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1.
St. Augustine; The University of the West Indies, Faculty of Medical Sciences, Department of Obstetrics and Gynaecology; 2 ed; 2000. 50 p.
Monografia em Inglês | MedCarib | ID: med-16312

RESUMO

This book entitled "Gynaecology made simple" is a revised edition of "Short notes in Gynaecology". It was prepared with the fervent wish that you, our medical students, would find it useful as you prepare for your final examinations. We think that a revision on how to take a gynaecological history is vital, especially when one takes into consideration that the final examination in Obstetrics and Gynaecology is heavily weighted in favour of the clinical component. You would find in this booklet common cases in the Gynaecological Clinical Examination such as fibroids, utero-vaginal prolapse, postmenopausal bleeding and ovarian cyst. Topics such as ectopic pregnancy, dilatation and curettage, hysterectomy and sterilization are commonly asked in the Oral Examination. We feel certain that this booklet would also be valuable in your day to day care of patients after graduation. An addition in this edition involves some common cases in the Clinical Examination as well as tips for you in the Oral Examination. It must be emphasized that this booklet must be used in conjunction with the recommended textbook in Gynaecology. We the authors would welcome any constructive criticism (AU)


Assuntos
Adulto , Feminino , Humanos , Ginecologia , Doenças dos Genitais Femininos , Educação de Graduação em Medicina/métodos
2.
Clin Infect Dis ; 28(5): 1086-90, May 1999.
Artigo em Inglês | MedCarib | ID: med-1381

RESUMO

Individuals presenting consecutively with genital ulcers in Kingston, Jamaica, underwent serological testing for human immunodeficiency virus (HIV) infection , chlamydial infection, and syphilis. Ulcer material was analyzed by the multiplex polymerase chain reaction (M-PCR) analysis DNA from herpes simplex virus (HSV), Haemophilus ducreyi, and Treponema pallidum was detected in 158 (52.0 percent), 72 (23.7 percent), and 31 (10.2 percent) of 304 ulcer specimens. Of the 304 subjects, 67 (22 percent) were HIV-seropositive and 64 (21 percent) were T. pallidum-seroactive. Granuloma inguinale was clinically diagnosed in nine (13.4 percent) of 67 ulcers negative by M-PCR analysis and in 12 (5.1 percent) of 237 ulcers positive by M-PCR analysis (P = .03). Lymphogranuloma venereum was clinically diagnosed in eight patients. Compared with M-PCR analysis, the sensitivity and specificity of a clinical diagnosis of syphilis, herpes, and chancroid were 67.7 percent, 53.8 percent, and 75 percent and 91.2 percent, 83.6 percent, and 75.4 percent, respectively. Reactive syphilis serology was 74 percent sensitive and 85 percent specific compared with M-PCR analysis. Reported contact with a prostitute in the preceding 3 months was associated with chancroid (P = .009), reactive syphilis serology (P = .011), and HIV infection (P = .007). The relatively poor pleads for syndromic management of genital ulcers in Jamaica. Prevention efforts should be intensified.(Au)


Assuntos
Adulto , Feminino , Masculino , Humanos , Doenças dos Genitais Femininos/microbiologia , Doenças dos Genitais Masculinos/microbiologia , Infecções por HIV/complicações , Úlcera/microbiologia , HIV-1 , HIV-2 , Jamaica , Linfogranuloma Venéreo/complicações , Linfogranuloma Venéreo/diagnóstico , Reação em Cadeia da Polimerase , Prevalência , Fatores de Risco , Sensibilidade e Especificidade , Simplexvirus/isolamento & purificação , Treponema pallidum/isolamento & purificação , Úlcera/complicações , Doenças dos Genitais Femininos/complicações , Doenças dos Genitais Femininos/diagnóstico , Doenças dos Genitais Masculinos/complicações , Doenças dos Genitais Masculinos/diagnóstico , Haemophilus ducreyi/isolamento & purificação , Herpes Genital/complicações , Herpes Genital/diagnóstico
3.
West Indian med. j ; 47(suppl. 2): 47, Apr. 1998.
Artigo em Inglês | MedCarib | ID: med-1840

