Significance of polymicrobic bacteriuria in a teaching hospital in Trinidad

OBJECTIVE: To compare microbial prevalence (mixed versus pure), define microbial combination in mixed urine cultures among inpatients and outpatients to identify factors that might allow a more objective interpretation of polymicrobic urine cultures. DESIGN: Case series. SETTING: The study involved inpatients (hospitalized) and outpatients (those attending outpatient clinics and the accident and emergency department) of the San Fernando General Hospital in southern Trinidad. MAIN OUTCOME MEASURES: Prevalence rates of bacterial isolates in mixed and pure cultures of urine specimens were determined using standard techniques and Kirby-Bauer disc diffusion methodology. RESULTS: The results showed that of 5,089 urine specimens, 1,491 (29.3 percent) yielded positive cultures. Of these positive cultures, 524 (35.1 percent) revealed significant polymicrobic bacteriuria. Eighty five percent yielded two organisms 13.2 percent had three organisms and 1.8 percent had four organisms. Repeat cultures 157 patients revealed the same organisms in only 57.3 percent of them. Almost all of the repeat cultures were from patients with in-dwelling Foley catheters. E. coli was the most common single isolate (42.8 percent), while Klebsiella, Enterobacter and Proteus organisms were most often encountered in mixed cultures. All isolates were relatively sensitive to routinely used antibiotics for urinary pathogens. CONCLUSION: The prevalence rate of polymicrobic bacteriuria at our institution was 10.2 percent. More than 65 percent of positive cultures were from patients with Foley catheters on open drainage (inpatients) and closed drainage (outpatients). Most were men with out-flow obstruction who either refused surgery, were unfit for surgery, or had to wait long periods to be booked for surgery. No cases developed bacteremia secondary to bacteriuria. All urinary isolates were susceptible to routinely used antimicrobial agents.(Au)

A comparison of US-born African-American and African-Caribbean psychiatric outpatients

This study compares US-born African Americans with African Caribbeans attending an urban psychiatric outpatient clinic on various items pertaining to sociodemographics, psychiatric history, current psychiatric illness, and physical health. A structured chart review was performed on a sample comprised of 135 native-born African Americans and 91 African Caribbeans who had attended the clinic during an 11-year period. A total of 28 clinical variables were examined. Nine clinical variables were found to significantly differentiate the two groups in bivariate analysis, and these were entered along with three demographic control variables into a logistic regression analysis. Seven variables attained significant independent effects. African Americans were differentiated from African Caribbean on history of greater alcholic abuse or dependence, presence of more delusions, worse health, longer history of previous outpatient treatment, and greater clinical improvement at 6 months. African Caribbeans were found to have a greater frequency of depression and aggressivity. These data underscore the importance of examining intraracial differences in mental illness as well as pointing to the potential benefits of using intraracial comparisons to interpret interracial analyses.(AU)

The out-patient treatment of infantile malnutrition in St. Vincent

A series of 40 cases was studied. Details of a cheap diet were discussed. It was suggested that limited funds could be used to best advantage to buy skimmed milk, arrowroot, cheap protein (meat, egg or dried peas), cod liver oil, fruit. Total weekly cost did not exceed $1.18 (W.I.) (AU)

Some observations on medical outpatient practice at the University College Hospital of the West Indies

Figures are given for the relative incidence of diseases in a representative sample of adults attending the Medical Outpatient Department of the Unversity College Hospital of the West Indies in 1957-58. Diabetes, hypertension and duodenal ulcer account for one third of the work of the department. Tropical diseases (excluding neuropathy) account for only 1 percent. Rheumatic disorders, luetic aortitis, coronary artery disease and cirrhosis were prominent in this series. Idiopathic neuropathy was a major neurological problem, and bronchial asthma was the commonest respiratory disorder.(AU)

Outpatient burn care

Provides guidelines for outpatient burn care

Use of herbal medicines by surgical outpatients in Trinidad

Herbal medications have been used worldwide before the time of the Egyptians. The Greeks, medical doctors, apothecaries and traditional healers all used herbal medicines throughout the ages. There is today an increase in the use of alternative therapies worldwide. In 1993 Australian alternative medicine use was 48.5 percent in the population. In 1997 use in the USA population was estimated at 42.1 percent, an increase from 33.8 percent in 1990. Traditionally in the Caribbean home remedies based on herbs have prominence among alternative therapies. In the media, well-known celebrities advocate the use of alternative therapies while the conventional medical fraternity argues it. The prevalence of alternative medication use by surgical patients is unfortunately only sparsely researched in the Caribbean. Our studies looked at adult surgical clinic patients in Trinidad. Over 70 percent of the patients interviewed used some form of herbal therapy (herbal medicines, bush medicine, bush tea). Some common herbs used by patients in our study were garlic, ginseng and gingko, which are known to affect clotting and may put the surgical patient at risk for bleeding. Patients also were using prescription medication and few informed their physician of their concurrent use. Various herbal medicines are known to have effects on the immune system, clotting, hepatic function, neurological status and the cardiovascular system. These changes may impact on the surgical patient, therefore their surgeons and anaesthetists need to ask specifically about herbal drug use to prevent unknown drug interaction and risk to patients (AU)