infections (15 percent, and gastroenteritis (10 percent). Most long-stay patients had either congenital heart disease (12 percent), social problems (11 percent) or diabetes mellitus (10 percent). We recommend that the establishment of a short-stay unit could eliminate 20 percent of admissions, who spent less than 24 hours. A further 21 percent (poisoning and gastroenteritis) could be significantly reduced with good health education (AU)

Effect of cigarette smoking and marihuana on respiratory tract function

Studies were conducted to elucidate the effect of tobacco smoking and marihuana on respiratory functions in both animals and human subjects. The airway resistance (Raw) was measured in apparently healthy Wistar rats using whole body plethysmograph. Histopathological and histochemical observations were also made to ascertain the damage induced by the inhalation of tobacco or marihuana smoke. Various pneometric tests viz. Vital capacity (VC), Functional Residual Capacity (FRC), Residual Volume (RV), Total Lung Capacity (TLC), Forced Expiratory Volume in one second (FEV1.0), Mean Transit Time (MTT), Peak Expiratory Flow Rate (PEFR) and Closing Volume (CV) were carried out in chronic tobacco, marihuana smokers and clinically assessed asthmatic patients. The effect of crude aqueous marihuana extract on specific airway resistance (sRaw) as well as on various pneometric parameters were observed both in animals and human subjects respectively. Animal Studies - inhalation of either marihuana or tobacco smoke significantly increased (p<0.01) airway resistance (Raw), functional residual capacity (FRC) and specific airway resistance (sRaw) as compared to the control rats. Apparent increases in the airway resistance were observed after the first week of exposure but significant differences were only noted in rats exposed for a period of 12 weeks or more. The smoking of either marihuana or tobacco increased the sensitivity of airways to acetylcholine from 18 weeks of exposure onwards. Attempts to elucidate the mechanism of action suggested that the increase in airway responsiveness of alpha adrenoceptors and increased vagal activity which may have resulted in the narrowing of the airways. This has been suggested on the basis of the following observations: i) Intraperitoneal administration of adrenaline (400 ug/kg body weight) following propranolol (2 mg/kg body weight) resulted in an increase in sRaw, whereas a decrease was observed following phentolamine (2 mg/kg body weight). ii) Intramuscular administration of atropine (2 mg.kg body weight) decreased sRaw. Bilateral vagotomy of marihuana or tobacco smoke to exposed rats. iii) The administration of subthreshold concentrations of acetycholine (0.25 ug and 0.5 ug Ach) in 36 weeks smoke exposed rats significantly increased sRaw in contrast to control rats. The administration of atropine prior to acetypcholine in subthreshold concentrations prevented such increase in sRaw in smoke exposed rats indicating the involvement of vagus in inducing the hypersensitivity. The possible existence of bronchitis in marihuana and tobacco smoke to rats from 12 weeks onwards has been further supported by histopathological and histochemical changes which include inter alia catarrhal inflammation resulting in ulceration of the bronchial mucosa, squamous cell metaplasia, increased goblet cell, increased sulphation of mucus, focal alveolitis and alveolar collapse. The interperitoneal administration of 1 ml aqueous crude marihuana extract (1.27 gm/100 ml) significantly decreased the value of sRaw in both marihuana and tobacco smoke exposed rats. This is suggestive of its bronchodilatory effect and has been further demonstrated to be acting through beta adrenoceptors. The cessation of smoking for one month resulted in a decreasing trend of sRaw in rats exposed to either marihuana or tobacco smoke for a period of 36 weeks. This suggests that improvement in the lung picture may be achieved if a longer recovery period is allowed. Human Studies - the comparison of lung functions in chronic marihuana smokers and non-smokers indicated narrowing of both central and peripheral airways as demonstrated by slight decreases in FEV1.0 percent and PEFR and increases in RV/TLC percent, CV/VC percent and CC/TLC percent. These lung functions were found to be more affected in chronic smokers. The bronchodilatory effect observed immediately after smoking a single dose of marihuana to the chronic marihuana smokers may be due to the presence of THC. This bronchodilation was followed by bronchoconstriction when observed after 60 minutes of marihuana smoking. The mechanism of initial bronchodilation is at present unclear but may be due to a direct effect of THC on the bronchial smooth muscle. The bronchoconstrictory effect of marihuana or tobacco smoke is probably due to increased vagal activity and increased responsiveness of alpha adrenoceptors as observed in the animal studies. The presence of a low responsive and a high responsive group of subjects in chronic marihuana smokers has been demonstrated. The high responsive group seems to be more susceptible to marihuana smoke as exemplified by greater decrease in FEV1.0 percent and increase in CV/VC percent. These changes further indicate that the impairment occurs predominantly in the larger airways even though there are signs of onset of small airway disease. The decreases in FEV1.0 percent and PEFR in the asthmatic subjects indicated abnormalities in the larger airways. Significant increases in MTT, CV/VC percent and CC/TLC percent is suggestive of obstruction in the peripheral airways. Administration of 30 mls aqueous extract (200 mg/100 mls) of marihuana to asthmatic subjects resulted in the improvement in lung functions after 30 minutes with the maximum improvement being observed at 60 minutes post administration. The bronchodilatory effect of marijuana extract was quite comparable to a known bronchodilator, ventolin (Salbutamol 200 ug), used in this study. However, the effect of ventolin was faster than aqueous marihuana extract. The bronchodilatory effect of aqueous marihuana extract may be due to the presence of some active ingredients other than THC and may be partly due to the increased activity of beta adrenoceptors (AU)