RESUMO

The purpose of this study was to determine the aetiology of genital ulcers (GUD) in STD clinic attenders, using state-of-the-art diagnostic tests, and to compare this with clinical diagnosis. Patients attending an STD clinic in Kingston, Jamaica for a new STD complaints were screened for GUD and clinically diagnosed. Swabs of ulcers were taken and tested for T. pallidum (TP), herpes simplex virus (HSV), and H. ducreyi (HD), using polymerase chain reaction (PCR). Sera were tested for syphilis and HIV infection. Of 4873 patients screened, 304 (6.2 percent) had GUD. In patients with ulcers, 158 (52 percent) were HSV (+), 73 (24 percent) were HD (+), and 31 (10 percent) were TP (+). Dual infections were identified in 20 (7 percent) ulcers. Clinically, herpes was diagnosed in 85/158 (54 percent) of HSV (+) ulcers, chancroid in 54/72 (75 percent) of HD (+) ulcers, and syphilis in 21/31 (68 percent) of TP (+) ulcers. Over three-quarters of GUD in Kingston had defined aetiology for herpes, chancroid or syphilis using PCR, with herpes being the commonest. Uniformly, clinical diagnosis performed poorly and Jamaican algorithms for the management of GUD will need to take into account the findings of this study, and should include counselling for herpes.(AU)


Assuntos
Humanos , Condiloma Acuminado , Doenças dos Genitais Femininos/etiologia , Doenças dos Genitais Masculinos/etiologia , Herpes Simples/diagnóstico , Sífilis/diagnóstico , Jamaica
4.
Genitourin Med ; 73(5): 362-4, Oct., 1997.
Artigo em Inglês | MedCarib | ID: med-1606

RESUMO

OBJECTIVE: To determine in the prevalence of genital Chlamydia trachomatis infections in commercial street sex workers (CSSW) in Jamaica. METHODS: The prevalence of C trachomatis infection was determined in 129 Jamaican CSSW using the direct fluorescent antibody (DFA) method and the isolation techniques which utilise fluorescent and iodine staining of endocervical cytobrush specimens cultured in McCoy cells. The seroprevalence of C trachomatis in the CSSW was also compared with that in blood donors (n = 435), using the microimmuofluorescence (MIF) test. RESULTS: The DFA detect C trachomatis in 16 percent (21/129) of the specimens. The prevalence as determined by the iodine and fluorescein stained cultures was 24 percent (31/129) and 25 percent (33/129) respectively. The overall prevalence of current chalmydial infection detected by the isolation techniques used was 25 percent (33/129). As determined by the MIF test, a statistically significantly higher seroprevalence rate of C trachomatis (95 percent, 61/64) was found in CSSW compared with blood donors (53 percent, 229/435; OR 22.6; chi 2 = 49.8; p < 0.001). The prevalence of current infection in CSSW as indicated by the isolation of C trachomatis was not influenced by history of previous pelvic inflammatory disease (PID), sexually transmitted disease, or condom use. N gonorrhoeae (9 percent) and Candida albicans (7 percent) were found in comparatively low frequencies, while Trichomonas vaginalis (0 percent) was not found in specimens from the CSSW. CONCLUSIONS: A high seroprevalence rate and a high rate of current infection with C trachomatis occur in Jamaican CSSW. In order to control the spread and prevent the severe clinical complications and sequeles of C trachomatis infection, the diagnosis and treatment in such high risk groups such as CSSW should be optimised.(AU)


Assuntos
Adolescente , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Infecções por Chlamydia/epidemiologia , Doenças dos Genitais Femininos/epidemiologia , Trabalho Sexual/estatística & dados numéricos , Doença Inflamatória Pélvica/epidemiologia , Doença Inflamatória Pélvica/microbiologia , Chlamydia trachomatis/isolamento & purificação , Doenças dos Genitais Femininos/microbiologia , Jamaica/epidemiologia , Prevalência
5.
West Indian med. j ; 46(3): 67-71, Sept. 1997.
Artigo em Inglês | MedCarib | ID: med-1989

