Zika virus infection clinical management protocol: Paediatrics

A clinical management protocol for the Zika Virus was prepared for medical professionals by the Emergency, Disaster Management and Special Services Branch of the Ministry of Health, Jamaica. This protocol outlines clinical features, symptoms, and management procedures for medical and health personnel and the way they should respond to suspected cases of ZIka among pregnant women.

Zika virus infection clinical management protocol: Pregnant women

This document outlines the clinical management protocol Jamaican medical professionals should employ for suspected cases of pregnant women infected with the Zika virus. Clinical features, case definitions, testing procedures, symptoms and pregnancy management are included in this article.

Same-visit HIV testing in Trinidad and Tobago

BACKGROUND: The Ministry of Health (hereafter, Ministry) of Trinidad and Tobago is responsible for delivery of all health services in the country. The Ministry takes responsibility for direct delivery of care in the public sector and has initiated a process whereby those seeking HIV test results could obtain confidential reports during a single-visit to a testing location. The Ministry requested technical assistance with this process from the Caribbean Epidemiology Centre (CAREC). The United States Centers for Disease Control and Prevention (CDC) played an important role in this process through its partnership with CAREC. METHODS: Under the technical guidance of CAREC and CDC, the Ministry organized a technical working group which included representatives from key national HIV program services and technical assistance partners. This working group reviewed internationally-recognized best practices for HIV rapid testing and proposed a program that could be integrated into the national HIV programs of Trinidad and Tobago. The working group wrote a consensus protocol, defined certification criteria, prepared training materials and oversaw implementation of "same-visit" HIV testing at two pilot sites. RESULTS: A Ministry-of-Health-supported program of "same-visit" HIV testing has been established in Trinidad and Tobago. This program provides confidential testing that is independent of laboratory confirmation. The program allows clients who want to know their HIV status to obtain this information during a single-visit to a testing location. Testers who are certified to provide testing on behalf of the Ministry are also counselors. Non-laboratory personnel have been trained to provide HIV testing in non-laboratory locations. The program includes procedures to assure uniform quality of testing across multiple testing sites. Several procedural and training documents were developed during implementation of this program. This report contains links to those documents. CONCLUSIONS: The Ministry of Health has implemented a program of "same-visit" HIV testing in Trinidad and Tobago. This program provides clients confidential HIV test reports during a single visit to a testing location. The program is staffed by non-laboratory personnel who are trained to provide both testing and counseling in decentralized (non-laboratory) settings. This approach may serve as a model for other small countries.

Research Ethics Committee: getting started

Unanticipated questions arose when starting an institutional research ethics committee in Grenada. Research ethics committees are charged with the ethical review of research protocols. They serve to protect people who volunteer as research subjects from harm or wrong that may result from participating in research. The Caribbean has a rich history of medical research involving human subjects. There is a growing will in the region to establish effective and sustainable research ethics committees that adhere to international standards. This paper examines uncertainties and questions that arose in starting a research ethics committee in Grenada, and describes how uncertainties were resolved. The questions centre on which guidelines to follow, who to appoint as members, what procedures to follow, and how to train members. An additional question relates to the role of a Ministry of Health in founding a research ethics committee. Resolution of these uncertainties shows that ethical review of research can be both effective and sustainable in the Caribbean. (AU)

Evaluation of neonatal sepsis screening in a tropical area. Part II: Evaluation of intrapartum chemoprophylaxis protocol

The authors report on an analysis of a chemoprophylaxis protocol at the University Hospital of Guadeloupe in the Caribbean. This study comprised 6,060 consecutive deliveries and was initiated to assess the application of an intrapartum chemoprophylaxis protocol, evaluate the results, and try to identify possible necessary modifications to the existing protocol. Although more than 90 percent of women had at least one bacterial screening (vaginal or urinary) during the last trimester of pregnancy, approximately 75 percent of mothers who were heavily colonized group B streptococcus (GSB) at delivery were not detected by this systematic screening. As is also reported in other tropical areas where a great portion of nenonatal sepsis occurs in term babies, low birthweight was not a specific risk factor in this study when controlling for other major risk factor such as fever and premature rupture of membranes. Intrapartum chemoprophlaxis was associated wiyh an approximate three fold decrease in the risk of GBS neonatal bacteraemia among at risk deliveries. The results suggest that, in our tropical context, prolonged rupture of membranes of at least 12 hours' duration should be considered as a cause for intrapartum chemopropylaxis as it accounted for the majority of neonatal bacteraemia that escaped the existing protocol. (AU)

