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1.
West Indian med. j ; 50(Suppl 5): 24, Nov. 2001.
Artigo em Inglês | MedCarib | ID: med-186

RESUMO

OBJECTIVE: The prospective comparison of a sub-cohort of persons diagnosed with schizophrenia five years from initial contact with the mental health care system in Jamaica. METHOD: In a five-year follow-up study, a sub-cohort of 54 patients (M=37, F=17 aged 15-55 years was reassessed from the initial cohort of 317 patients identified in 1992 with a CATEGO ñ diagnosis of schizophrenia. The sub-cohort was chosen from one rural parish (St.Thomas) and one mixed urban/rural parish (St.Catherine). The main outcome measures collected from case notes and patient interviews included clinical status and medication usage at contact with clinical service, employment status, outpatient clinical compliance, relapse rate, and Krawiecka and Goldberg rating scale for the severity of psychotic symptoms. RESULTS: Relapse rate at year five was 14 percent. There were no significant differences between the number of relapses in the first year and the fifth year (z= -2.714, p= 0.007, Wilcox sign test). Outpatient compliance five years from onset showed 97.3 percent of patients had been in contact with the community mental service at least twice during the five-year period. CONCLUSIONS: The favourable outcome in the fifth year after first contact is consistent with the previously reported favourable outcome in the first year after initial contact with the mental health care system in Jamaica. More importantly, the relapse rates continue to be well below the present worldwide relapse rate. (AU)


Assuntos
Adulto , Pessoa de Meia-Idade , Feminino , Humanos , Masculino , Adolescente , Esquizofrenia/diagnóstico , Jamaica , Seguimentos , Recidiva , Avaliação de Resultados em Cuidados de Saúde
2.
West Indian med. j ; 50(3): 194-7, Sept. 2001.
Artigo em Inglês | MedCarib | ID: med-303

RESUMO

Several previous studies have identified high incidence rates, high relapse rates and poor short term outcome for schizophrenia in African-Caribbeans in the United Kingdom (UK). Studies in the Caribbean have found the incidence of schizophrenia to be within worldwide levels, and one-year outcome to be much lower than that reported for African Caribbean patients in the UK. First contact patients with schizophrenia identified prospectively by the Present Status Examination were followed prospectively for one year. The main outcome measures which were collected from case notes included: clinical status and medication usage at contact with clinical service, employment status, outpatient clinic compliance, relapse rate and in-patient hospital status, after 12 months. Three hundred and seventeen patients between ages 15 and 55 years who had made first contact with the psychiatric service in Jamaica in 1992 received a computer diagnostic programme for the present status examination (CATEGO) diagnosis of schizophrenia. The majority 197 (62 percent) were treated at home, and 120 (38 percent) were admitted to hospital for treatment. Two hundred and sixty four (83 percent) were still being seen after one year. The relapse rate was 13 percent (41 patients), higher for admissions (24, 20 percent) than for those treated at home (17, 9 percent; p<0.001). The relapse rate was higher for patients brought into care by the police and mental health officers (p<0.005). One hundred and thirty five (43 percent) were in gainful employment within the 12 month period of follow up, contrasted with the 40 percent unemployment rate for the 2.4 million population of the island (chi square = 39.322, p<0.001). There was a self-reported use of medication in 213 (67 percent) patients, with 142 (45 percent) on monthly intramuscular depot medication. The low relapse rates and good outcome measures after 12 months of first srevice contact with schizophrenia are related to high levels of gainful employment and good intramuscular medication compliance. The favourable short term outcome in Jamaica does not correspond to the high relapse rate for this condition found in African Caribbeans in the UK. (AU)


Assuntos
Humanos , Estudo Comparativo , Esquizofrenia/epidemiologia , Reino Unido/epidemiologia , Jamaica/epidemiologia , Afro-Americanos , Diagnóstico por Computador/estatística & dados numéricos , Estudos de Coortes , Recidiva , Avaliação de Resultados em Cuidados de Saúde , Esquizofrenia/diagnóstico , Esquizofrenia/terapia , Injeções Intramusculares
3.
West Indian med. j ; 50(1): 22-6, Mar. 2001. gra
Artigo em Inglês | MedCarib | ID: med-325