RESUMO

Two cross-sectional surveys were undertaken, from December 1982 to August 1983 and from November 1990 to January 1991, to estimate the prevalence rates of genital ulcer disease (GUD) in all patients presenting with a new sexually transmitted disease (STD) complaint to the STD clinic at the Comprehensive Health Centre in Kingston, Jamaica. Diagnosis of syphilis and human immunodeficiency virus (HIV) infection was based on results of laboratory tests, but diagnosis of other STDs was based on clinical features. Data from these two surveys were compared, and reported national annual incidence data for GUD reviewed. In 1982/83 6.8 percent of 23,050 patients had GUD, men (9.3 percent) more often than women (4.2 percent; p < 0.001). In 1990/91 the prevalence rate was 12.8 percent with increased rates for both men (18.2 percent) and women (6.8 percent; p < 0.001). In patients with GUD, a clinical diagnosis of genital herpes was made, in 1982/83 and 1990/91, respectively, in 16.8 percent and 7.8 percent of the patients; syphilis, in 12.9 percent and 18.8 percent; chancroid, in 12.4 percent and 13.3 percent; viral warts, in 5.7 percent and 6.3 percent; lymphogranuloma venereum, in 4.1 percent and 3.9 percent; and granuloma inguinale, in 3.6 percent and 2.3 percent. In men the rate for syphilis was 19 percent in 1990/91 and 8 percent in 1982/83 (p=0.001); and for genital herpes it was 7 percent in 1990/91 and 17 percent in 1982/83 (p=0.025). These reversals were attributed to intense media coverage of herpes in 1982/83. There was no difference in prevalence rates between the two surveys for these diseases in women, or for lymphogranuloma venereum, granuloma inguinale and genital warts in men and women. A clinical diagnosis could not be made in 44.4 percent of cases in 1982/83 (particularly in men), and in 47.6 percent of cases in 1990/91. GUDs faciltate transmission and adversely affect the prognosis of HIV. The increase in their prevalence has implications for the evolution of the local HIV epidemic, and should be addressed effectively by stregthening the STD/HIV control programme.(AU)


Assuntos
Adulto , Feminino , Humanos , Masculino , Doenças dos Genitais Femininos/epidemiologia , Doenças dos Genitais Masculinos/epidemiologia , Úlcera/epidemiologia , Herpes Genital/epidemiologia , Fatores de Risco , Jamaica/epidemiologia , Infecções por HIV/transmissão , Doenças Sexualmente Transmissíveis/prevenção & controle , Estudos Transversais , Prevalência
6.
West Indian med. j ; 45(suppl. 2): 15, Apr. 1996.
Artigo em Inglês | MedCarib | ID: med-4657

RESUMO

The polymerase chain reaction (PCR) was used to detect the presence of a variety of genital human papilloma virus (HPV) types in cervico-vaginal lavages obtained from 44 women. Of these, one-half were diagnosed, by cytological and/or histological methods, with a cervical abnormality indicative of HPV infection and the other twenty-two had no history of cervical HPV infection or cervical intraepithelial neoplasia (CIN). Fourteen (64 percent) of the women suspected of having an HPV infection of the cervix, and seven (32 percent) of those with no history of HPV infection were found to be positive after PCR amplification of a 188 bp fragment of the HPV genome using the CPI/CPIIG consensus primer set designed to detect genital HPV types. The results show that this primer set can be used to detect HPV in the cervix and give some indication of the presence of HPV in the genital tract of presumably "health" women (AU)


Assuntos
Feminino , Humanos , Sondas de DNA de HPV , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/diagnóstico , Doenças dos Genitais Femininos
7.
West Indian med. j ; 44(4): 128-32, Dec. 1995.
Artigo em Inglês | MedCarib | ID: med-4794

RESUMO

Ninety-eight women attending three different clinics were prospectively studied for the presence of genital tract infections, including Chlamydia trachomatis. Of these 98 women, 35 were presenting to a polyclinic with symptoms of genital tract infection, 55 were attending an antenatal clinic for their first visit, and 8 referred to a colposcopy clinic because of an abnormal Papanicolaou smear were included. Gonorrhoea was detected in one patient, syphilis in two, and Trichomonas vaginalis in six. Candida albicans and Chlamydia trachomatis were each detected in 18 patients, while the most common condition was bacterial vaginosis, detected in 35 patients. The prevalence of these infections was lowest in patients referred for colposcopy and highest in the women attending the antenatal clinic, Chlamydia trachomatis was the most common sexually-transmitted pathogen detected in this population. These data emphasise the need for an aggressive approach to the diagnosis and treatment of chlamydial infection in females (AU)


