Guillain-Barré syndrome and its variants: a case of acute motor-sensory axonal neuropathy in Jamaica.

This paper reports a case of a Jamaican young woman who experienced flaccid quadriparesis and bulbar weakness over a three-week period after a gastrointestinal illness. Nerve conduction studies confirmed an axonal type neuropathy consistent with the acute motor-sensory axonal neuropathy variant of the Guillain-Barré syndrome. Recovery, although evident, was slow and was augmented after a course of intravenous immunoglobulin. The patient was discharged from hospital after three months but was re-admitted one week later and eventually succumbed to complications of the illness. This case serves as a reminder that Guillain-Barré syndrome is now the most common cause of acute flaccid paralysis and should be considered early in all patients presenting with flaccid quadriparesis.

Human T-cell leukaemia/lymphoma virus type-1 associated myeloneuropathies--a Caribbean perspective.

This review follows the contributions of researchers from the Caribbean in improving the understanding of the disease mechanisms, clinical features and aetiology of neurological syndromes manifesting as diseases of the spinal cord and peripheral nerves. The evolution from the initial descriptions of neuropathies of presumed nutritional aetiology and later the recognition of two distinct subgroups, an ataxic neuropathy and a spastic myelopathy, are highlighted. The link between the natural history of human T-cell leukaemia/lymphoma virus type-1 (HTLV-1) infection and the immunopathogenesis of tropical spastic paraparesis is explored.

Lateral medullary infarct/Wallenberg syndrome--Jamaica.

We describe two cases of lateral medullary syndrome at the University Hospital of the West Indies, Mona, Jamaica. This diagnosis is often missed and not well understood, so we will discuss the underlying pathophysiology.

Transient cortical blindness post angiography--a case report.

A 56-year old female reported having had a fall two weeks prior to presentation. Computed Tomography (CT) scan showed an acute right-sided convexity subdural haematoma. A computed tomography angiogram revealed no vascular anomaly. One hour post procedure she had bilateral cortical blindness. Her vision subsequently was fully restored. A diagnosis of transient cortical blindness was made. Transient cortical blindness is a rare but recognized complication ofintra-arterial injection of iodinated contrast agents.

HIV seroprevalence among hospital inpatients with neuropsychiatric and other central nervous system disorders.

OBJECTIVE: To determine the seroprevalence of HIV among inpatients with neuropsychiatric and other central nervous system (CNS) disorders at the University Hospital of the West Indies (UHWI). METHODS: Sera and data of hospital inpatients with disorders of the CNS were prospectively investigated and reviewed at the Virology Laboratory, UHWI, over the period January 1 to December 31, 2007. The study population included inpatients with a principal diagnosis of a neuropsychiatric or other CNS disorder and for whom a serological analysis for HIV had been requested. The CNS disorders were categorized as follows: neuropsychiatric disorder (eg schizophrenia), CNS infection (eg viral, bacterial), motor and psychogenic dysfunction not included in other categories (eg seizures), gross structural brain lesion (eg tumours) and other HIV prevalence rates were calculated and compared according to age, gender and diagnostic category. RESULTS: Eighty-two patients were included. Sixty-one per cent were males and 39% females. The mean age in years (+/- SD) was 37.6 (+/- 16.3). There were significant differences in prevalence rates according to diagnostic category (p = 0.026). All of the patients with psychiatric disorders (n = 40) were HIV-negative and 25% (3 out of 12) of patients with CNS infection were HIV-positive. There were no statistically significant associations demonstrated between HIV and age or gender (p > 0.05). CONCLUSION: Clinicians should have a high index of suspicion for HIV infection when faced with patients with CNS infection. Further research is needed to clearly identify the reasons for the comparatively low prevalence of HIV among the psychiatric patients included in this study.

Quality of life in end stage renal disease: a multicentre comparative study.

