Syphilis in a Jamaican psychiatric hospital: a review of 52 cases including 17 of neurosyphilis

Syphilis was diagnosed in 52 of 200 patients in an admission ward at the psychiatric hospital in Jamaica. 17 (8.5 percent) had neurosyphilis, tabes dorsalis was absent, meningovascular syphilis was rare (2 cases), GPI was common (10 cases) and 5 cases were unclassified. The present-day difficulties in diagnosis associated with previous inadequate penicillin therapy are stressed. A disappointly high cronicity rate of 35.3 percent was noted among neurosyphilis patients, one of whom died. (Summary)

Severe Neurological complications post-open heart surgery: the Jamacian experience

During the period January 1994 to December 1999, a total of 395 patients - adults and children - underwent various types of open heart surgical (OHS) procedures. The range of these patients was 10 days to 77 years. Most (43.5 percent) of these patients underwent valve replacement - first time and "redo" - as a result of rheumatic heart disease of varying duration and severity. The other large group was the complex congenital heart abnormalities (16 percent), followed by the group that underwent repair of atrial septal defect (13 percent), coronary artery bypass graft (13 percent) and repair of the ventricular septal defect (12 percent). Open valve repair (2 percent) developed severe neurological complications (NCs) post-OHS. These included: a short period (< 48 hours) of irritability and fluctuating consiousness level; seizure activity associated with hemiparesis and/or blindness; severe encephalopathy and vegetative state. Four patients showed complete recovery, but one died as a result of complications of the anti-seizure medication. Of the five, four died as a result of the NCs, and one was discharged in a vegetative state. Such severe neurological complications after an otherwise successful cardiac surgery represented a devastating outcome for patients and their families, and the social and economic impacts are enormous. Several factors were identified. The main ones being mitral valve replacement (MVR), especially "redo" surgery, female gender, age over 60 years, high New York Association functional class and post-operative hypotension. However, the true incidence of NCs (gross and subtle) in the study group cannot be ascertained. A detailed, structured neurological and neuropsychiatric assessment, both pre-and post-operatively, is therefore needed to document the true incidence of this complication. There is also the need for public education, especially for those with valvular disease, in order to encourage changes in attitude and behaviour towards continued follow-up care and valve surgery, both first and `redo'. (AU)