Assuntos
Adolescente , Adulto , Feminino , Humanos , Gravidez , Doenças dos Genitais Femininos/epidemiologia , Doenças Sexualmente Transmissíveis/epidemiologia , Doenças dos Genitais Femininos/microbiologia , Esfregaço Vaginal , Infecções por Chlamydia/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Barbados/epidemiologia
8.
Kingston; s.n; 1995. 318 p.
Tese em Inglês | MedCarib | ID: med-3013

RESUMO

Genital chlamydial infection has evolved as the leading sexually transmitted disease, both in the developed and the developing countries. The impact of genital chlamydial infection as a public health problem in the Caribbean is probably as high as in industrialized countries. Accurate statistics are therefore needed to obtain knowledge of the epidemiology of this disease. A prevalence study was carried out in Jamaica on persons attending different health facilities and locations. This was to ascertain the prevalence of chlamydial antibodies and of chlamydial infection in these selected populations. Microbiological methodologies employed were the microimmunofluorescent technique (MIF) for detecting antichlamydial antibodies, the direct immunofluorescent test (DFA) for detecting chlamydia antigens in specimens, and also isolation of C. trachomatis by culture in McCoy cells. A total of 1228 sera were tested for antichlamydial antibody resulting in the following seroprevalence rates. Prostitutes -95.3 percent, gynaecology patients -60.0 percent, family planning clinic attendess -59.8 percent, blood donors -52.6 percent, sexually transmitted diseases (STD) clinic patients -70.1 percent, pregnant women -25.0 percent. The 95.3 percent seroprevalence rate observed in prostitutes was significantly higher than that found in the other groups. From 1641 patients, specimens including urethral, endocervical, conjunctival and nasal swabs were cultured for C. trachomatis. The organism was isolated from 18.5 percent to 59.3 percent in this study group; in pregnant women 18.5 percent (n=200), neonates 24.0 percent (n=100), prostitues 24.8 percent (n=129), student 33.9 percent (n=103), family planning clinic attendess 34.0 percent (n=238), gynaecology patients 45.8 percent (n=170) and STD patients 59.3 percent (n=701). The seroprevalence of C. trachomatis is high in Jamaican population, although the rate of infection was found to be much lower. A wide cross-section of the Jamaican population in different age groups from different strata of the society and having different behavioural patterns was found to be infected with C. trachomatis. The prevalence of C. trachomatis infection was not influenced significantly by demographic factors or socioeconomic status, since both chlamydial antibody and C. trachomatis were demonstrated in all age groups and in individuals from different strata of the society with different behavioral patterns. (AU)


Assuntos
Humanos , Adulto , Adolescente , Feminino , Masculino , Infecções por Chlamydia/epidemiologia , Infecções por Chlamydia/diagnóstico , Jamaica/epidemiologia , Fatores Socioeconômicos , Infecções por Chlamydia/prevenção & controle , Doenças dos Genitais Femininos , Doenças dos Genitais Masculinos , Doenças Bacterianas Sexualmente Transmissíveis/epidemiologia , Doenças Bacterianas Sexualmente Transmissíveis/etiologia , Doenças Bacterianas Sexualmente Transmissíveis/prevenção & controle , Comportamento Sexual , Prevalência
9.
J Acquir Immune Defic Syndr ; 7(3): 310-6, Mar. 1994.
Artigo em Inglês | MedCarib | ID: med-8236

