Pneumoconioses diagnosed at the National Chest Hospital, characteristics of patients and their environment, 1980-1989

The primary focus of the study is the prevalence of pneumoconioses diagnosed at the National Chest Hospital during the decade 1980-1989, with a view to determining the characteristics of the patients and the characteristics of the environment to which patients had been exposed. It is hoped that the finding will give a general picture of the status of the disease in Jamaica. The methodology used for data collection was primarily the perusal of dockets at the hospital. A total of thirty cases were diagnosed over the decade representing four disease in the category namely, pulmonary fibrosis, asbestosis, anthracosis and silicosis. Owing to the rarity of the diseases and consequently the few cases diagnosed over the period the data did not lend itself to certain statistical analyses. The cases diagnosed were more frequent among males in the older age groups. Most cases were also from Kingston due to the fact that it is the primary urban centre in Jamaica. Based on occupation, it was easy to fathom why some persons were diseased. (AU)

Effects of a hurricane on growth and morbidity in children from low-income families in Kingston, Jamaica

This is the first report of the effects of a hurricane on children's health and nutritional status in which data were available preceeding and following the event. When Hurricane Gilbert struck Jamaica in 1988, a longitudinal study was in progress in which children's weights and heights were recorded every 2 months and their morbidity histories taken every week. The investigation included 127 stunted (low height-for-age) and 32 non-stunted children aged 23-44 months, living in poor areas of Kingston. The data from the 4 months before and after the hurricane were compared. There was an increase in the occurrence of respiratory symptoms including rapid or difficult breathing (P < 0.04), coughs (P < 0.001) and nasal discharges (P < 0.001) during the first 2-month period after the hurricane. Howerver there was no significant effect on the occurrence of diarrhoea and injuries. Deficits were also found in height gain (P < 0.0001) during the same period. These adverse effects were found in spite of the large amount of food aid received and the aggressive health education programme implemented after the hurricane (AU)

Fat embolism syndrome following long bone fractures

During the period August, 1979 to December, 1992, 14 patients with the fat embolism syndrome (FES) were admitted to the University Hospital of the West Indies (UHWI). Two were females and 12 males, their ages ranging from 18 to 78 years, with a median age of 23.5 years. All had lower limb long bone fractures. Clinical features included fever, tachypnoea, confusion and drowsiness. They were all hypoxaemic; 9 required Intensive Care Unit (ICU) admission and, of these 4 needed ventilatory support. Five patients became comatose, 4 of whom developed decerebrate posturing. There was one death from Klebsiella septicaemia, and 13 patients recovered fully. The FES is a serious life-threatening complication of long bone fractures whether simple or compound, usually occurring within 72 hours of the injury. A high index of suspicion is needed for its prompt detection, and early attempts at maintaining adequate tissue oxygenation most be instituted if serious neurological complications and death are to be avoided. (AU)

Pulmonary artery pressure and the acute chest syndrome in homozygous sickle cell disease

OBJECTIVE; to investigate whether attacks of acute chest syndrome affected pulmonary artery pressure in patients homozygous for sickle cell disease. MAIN OUTCOME MEASURES: Pulmonary artery pressure, assessed by non-invasive echocardiographic techniques. PATIENTS; 20 patients with homozygous sickle cell disease with a history of at least six episodes of acute chest syndrome and in 20 age, sex, and height matched controls with homozygous sickle cell disease without a history of acute chest syndrome. RESULTS: There was no difference in any of the echocardiographic or Doppler indices between these two groups. CONCLUSIONS: Repeated attacks of acute chest syndrome by the mean age of 12 ( range eight to 16 ) years have not had a discernible effect upon pulmonary artery pressure (AU)

Assessment of the effects of ascorbic acid on respiratory and alimentary immune reaction

Clinical observation of diseases associated with the occurence of upper respiratory symptoms indicates that clinical features are also present in the alimentary system. Respiratory symptoms occur in consequence of viral or allergic reactions in the respiratory tract, both of which are associated with changes in ascorbic acid metabolism. Alimentary allergic symptoms occur as a rsult of recurrent antigen challenge with specific foods to which patients are sensitive. The specific allergens cause alteration in buccal taste and sensation, and the occurrence of abdominal symptoms. These effects provide sensitive and precise methods for diagnosis of food allergens. Aphthous ulceration has been shown to have a specific allergic basis by challenge of the ulcers with the causative allergens. The pain and inflammation of aphthous ulcers can be completely alleviated by buccal administration of ascorbic acid. The simultaneous occurrence of respiratory and alimentary symptoms following allergenic challenge indicates their common etiology in the allergic syndrome. The beneficial effect of ascorbic acid in the allergic syndrome is discussed. The lay person has a clear definition for himself of the symptoms which make up a cold. For the doctor Tyrell defined a cold as a mild illness in which the main local symptoms are found in the upper respiratory tract and in which nasal symptoms predominate. The early features are produced as a result of primary infection of the nose and nasopharynx by several viruses especially the rhinovirus. Amongst the complications of a cold, however, Macleod only includes sinusitis, eustachian catarrh, and lower respiratory infection. Clinical observation of diseases associated with the occurrence of upper respiratory symptoms indicates that many other features may be present in addition to those occurring in the respiratory tract. The purpose of this paper is to analyse these features, to determine their relationship to each other, and to investigate the effects of administration of supplementary Vitamin C on them. (AU)