The Barbados AIDS audit: a profile of first neurological admissions

Conditions affecting the CNS are the commonest cause of HIV-related death at the Queen Elizabeth Hospital. The medical records were reviewed for 185 HIV-positive patients on their first admission for a neurological problem (covering the period 1994-1995). Mortality was 70 percent and did not change overtime. Mortality was highest (81 percent) when no firm diagnosis was reached but was still high (45 percent) in the 77 cases where a CT and/or LP confirmed the diagnosis. The commonest confirmed diagnoses were cerebral toxoplasmosis (20 deaths out of 50 first admissions) and crytococcal meningitis (7 deaths out of 16 admissions). Currently, the favoured diagnostic strategy for neurological presentations is to obtain a CT and then do LP. Due to the apparent relationship between a CT and mortality in our population this strategy needs to be reconsidered. The presence of symptoms and/or signs of lower respiratory tract infection in a patient with no focal deficit appears to have a high predictive value for cryptococcal meningitis. An appropriate management strategy of neurological presentations in our setting may be to perform LP on admission in such patients with all others treated empirically for cerebral toxoplasmosis. We will prospectively evaluate this algorithm (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)

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)

Influenza A virus associated neurological disorders in Jamaica

During 1979, three cases of influenza A virus infection associated with neurological disorders were observed. In all three cases the virus was isolated from the cerebrospinal fluid. A mechanism for the development of post-influenzal encephalopathy is postulated (AU)

Inappropriate secretion of antidiuretic hormone induced by chlorpropamide

A patient with diabetes mellitus treated with the sulfonylurea chlorpropamide developed the syndrome of inappropriate secretion of antidiuretic hormone. The mode of clinical presentation was one suggesting a central nervous system disorder. A clinical study of the patient's response to chlorpropamide was carried out. Headache, systolic hypertension, serum hypo-osmality, hyponatremia, urine hyperosmolality, fall in urinary output and continued renal excretion of sodium were demonstrated, confirming the initial diagnosis (AU)