RESUMO

Between November 1990 and January 1991, status of human immunodeficiency virus (HIV) infection was assessed for 522 men and 484 women attending the Comprehensive Health Centre in Kingston, Jamaica, for a new sexually transmitted disease (STD) complaint. Prevalence of HIV type 1 (HIV-1) infection was 3.1 percent (31 of 1,006), a tenfold rise in seroprevalence in 4.5 years. Nineteen of 517 (3.7 percent) heterosexual men, 3 of 5 (60 percent) homosexual/bisexual men, and 9 of 484 (1.9 percent) women were infected with HIV. In heterosexual men, factors associated with HIV infection after age adjustment included present complaints of genital ulcers [odds ratio (OR) 7.3; 95 percent confidence interval (CI) 1.4-72], past history of genital ulcer (OR)4.3; CI, 1.4-12), positive MHATP syphilis serology (OR, 3.4; CI, 1.1-10), sex with a prostitute in the past month (OR, 3.8; CI, 1.1-11). Three or more sex partners in the month prior to the complaint (OR, 3.6; CI, 1.0-12), and bruising during sex (OR, 4.0; CI, 1.4-13). On multiple logistic regression analysis, independent associations with HIV infection were shown for bruising during sex (OR, 3.0; CI, 1.1-8.3), positive MHATP syphilis serology (OR,3.2; CI, 1.1-9.5), and history of genital ulcer (OR 2.9; CI, 1.0-8.0). (AU)


Assuntos
Humanos , Adulto , Masculino , Feminino , HIV-1 , Infecções por HIV/epidemiologia , Doenças dos Genitais Femininos/complicações , Doenças dos Genitais Masculinos/complicações , Genitália/lesões , Estudos Transversais , Infecções por HIV/etiologia , Jamaica/epidemiologia , Fatores de Risco , Comportamento Sexual , Parceiros Sexuais , Doenças Sexualmente Transmissíveis/complicações , Úlcera
10.
West Indian med. j ; 41(suppl 1): 49, Apr. 1992.
Artigo em Inglês | MedCarib | ID: med-6560

RESUMO

The main reasons for paediatric gynaecological emergency assesment in 60 girls over a 7 year period were vaginal bleeding (61.6 percent), vaginal discharge (21.6 percent), vaginal growths (8.3 percent) and sexual assault (8.3 percent). Lacerations were discovered in 19 girls. Fifteen girls had straddle injuries resulting solely in vulval (external) lacerations. Of the 5 girls who presented with alleged sexual abuse, 3 were 9 to 10 years of age and were found to have vaginal (internal) lacerations; 12 of the 17 girls with prolapsed urethral mucosa presented with vaginal bleeding and of the 13 girls, who complained of vaginal discharge, foreign bodies were located in 4. Two girls with abdominal pain had ovarian tumours and required laparotomy. As it is generally difficult to make a diagnosis on the basis of the presenting complaint and simple examination, all the girls were examined under anaesthesia. Furthermore, it appears that vaginal (internal) lacerations, especially in older girls, carries a high index of suspicion of sexual molestation and so warrants forensic evaluation (AU)


Assuntos
Humanos , Pré-Escolar , Criança , Feminino , Doenças dos Genitais Femininos/diagnóstico , Abuso Sexual na Infância
11.
Port of Spain; Paria Publishing; 2 ed; 1991. xii,555 p. ilus.
Monografia em Inglês | MedCarib | ID: med-16395
12.
Epidemiol Infect ; 104(1): 55-61, Feb. 1990.
Artigo em Inglês | MedCarib | ID: med-12558

RESUMO

During a study of genital infection in inner-city family-planning patients we examined 452 women for Chlamydia trachomatis. The prevalence of infection was 7.3 percent. There was no significant difference between patients attending because of genital symptoms and those who were attending for routine family-planning advice. Infection was found to be correlated with five main demographic parameters; age less than 25, no stable partnership, hormonal contraception, nulliparity and West Indian Ethnic origin. Using these parameters a simple scoring system was devised which allowed a high-risk population to be defined in whom screening would be economically justified. (AU)


Assuntos
Humanos , Adulto , Feminino , Infecções por Chlamydia/epidemiologia , Doenças dos Genitais Femininos/epidemiologia , Fatores Etários , Colo do Útero/microbiologia , Inglaterra/epidemiologia , Serviços de Planejamento Familiar , Prevalência , Estudos Prospectivos , Inquéritos e Questionários , Fatores de Risco , Esfregaço Vaginal , Índias Ocidentais/etnologia
13.
West Indian med. j ; 38(Suppl. 1): 31, April 1989.
Artigo em Inglês | MedCarib | ID: med-5689