RESUMO

In order to evaluate the efficacy and safety of coronary stenting, we reviewed the first 32 consecutive patients (34 vessels) who underwent elective coronary stenting during the period August 1999 to August 2000 inclusive at the Digital Lab installed at the Eric Williams Medical Complex, Trinidad and Tobago. Aspirin, heparin and ticlopidine were used routinely. Abciximab was used in selected cases (38 percent). The mean age of patients was 55 ñ 10 years. Eighty-one percent were male, 52 percent were hypertensive and 21 percent diabetic. Sixty-five percent had severe angina. Prior Coronary Artery Bypass Grafting (CABG) was performed in 3 percent and previous Percutaneous Transluminal Coronary Angioplasty (PTCA) in 3 percent. Multivessel disease was present in 43 percent. The mean left ventricular ejection fraction was 53 ñ 12 percent. The culprit lesion was located in either the native left anterior descending (LAD) coronary artery (53 percent), right coronary artery (RCA) (31 percent), circumflex artery 13 percent and saphenous vein graft (3 percent). The mean baseline diameter stenosis was occluded vs 50 percent for 8 totally occluded vessels. For the total occlusions, procedural sucess was inversely related to the duration of the occlusion. There were no cases of death, acute vessel closure, Q-wave myocardial infarction, repeat PTCA or emergency Coronary Artery Bypass Graft (CABG) during and following the procedure. Distal embolization occurred in one patient. The mean duration of hospital stay was one day (for 30 outpatient cases). One patient had recurrence of symptoms with a negative stress test. No patient underwent repeat angiography during the first year of follow-up. Coronary stents were successfully implanted at a tertiary care facility in the Caribbean with low in-hospital morbidity and mortality. Stents markedly reduced the diameter stenosis of the coronary lesion during PTCA. The incidence of clinical restenosis was low. Coronary revascularisation can be successfully achieved by coronary stenting in the Caribbean (AU)


Assuntos
Pessoa de Meia-Idade , Feminino , Humanos , Masculino , Doença das Coronárias/terapia , Stents , Angioplastia Coronária com Balão/métodos , Trinidad e Tobago , Ponte de Artéria Coronária , Anticoagulantes/uso terapêutico , Tempo de Internação , Recidiva
4.
J Pediatr ; 138(1): 65-70, Jan. 2001. tab
Artigo em Inglês | MedCarib | ID: med-117

RESUMO

OBJECTIVES: To examine the clinical features and epidemiology of invasive pneumococcal disease in homozygous sickle cell (SS) disease and the efficacy of pneumococcal prophylaxis. STUDY DESIGN: A retrospective study of 80 episodes in 68 patients in the Jamaican Sickle Cell Clinic in a 25-year period (1973-1997). RESULTS: Clinical features included a history of fever (94 percent), vomitting (70 percent), an ill appearance (80 percent), fever (89 percent), abnormal chest signs (43 percent), and meningismus (39 percent). There were 14 deaths - 13 among 68 initial episodes (6 of which were deaths on arrival) and one death during a recurrence. Thirteen episodes occurred in patients who should have been receiving antibiotic prophylaxis. Ten were due to failure to adhere to protocols, and 3 occurred during prophylaxis; one patient was receiving oral erythromycin, and two had received injections of benzathine penicillin 4 and 24 days before the episode. All but one of the pneumococcal isolates were susceptible to penicillin. The 32 patients who received pneumococcal vaccine had more mild clinical courses as indicated by a greater chance of being treated as outpatients or surviving after admission (Mann-Whitney U test, P = .03). CONCLUSIONS: Penicillin remains the mainstay of prophylaxis, although breakthroughs occur and will become more common with the increasing frequency of penicillin-resistant organisms. Pneumococcal immunization appears to ameliorate the course of invasive disease. (AU)


Assuntos
Criança , Pré-Escolar , Feminino , Humanos , Masculino , Lactente , Adolescente , Anemia Falciforme/complicações , Infecções Pneumocócicas/etiologia , Infecções Pneumocócicas/prevenção & controle , Jamaica/epidemiologia , Infecções Pneumocócicas/epidemiologia , Antibioticoprofilaxia , Antibacterianos/uso terapêutico , Ambulatório Hospitalar , Estudos Retrospectivos , Resultado do Tratamento , Vacinação , Análise de Sobrevida , Recidiva , Hospitais Universitários
5.
West Indian med. j ; 49(3): 210-11, Sept. 2000.
Artigo em Inglês | MedCarib | ID: med-677

RESUMO

This is a retrospective study of relapses among leprosy patients who received multiple drug therapy in Trinidad and Tobago between January 1982 and Decembe 1994. The results of the study reveal a relapse of 0.65 percent for multibacillary cases and 1.5 percent for paucibacillary cases. These results are comparable to the relapse rates reported by the World Health Organisation.(Au)