Spinal Injuries at the University Hospital of the West Indies

Acute spinal damage forms a small percentage of total trauma injury but it has tremendous significance because of the resultant disability, poor prognosis, economic and social cost and the burden on victims, family, taxpayers and health workers. Of fifty-five patients admitted to the University Hospital of the West Indies (UHWI), Mona, Jamaica, over a seven-year period, forty form the basis of this report. Young males accounted for most victims and 85 percent of the injuries were non-intentional. The cervical spine, most commonly C6, was the region most frequently injured, followed by the lumbar and the thoracic regions. On admission, the mean Glasgow Coma Score was 14.6 and the mean Modified Injury Severity Score 12.7. Five patients were admitted in Frankel Grade A, complete paraplegia. Of eighteen patients treated with steroids, only eleven had methylprednisolone and only six of these appropriately. Nine patients had surgery after a mean time of 10.1 days. The average length of hospital stay was 18.2 days. Of 35 patients whose outcomes were known, eleven improved; two patients died in hospital. With the modernisation of the management of this condition, we recommend that attention be focused on prevention, pre-hospital immobilisation and transport, prompt resuscitation, the standardisation of written protocols and early operative intervention. Also essential is the continuing medical education of all levels of personnel and the formalisation of a well-coordinated and rehearsed Spine team.(Au)

New protocol of early preventative screening of children in coorporation with the island health services [abstract]

The protocol "Early Preventive Visual Screening of Children" has been developed in mutual Cooperation with both the Islands Ophthalmologic Society and the Department of Youth Preventitive Medicine of the Island Health Service. The aim is to periodically screen for function of the visual system in children starting at a very young age and going up to age 15 years. This means that at an early stage, dysfunctional problems can be detected and appropriately dealth with. This protocol has two parts. The first one is about the visual examination and the second part has to do with the visual acuity measurement in children. (AU)

Necrotising enterocolitis: A management protocol for developing countries

28 cases of necrotising enterocolitis (NEC) comprising 11 term and 17 preterm patients were diagnosed between January 1990 and December 1995 at the University Hospital of the West Indies (UHWI). Treatment was in accordance with a management protocol which emphasised aggressive screening of potential cases, early laparotomy for bowel perforation and primary anastomosis after small bowel resection. There were three deaths among the 13 cases of bowel perforation. Centres in developing countries can achieve rates of survival comparable to those in the developed world in babies with NEC weighing over 1000 grams by adopting the UHWI management protocol.(AU)

Non-operative management of stab wounds to the abdomen with omental evisceration

A consecutive series of 12 patients with anterior abdominal stab wounds and omental evisceration treated at the Kingston Public Hospital Jamaica over a 3-year period is presented. During this period 223 patients with abdominal stab wounds were seen of which 66 had omental evisceration. Conservative surgical management was the approach followed in 14 patients who presented without signs of peritonitis. There were no late complications or missed visceral injuries necessitating laparotomy. Serial physical examination was the method used to select patients for conservative surgical management with the exclusion of patients with deteriorating clinical signs or peritonitis. Omental evisceration through an abdominal stab wound in a patient with stable clinical signs and without evidence of peritonitis is not an absolute indication for exploratory laparotomy. (AU)

Insane patients and their insanities

This book addresses the following issues:-(1)What the medical meaning of insanity is,(2)What the causes of insanity are, (3)What common types of insanity exist in the general population, how these are diagnosed by the psychiatrist, what the principles of their treatment are,and (4) What current trends of or factors promote or frustrate insanity management in the society.(AU)

Colorectal cancer: prospects for prevention

Primary prevention has too often been elusive and mythical with regard to the activities of a physician. Colorectal cancer appears too often as an exceptionally opportunity. New information about the epidemiology, the development of a better method of testing for occult blood and the flexible fiberoptic endoscopic has made mass screening for precursors of an early stage of cancer of the colon practical and cost effective (AU)