RESUMO

The importance of Chlamydial trachomatis as a cause of genital tract infection in Caribbean countries is largely unknown. Two hundred and sixteen cervical and urethral specimens were collected from patients attending a Sexually Transmitted Disease Clinic, a Gynaecology Clinic and a Family Plannin Clinic, in Kingston. Specimens were tested for chlamydiae by direct immuno-fluorescence and cell methods. These were also investigated for N. gonorrheae infections. Seventy-two of 138 patients (52 percent) at the STD Clinic were positive for chlamydia; 28 of 50 (56 percent) from the Gynaecology Clinic and 11 of 28 (39 percent) from the Family Planning Clinic were positive. The prevalence of C. trachomatis (52 percent) was higher than that of N. gonorrheae (11.2 percent) in all groups. The results indicate that C. trachomatis is a common cause of genital tract infections in Jamaica (AU)


Assuntos
Humanos , Feminino , Doenças dos Genitais Femininos/epidemiologia , Doenças Sexualmente Transmissíveis/epidemiologia , Chlamydia trachomatis , Jamaica/epidemiologia
14.
West Indian med. j ; 35(2): 92-5, June 1986.
Artigo em Inglês | MedCarib | ID: med-11606

RESUMO

The chief application of diagnostic laparoscopy among 246 women was in the investigation of infertility. The inaccuracy of the salpingogram was evident, and endoscopic findings conflicted with clinical parameters in several patients with pelvic pain. The occasional use of laparoscopy to resolve the diagnosis of uterine perforation or to locate a lost intra-uterine device is illustrated (AU)


Assuntos
Adolescente , Adulto , Feminino , Humanos , Doenças dos Genitais Femininos/diagnóstico , Laparoscopia/estatística & dados numéricos , Infertilidade Feminina/diagnóstico , Estudo de Avaliação , Trinidad e Tobago
19.
West Indian med. j ; 25(1): 35-42, Mar. 1976.
Artigo em Inglês | MedCarib | ID: med-11183

RESUMO

Of the 195 cases investigated, paracervical block anaesthesia was found to be effective for cervical dilatation and curettage, evacuation of retained products, termination of pregnancy, biopsy and cauterization of cervix, polypectomy and removal of embedded intra-uterine device. In one case mentioned, the anaesthesia wore of after 20 minutes, making it necessary to anesthetise the patient to carry out the procedure. There were no complications and no contra-indications were found in the use of this method. From the above, it is concluded that paracervical block anaesthesia for minor gynaecological survey is simple, safe and effective. (AU)


Assuntos
Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Anestesia Local , Colo do Útero , Doenças dos Genitais Femininos/cirurgia , Estudo de Avaliação
20.
Clin Radiol ; 25(4): 535-42, Oct. 1974.
Artigo em Inglês | MedCarib | ID: med-15898

RESUMO

Diverticulosis of the fallopian tubes is uncommon, but is 9 times as common in Negro women of Jamaican origin as in Caucasian women living in Bristol. 58 examples were encountered in 918 hysterosalpingograms done in Kingston, Jamaica (426) and in Bristol (492) from 1968-1972. In 41 cases (71 per cent) diverticulosis was bilateral. There are several possible predisposing causes, of which infection, including tuberculosis, is the most important. The radiological appearances are distinctive, but, with the possible exception of tuberculosis, do not give any indication of cause. Infertility was the commonest clinical association of diverticulosis. Among infertile patients, hydrosalpinx and tubal obstruction were slightly commmoner in the presence of diverticulosis and the significance of this is discussed. Ectopic pregnancy is the most important associated condition and diverticulosis predisposes to its occurence. Hysterosalpingography is indicated following ectopic pregnancy to show whether there is diverticulosis to the contralateral tube, as this may influence prognosis and management (AU)


Assuntos
Humanos , Gravidez , Feminino , Divertículo/diagnóstico por imagem , Divertículo/complicações , Divertículo/epidemiologia , Inglaterra , Tubas Uterinas/patologia , Doenças dos Genitais Femininos/epidemiologia , Histerossalpingografia , Infertilidade Feminina/etiologia , Jamaica , Gravidez Ectópica/complicações , Tuberculose dos Genitais Femininos/complicações
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