Assuntos
Humanos , Hanseníase/tratamento farmacológico , Trinidad e Tobago , Quimioterapia Combinada , Recidiva
6.
Aust Dent J ; 43(6): 390-4, Dec. 1998.
Artigo em Inglês | MedCarib | ID: med-1414

RESUMO

The authors reviewed 15 new cases of fibrous dysplasia of the jaw bone and two cases of recurrence seen in Jamaica between 1980 and 1995. Only cases which had a histological confirmation of fibrous dysplasia were included. The clinical behaviour and radiological findings of these cases were studied from the case files, either at the Cornwall Regional Hospital or the Kingston Public Hospital in Jamaica (AU)


Assuntos
Adolescente , Relatos de Casos , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Displasia Fibrosa Monostótica/diagnóstico , Doenças Mandibulares/diagnóstico , Doenças Maxilares/diagnóstico , Jamaica , Recidiva , Displasia Fibrosa Monostótica/patologia , Displasia Fibrosa Monostótica/diagnóstico por imagem , Doenças Mandibulares/patologia , Doenças Mandibulares/diagnóstico por imagem , Doenças Maxilares/patologia , Doenças Maxilares/diagnóstico por imagem
7.
West Indian med. j ; 47(suppl. 2): 51, Apr. 1998.
Artigo em Inglês | MedCarib | ID: med-1828

RESUMO

The authors review 12 instances of recurrence of ameloblastoma of the mandible in Jamaica between 1980 and 1995, a period of 15 years. A "historic" case report is also presented for a patient in who ameloblastoma recurred about 7 times in his mandible within a 20 year period. Over the last 15 years various modalities of treatment have been used in the management of ameloblastoma in Jamaica and this includes enucleation, curettage, radical resection followed by reconstruction with corticocancellous autogenous bone grafts from iliac crest, and cryosurgery with or without enucleation. Irrespective of which modalities of treatment were used, the ameloblastoma recurred. It is interesting to come across a case of recurrent ameloblastoma within a bone graft from the iliac crest 13 years after radical resection and reconstruction with the bone graft in question. In conclusion, the management of ameloblastoma may seem to be controversial. We suggest a radical procedure for these lesions which can be said to benign yet aggressive and locally recurrent. Conservative management may only lead to an unacceptable rate of recurrence.(AU)


Assuntos
Humanos , Relatos de Casos , Ameloblastoma/terapia , Recidiva , Jamaica
8.
West Indian med. j ; 47(1): 26-30, Mar. 1998.
Artigo em Inglês | MedCarib | ID: med-1633

RESUMO

Although percutaneous balloon mitral valvuloplasty has been performed in the Caribbean before, there has not been any detailed description in the English-speaking West Indian Medical literature hitherto. This report provides a description of the first four case of percutaneous balloon mitral valvuloplasty performed in Jamaica(AU)


Assuntos
Adulto , Relatos de Casos , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cateterismo , Estenose da Valva Mitral/terapia , Cardiopatia Reumática/terapia , Ecocardiografia Transesofagiana , Jamaica , Estenose da Valva Mitral/diagnóstico por imagem , Recidiva , Cardiopatia Reumática/diagnóstico por imagem , Resultado do Tratamento
9.
WEST INDIAN MED. J ; 46(Suppl 2): 25-6, Apr. 1997.
Artigo em Inglês | MedCarib | ID: med-2301

RESUMO

The study was to identify pathways to care and determine clinical outcome after one year in a cohort with first contact schizophrenia in Jamaica. 317 first contact patients identified prospectively were followed blind by psychiatrists and mental health officers and clinical outcome variables were recorded monthly. Relapse was identified as admission/readmission to hospital, re-emergence of symptoms and/or the return of abnormal behaviour. Data in the first 12-month period following first contact were analyzed by the Chi-squared method. 65 percent were males, 98 percent were of African origin, and 90 percent of social classes IV and V. They were treated at home (63 percent), in the mental hospital (20 percent) and community psychiatric beds (17 percent). Only 5 percent were admitted using a compulsory detention section order. The mean length of stay in the mental hospital was 93 days, and in the community beds was 24 days. 70 percent were still being followed in clinics and 21 percent had ceased contact and had been discharged. The relapse rate was 7 percent and these patients were more likely to have come into care through the police or mental health officers (p<0.05), and more likely to have been treated in hospitals (p>0.05) and more likely to have received an increase in psychotropic medication (p>0.05). The relapse status of an additional 7 percent patients could not be ascertained. We concluded that low relapse rate in schizophrenia is related to close involvement of families of the patients as caregivers, early recognition and treatment in community and home settings, significant reduction in the use of compulsory detention, and the provision of high compliance pharmacological follow-up treatment. (AU)