BACKGROUND: Quality of Life (QOL) in patients with End Stage Renal Disease (ESRD) is an important measure of dialysis adequacy. Health related QOL is an independent risk factor for mortality in ESRD. The Kidney Disease QOL questionnaire is a highly validated disease targeted instrument with global application. We sought to document QOL and the predictive factors in a cohort of patients with ESRD in Jamaica and Panama. METHODS: Two hundred patients were recruited consecutively from November 2006 - November 2007. Seventy patients were from a tertiary hospital based outpatient dialysis centre, the University Hospital of the West Indies (UHWI), and 40 patients from a private centre, Diabetes Association Renal Unit (DARU) both in Kingston, Jamaica. Ninety patients were consecutively recruited from a tertiary hospital based outpatient dialysis centre in Panama City, Panama. The Kidney Disease Quality of Life - Short Form Questionnaire was administered. Each QOL domain was scored from 0 - 100 with higher scores representing better rating. RESULTS: Mean age was 50 +/- 4 years, with no difference between the cohorts. Panama, however, had significantly higher parameters than the Jamaican cohorts: mean haemoglobin (Hb) 12.4g/dL (p = 0.004), mean serum albumin 45g/dL (p = 0.03) and Urea Reduction Ratio (URR) 78% (p = 0.004). Diabetes Association Renal Unit recorded mean Hb 11.4 +/- 1.3g/dL, mean serum albumin 42.1 +/- 2.3g/dL and URR 72%. The University Hospital of the West Indies documented mean Hb 11.2 +/- 2.4g/dL, mean serum albumin 41 +/- 4.5g/dL and URR 68%. All three cohorts had good overall QOL scores when compared with the reference population. Patients from Panama had higher overall QOL scores than Jamaican patients (p = 0.02). By centre, UHWI had higher overall QOL scores than DARU (p = 0.04). Burden of Kidney Disease domain recorded the lowest overall scores (Reference Population 49, DARU 19.0 (p = 0.001), UHWI 24.0 (p = 0.002), Panama 32.9 (p = 0.03). Patient Satisfaction scores were also significantly reduced across all cohorts (Reference population 72, DARU 52, UHWI 54, Panama 58). The University Hospital of the West Indies had significantly decreased dialysis staff encouragement (p = 0.003). The Diabetes Association Renal Unit noted significant reductions in general health (p = 0.04), physical functioning (p = 0.001), physical role (p = 0.001) and emotional role (p = 0.005) domains. Panama had the lowest overall physical functioning (p = 0.01), pain (p = 0.01) and social support (p = 0.04) scores. In the Panamanian cohort, age< 65 years (p = 0.0004). Hb > 11.1 g/dL (p = 0.01), albumin > 40g/dL (p = 0.01), URR > 65% (p = 0.03), race (p = 0.04), at least high school educational attainment (p = 0.01) and household yearly salaries > US$5000 (p = 0.002) predicted good QOL scores. These accounted for 55% of the variance. In the Jamaican cohort, however, younger age (p = 0.02), race (p = 0.001), higher URR (p = 0.01) and higher serum haemoglobin (p = 0.001) predicted higher QOL scores, accounting for only 40% of the variance. By modality, haemodialysis patients had significantly higher haemoglobin (p = 0.003) and albumin (p = 0.002) levels and ultimately higher overall QOL scores (p = 0.01). CONCLUSION: Overall, QOL is good in patients with ESRD. Domains of highest concern include Burden of Kidney Disease and Patient Satisfaction. The role of spirituality, depression and nutritional markers (eg prealbumin) needs to be assessed. Quality of Life must therefore be routinely documented in ESRD patients and targeted interventions implemented.

Stroke subtypes on imaging in a Jamaican population: a hospital-based study.

OBJECTIVE: To examine the pattern of stroke subtypes found on Computed Tomography (CT), Magnetic Resonance Imaging (MRI) at the University Hospital of the West Indies (UHWI), Kingston, Jamaica. METHOD: A retrospective review was conducted for all patients diagnosed with stroke and who were subjected to CT or MRI evaluation at UHWI between January 2001 and December 2004. Data were collected for patient age and gender and type of stroke. RESULTS: Four hundred and thirty-three patients were identified and classified as having cerebral infarct, intra-parenchymal haemorrhage or subarachnoid haemorrhage. There were 414 patients who had CT scans and 19 had MRI scans. Within and across genders, over 80% suffered infarcts with no significant statistical difference between male and female patients. Subarachnoid haemorrhage was the least frequent subtype and occurred in younger patients. CONCLUSION: The pattern of stroke subtypes seen in this population was similar to that of Australian and European cohorts of patients but differed from that reported in Asians. Ischaemic infarct was the most frequent stroke subtype followed by intra- parenchymal haemorrhage and subarachnoid haemorrhage. There was no gender predilection for any specific type of stroke.

Central myelinolysis in a patient with hyponatraemia.

We present a case of a 50-year old man who developed mutism and a flaccid quadriparesis within 48 hours of presentation to hospital with severe hyponatraemia. A diagnosis of central pontine myelinolysis was made based on the clinical features and typical appearances on magnetic resonance imaging.

Cardiac disease in dialysis patients in a Jamaican hospital: echocardiographic findings that predict mortality.

