Right ventricular cardiomyopathy: a rare and underdiagnosed cause of sudden death in young adults

We present an example of right ventricular cardiomyopathy, a very uncommon condition which caused sudden death in an adolescent boy. This case report is used to highlight the pathological features of this rare and poorly understood condition, which is often undiagnosed (AU)

Strongyloidiasis - the clinical enigma - abstract

The most important human parasitic infection in Jamiaca is Stronglyloidiasis, not because it is the most prevalent but because it causes significant morbidity and mortality, persists for many years, and is difficult to diagnose and treat. The parasite is capable of living in the moist ground as well as the human host and in both sites it is able to grow and multiply. Less is known about this parasite than most in Jamaica although in the past 40 years one Ph.D. thesis and many papers and abstracts have been published by University of the West Indies workers. They have shown that the parasite causes a malabsorption syndrome due to subtotal villous atrophy, that the blood flow to the small intestine is increased, often producing an audible epigastric bruit, and that the lymphatic flow from the small intestine is also increased, that the free-living cycle is dependent upon critical temperature and humidity and that a culture of the stool in charcoal may improve the diagnostic yield. There is a true association with the hyperinfection syndrome and lymphoma; hyperinfection is also likely to occur when corticosteroids are used and the use of anti-biotics in the hyperinfection syndrome is beneficial. Currently the Parasitic Research Group comprises members of the Departments of Medicine, Microbiology, Pathology, Zoology, and the Tropical Metabolism Research Unit. Recently it has been shown that the best method of diagnosis is the Harad-mori culture of fresh stool, which is better than Formolether concentration, or more invasive methods such as duodenal biopsy (either for direct microscopy for parasites or for histology) or aspirate of duodenal juice for microscopy. Anorexia and malnutrition are common, with evidenc of zinc deficiency. The cure rate with standard therapy is about 35 percent, much lower than stated in textbooks. Association of Strongyloides stercoralis with human T-cell lymphoma/leukaemia virus-1 (HTLV-I) is recognized and patients with Tropical Spastic Parapresis and Strongyloides spp., apparently stercoralis. A new method of finding out more about the parasite in the human host has been devised using the Whole Gut Irrigation technique; this allows a much better assessment of the worm burden, up to 100,000 adult parasites in an asymptomatic out-patient and also gives an assessment of the fecundity of the adult worm and what factors influence the behaviour of the parasite. Ultimately, the goal is eradication of the parasite from Jamaica (AU)

Zinc and immunocompetence in protein-energy malnutrition

Malnourished children have thymic atrophy which is reversed by zinc supplementation. To see if their defect in cell-mediated immunity was also associated with zinc deficiency ten children were skin-tested with Candida antigen on both arms. One test site was covered with local zinc sulphate and the other with placebo ointment. There was a highly significant increase in the typical delayed-hypersensitivity reaction at the site covered with zinc. The magnitude of the difference between the supplemented and unsupplemented arms correlated negatively with the plasma-zinc concentration. These data show that zinc deficiency is a cause of the immunoincompetence seen in malnutrition. The normal reactions of the zinc-supplemented side indicate that, of the many nutritional deficits of malnourished children, zinc deficiency specifically impairs the cell-mediated immune system. Local skin-testing with and without zinc may provide a measure of zinc status. Local application of zinc may enhanc the reliability of tests to diagnose diseases such as tuberculosis in malnourished patients.(AU)

Effect of zinc on thymus of recently malnourished children

Zinc-deficient animals and children have thymic atrophy and an increased susceptibility to infections. Children with protein-energy malnutrition similarly have thymic atrophy, zinc deficiency, and increased susceptibility to infections. 8 children, recently malnourished, who were supplemented with zinc, showed an increase in thymic size as judged radiographically. It is suggested that zinc deficiency may play a part in the thymic atrophy and infections associated with malnutrition (AU)

An evaluation of the use of change in hair root morphology in the assessment of protein-calorie malnutrition

A study was carried out to evaluate the use of changes in hair root morphology in the assessment of protein-calorie malnutrition (PCM) among a group of black West Indian children. The following five hair root characteristics were measured: percentage of anagen (the growing phase), percentage of telogen (the resting phase), percentage of atrophy, diameter of anagen bulbs, and shaft diameter. Significant differences in shaft diameter, percentage of anagen, and percentage of telogen were found only between well-nourished and severely malnourished children. Significant correlation coefficients were obtained between both bulb diameter and percentage of atrophy and muscle circumference. No significant differences in any of the hair root characteristics were obtained between children with nutritional marasmus and those with kwashiorkor. The method was found to be time-consuming; it can be said for differentiating well-nourished children only from those with severe PCM; and it is unsuitable for determining the prevalence of the three degrees of PCM. For these reasons, the method is not the field assessment of protein-calorie malnutrition.(AU)

Unusual chorioretinal degeneration in sickle cell disease. Possible sequelae of posterior ciliary vessel occlusion

The vascular occlusive process characteristic of sickle cell disease may affect the retinal circulation and the resulting pathological changes, from peripheral vessel obstructions to a proliferative retinpathy, are well recognized. In the present report, three cases of sickle cell disease are described with an unusual chorioretinopathy. It is suggested that these change may have resulted from the vascular occlusive process affecting the posterior ciliary vessels. (Summary)