Changes in the pattern of mortality following the eradication of hyperendemic malaria from a highly susceptible community

The population of the sugar estate of the Guyana coastlands was 110 000 in 1966; malaria was eradicated between 1945-1951. A study has been made of the pattern of mortality before and after malaria eradication, during the 30-year period from 1937-1966. The decline in general mortality has greatly exceeded the fall in mortality specifically related to malaria and has continued for almost 10 years after registation of the last death from malaria. In infants, mortality has been reduced, mainly through a decline in the number of deaths from prematurity and cogenital debility that were due mainly to malaria and its sequelae in the expectant mother. In children (1-14 years of age) the decline has resulted from the disappearance of malaria and chronic nephritis as causes of death. In adults, mortality has fallen mainly through the progressive decline in the incidence of a number of diseases not overly related to malaria: acute and chronic respiratory diseases, chronic nephritis, and the anaemias. Cardiovascular diseases, on the contrary, have shown a tendency to increase since malaria was brought under control (AU)

A community survey of respiratory disease among East Indian and African adults in Guyana

The belief that chronic bronchitis is more prevalent among Indians than Africans in the Caribbean area was investigated by a community survey in Guyana. Respiratory symptoms were assessed by a standard questionnaire, ventilatory capacities were measured, and chest radiographs were taken of some 800 African and Indian men and women aged 35 to 54 years living in adjacent and similar communities. Histories of morning cough, chronic cough, morning phlegm, and chronic phlegm (chronic bronchitis) were more common in Indians than Africans. Although these respiratory symptoms were much more common in smokers than non-smokers, the higher prevalence rates in Indians could not be explained by smoking habits which were similar in the two races. Chronic bronchitis occurred in 17.3 percent of Indian and 2.4 percent of African male smokers and in 6.1 percent and 2.2 percent of Indian and African female non-smokers respectively. Judging by the history, lung infection, and clinical signs, chronic bronchitis was more severe in Indians than Africans. The condition was more common among field labourers on sugar estates but, although the majority of field labourers were Indian, this occupational difference only partially explained the difference in prevalence between Indians and Africans. Indians, for reasons unknown, appear to have a greater susceptibility than Africans to chronic bronchitis.(AU)

Bagassosis: an epidemiological and environmental survey - abstract

An epiemiological and environmental survey of 170 bagasse workers employed by a raw sugar producing company in Trinidad was carried out in order to assess the prevalence of respiratory symptoms, and to determine if exposure to bagasse was associated with alterations in ventilatory capacity. The epidemiological survey failed to reveal a significantly increased prevalence of respiratory symptoms in the more exposed group, but showed that the group of Indian workers who were regularly and continuously exposed to bagasse had a significantly lower ventilatory capacity than the control group (p < 0.001). This diminished ventilatory capacity was demonstrated despite negligible dust concentrations in the plant. Dust concentrations were measured using a Hexhlet sampler, the highest mean total dust concentration of 0.71 mg./m3 being found in the unloading area. However, the possibility that persistent exposure to low concentrations of bagasse may be the cause of the diminished ventilatory capacity must be considered (AU)

Causes of death in Jamaica, 1953 to 1964: an analysis of post-mortem diagnosis at the University of the West Indies

During the period 1953 to 1964, post-mortem examinations were performed on 4,115 cases at the University Hospital of the West Indies. The diagnosed made in these cases have been reviewed and are presented in this paper. 48 per cent of the cases were less than seventeen years of age, of which 18.5 per cent were in the perinatal age group. The number of deaths from malnutrition and infection in children aged under three years has declined during the period of study. In the adult group neoplastic disease was the major cause of death followed closely by cardiovascular lesions, amongst which hypertensive heart disease was a common entity. Chronic bronchitis and emphysema was common amongst the respiratory causes of death.(AU)

The role of parainfluenza viruses in respiratory diseases in Trinidad

Studies in other countries have shown that the parainfluenza viruses play an important role in respiratory disease especially among infants and children. Serologic evidence of infection with parainfluenza three was found to be widespread reaching up to 90 percent in children and 100 percent in adults. This study, conducted in Trinidad, W.I. shows that the parainfluenza viruses are not the major cause of respiratory disease in that country. Serological tests, hemagglutination inhibition, neutralization tests and complement fixation tests show that the incidence of antibody in Trinidad is much lower than that in other countries of temperate climate. Parainfluenza 1, 2, and 3 viruses were isolated from cases of respiratory disease during the course of the study but no epidemics caused by these viruses were seen. That is, no real increase of respiratory disease reflected in increased admissions to hospital or attendance at clinics was seen that could be traced to parainfluenza virus infections. These viruses seem to be the sporadic cause of respiratory disease in Trinidad. The incidence seems to be spaced over a period of months in a given year (AU)

Acute respiratory disorders in the newborn at the Mount Hope Women's Hospital, Trinidad

This retrospective study was undertaken to determine the incidence of acute respiratory disorders (ARD) in newborns delivered at the Mount Hope Women's Hospital(AU)