The aim of the study was to assess, by echocardiography, the cardiac abnormalities in a group of patients with chronic renal failure and to determine the cardiovascular predictors of mortality. The study comprised forty-five patients from the Renal Unit, University Hospital of the West Indies, Kingston, Jamaica, and was undertaken between October 1, 1998 and July 31, 2000. All echocardiography was done by a single operator. The parameters assessed were systolic dysfunction, diastolic dysfunction, ejection fraction, regional wall motion abnormalities and valvular disease. Left ventricular cavity size, septal and posterior wall thickness were measured and left ventricular mass calculated. Demographic data were obtained directly from each patient by interview. The patients were mainly of African/mixed-African origin. Their mean age was 43.2 +/- 16.0 years. The average body mass index was 23.7 +/- 6.9. Twenty-eight (60.9%) patients were male and seventeen (39.1%) female. Hypertension, chronic glomerulonephritis and diabetes mellitus were the leading causes of chronic renal failure. Blood pressure was controlled at a mean value of 145/90 mm Hg pre-dialysis and 140/90 mm Hg postdialysis. The mean duration of renal failure was 2.8 years. Echocardiographic M-mode and two dimensional apical, four chamber view measurements indicated that mean left ventricular internal diameter (LVID) diastole was 55.7 +/- 7.9 mm (normal 38-56 mm) and LVID systole was 38.9 +/- 9.8 mm (normal 24-45 mm); the mean thickness of the chamber walls was 10.3 +/- 2.8 mm and 10.6 +/- 2.4 mm for the interventricular septum (normal 6-11 mm) and left ventricular posterior wall (normal 6-11 mm) respectively. Diastolic dysfunction was seen in 15 (34%) patients and systolic dysfunction in 12 (23%) patients who had ejection fractions less than 50%. The mean left ventricular ejection fraction was 56.3% +/- 16% (normal 65-85%), mean stroke volume was 82.9 +/- 27.2 mls (normal 51-96 ml). After 21 months enrolment in the study, Kaplan Meier analysis revealed a two-year mortality of 28.3%. Cox regression analysis indicated that a history of smoking current or past, low haemoglobin level, high aorta flow velocities, severity of mitral regurgitation and a negative association with serum creatinine were independent predictors of mortality. The correction of anaemia and control of other factors that impact negatively on cardiac function in dialysis patients is vital to enhance survival.

The correspondence bias.

The correspondence bias is the tendency to draw inferences about a person's unique and enduring dispositions from behaviors that can be entirely explained by the situations in which they occur. Although this tendency is one of the most fundamental phenomena in social psychology, its causes and consequences remain poorly understood. This article sketches an intellectual history of the correspondence bias as an evolving problem in social psychology, describes 4 mechanisms (lack of awareness, unrealistic expectations, inflated categorizations, and incomplete corrections) that produce distinct forms of correspondence bias, and discusses how the consequences of correspondence-biased inferences may perpetuate such inferences.

Overhelping.

Overhelping occurs when one attempts to spoil an observer's impression of a performer by explicitly helping the performer achieve a goal, thereby inviting the observer to attribute the performer's success to the help. The results of 4 experiments suggest (a) that people are most likely to overhelp when they believe that their interventions will be ineffective but will be considered effective by observers and (b) that when either of these beliefs is wrong, the strategy will backfire. The results point to an intervention principle that predicts how and when people may most effectively influence a performance so as to shape observer's inferences about the performer.

When comparisons arise.

People acquire information about their abilities by comparison, and research suggests that people restrict such comparisons to those whom they consider sources of diagnostic information. We suggest that diagnosticity is often considered only after comparisons are made and that people do not fail to make nondiagnostic comparisons so much as they mentally undo them. In 2 studies, participants made nondiagnostic comparisons even when they knew they should not, and quickly unmade them when they were able. These results suggest that social comparisons may be relatively spontaneous, effortless, and unintentional reactions to the performances of others and that they may occur even when people consider such reactions logically inappropriate.

You can't not believe everything you read.

Can people comprehend assertions without believing them? Descartes (1644/1984) suggested that people can and should, whereas Spinoza (1677/1982) suggested that people should but cannot. Three experiments support the hypothesis that comprehension includes an initial belief in the information comprehended. Ss were exposed to false information about a criminal defendant (Experiments 1 and 2) or a college student (Experiment 3). Some Ss were exposed to this information while under load (Experiments 1 and 2) or time pressure (Experiment 3). Ss made judgments about the target (sentencing decisions or liking judgments). Both load and time pressure caused Ss to believe the false information and to use it in making consequential decisions about the target. In Spinozan terms, both manipulations prevented Ss from "unbelieving" the false information they automatically believed during comprehension.

The fleeting gleam of praise: cognitive processes underlying behavioral reactions to self-relevant feedback.

We propose that a preference for favorable social feedback (i.e., self-enhancement) requires only that feedback be characterized as favorable or unfavorable but that a preference for self-confirming feedback (i.e., self-verification) is based on a more elaborate set of cognitive operations that requires both the characterization of feedback and a subsequent comparison of that feedback to a representation of self stored in memory. Study 1 set the stage for testing this hypothesis by showing that depriving people of processing resources interfered with their tendency to access their self-conceptions. In Studies 2 and 3, participants who were deprived of resources preferred the favorable, self-enhancing evaluator, whereas control participants displayed a preference for the self-verifying evaluator, even if that evaluator was relatively unfavorable.

Immune neglect: a source of durability bias in affective forecasting.

People are generally unaware of the operation of the system of cognitive mechanisms that ameliorate their experience of negative affect (the psychological immune system), and thus they tend to overestimate the duration of their affective reactions to negative events. This tendency was demonstrated in 6 studies in which participants overestimated the duration of their affective reactions to the dissolution of a romantic relationship, the failure to achieve tenure, an electoral defeat, negative personality feedback, an account of a child's death, and rejection by a prospective employer. Participants failed to distinguish between situations in which their psychological immune systems would and would not be likely to operate and mistakenly predicted overly and equally enduring affective reactions in both instances. The present experiments suggest that people neglect the psychological immune system when making affective forecasts.

Focalism: a source of durability bias in affective forecasting.

The durability bias, the tendency to overpredict the duration of affective reactions to future events, may be due in part to focalism, whereby people focus too much on the event in question and not enough on the consequences of other future events. If so, asking people to think about other future activities should reduce the durability bias. In Studies 1-3, college football fans were less likely to overpredict how long the outcome of a football game would influence their happiness if they first thought about how much time they would spend on other future activities. Studies 4 and 5 ruled out alternative explanations and found evidence for a distraction interpretation, that people who think about future events moderate their forecasts because they believe that these events will reduce thinking about the focal event. The authors discuss the implications of focalism for other literatures, such as the planning fallacy.

The illusion of external agency.

People typically underestimate their capacity to generate satisfaction with future outcomes. When people experience such self-generated satisfaction, they may mistakenly conclude that it was caused by an influential, insightful, and benevolent external agent. In three laboratory experiments, participants who were allowed to generate satisfaction with their outcomes were especially likely to conclude that an external agent had subliminally influenced their choice of partners (Study 1), had insight into their musical preferences (Study 2), and had benevolent intentions when giving them a stuffed animal (Study 3). These results suggest that belief in omniscient, omnipotent, and benevolent external agents, such as God, may derive in part from people's failure to recognize that they have generated their own satisfaction.

Arsenic: the forgotten poison?

Chronic arsenic poisoning is an uncommon cause of peripheral neuropathy in Jamaica. A patient with this disorder is described. The insidious nature of chronic arsenic poisoning, with its disabling complications, is emphasised.

Autoantibodies, human T lymphotropic virus type 1 and type 1 diabetes mellitus in Jamaicans.

The clinical characteristics, autoantibody profiles and seroprevalence of human T lymphotropic virus Type 1 (HTLV-1) were assessed in 30 Jamaican patients with Type 1 diabetes mellitus. Two hundred and fifty-two blood donors and 108 patients with Graves' disease were included as controls for the HTLV-1 component of the study. The mean age of onset of diabetes mellitus was 20.5 +/- 9.2 years and the mean duration of diabetes mellitus was 10.5 +/- 6.1 years. The remarkable clinical data included an absence of other associated organ-specific autoimmune diseases, and clinical evidence and history of congenital rubella in one patient. Islet cell cytoplasmic antibodies (ICA) were absent but 17% (5/30) of the diabetic patients tested positive for glutamic acid decarboxylase (GAD) antibodies. No other organ-specific autoantibodies were detected but non-organ-specific autoantibodies were present in 9 (30%) of the sera of diabetic patients. The seroprevalence of HTLV-1 in the patients with diabetes mellitus was significantly higher than that in the healthy controls (17% (5/30) versus 4% (11/252), p = 0.05). Autoantibodies were found in the sera of 4/5 (80%) of the diabetic patients who were positive for HTLV-1. None of the patients with onset of diabetes mellitus below age 15 years was HTLV-1 positive. The likely polyaetiological nature of Type 1 diabetes mellitus in Jamaicans is being further investigated at the molecular level.