Assuntos
Feminino , Humanos , Masculino , Esquizofrenia/epidemiologia , Recidiva , Hospitalização , Jamaica , Resultado do Tratamento
11.
WEST INDIAN MED. J ; 45(4): 116-18, Dec. 1996.
Artigo em Inglês | MedCarib | ID: med-2976

RESUMO

Bilateral total adrenalectomy is a common treatment for Cushing's Syndrome in underdeveloped countries where limited resources restrict the use of extensive investigations, where the source of ACTH secretion is not identified or where neurosurgical facilities are minimal. Two cases of recurrence of cortisol secretion managed at the University Hospital of the West Indies are presented. The aetiology is discussed. (AU)


Assuntos
Humanos , Feminino , Adulto , Relatos de Casos , Adrenalectomia , Síndrome de Cushing/etiologia , Síndrome de Cushing/terapia , Hormônio Adrenocorticotrópico/metabolismo , Jamaica , Recidiva
12.
West Indian med. j ; 45(3): 92-4, Sept. 1996.
Artigo em Inglês | MedCarib | ID: med-3499

RESUMO

Fifty seven children with idiopathic nephrotic syndrome who were seen at two hospitals in Trinidad between 1989 and 1995 (median follow-up period, 38 months) were classified according to their response to glucocorticoids. 27 (47 percent) were two to six years old at presentation; 37 (65 percent) were of East Indian descent, 7 (12 percent) were of African descent, and 12 (21 percent) were of mixed race. 55 (96 percent) responded to glucocorticoids. Renal biopsies in 15 patients revealed membranoproliferative glomerulonephritis and membranous nephropathy in the two patients who had not responded to glucocorticoids. Ten patients showed mesangial hypercellularity, associated with immunoglobulin deposits in 7 cases. Age, presentation with nephrotic features, mesangial hypercellularity and immunoglobulin deposits did not predict for unresponsiveness to glucocorticoids. These findings may be explained by the predominance of East Indians in the study group.(AU)


Assuntos
Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Síndrome Nefrótica/terapia , Glucocorticoides/uso terapêutico , Síndrome Nefrótica/etnologia , Síndrome Nefrótica/patologia , Biópsia , Recidiva , Idade de Início , Trinidad e Tobago , Glomerulonefrite Membranoproliferativa
13.
Ann Trop Paediatr ; 15(4): 285-9, Dec. 1995.
Artigo em Inglês | MedCarib | ID: med-3172

RESUMO

Chronic relapsing pancreatitis is a rare cause of abdominal pain in children and exceptionally rarely is related to a scorpion sting. We describe a 13-year-old girl who, following envenoming by a scorpion, developed recurrent attacks of sharp, intermittent pain in the umbilical region associated with fever, nausea, anorexia and vomiting, and changes in her psychological behaviour. Thorough clinical evaluation, including CT scanning, disclosed unabated pancreatitis, particularly in children, a scorpion sting should be considered an aetiologically possibility(AU)


Assuntos
Humanos , Feminino , 21003 , Adolescente , Picaduras de Aranhas/complicações , Picaduras de Aranhas/diagnóstico , Pancreatite/etnologia , Pancreatite/diagnóstico por imagem , Dor Abdominal , Doença Crônica , Diagnóstico Diferencial , Recidiva , Escorpiões , Tomografia Computadorizada por Raios X , Trinidad e Tobago
14.
J Trop Med Hyg ; 98(3): 179-84, June 1995.
Artigo em Inglês | MedCarib | ID: med-5351

RESUMO

A fifteen-year retrospective study of 108 cases of tetanus admitted to the Intensive Care Unit (ICU) at the University Hospital of the West Indies is presented. Males predominated (70 percent), with peak incidence occurring amongst the young and the elderly. In 57 percent the disease was severe enough to require neuromuscular blockade and controlled ventilation. Respiratory complications occurred most commonly (80 percent), predominantly as a result of infection. Dysautonomia, exhibited by 55 percent of patients, presented the greatest difficulty in management. Mortality was high (20 percent), with sudden cardiac arrest being the most common cause of death. The average duration of stay in the ICU was long (27 days). As Jamaica is a Third World country with limited resources, the continued occurrence of this preventable disease represents a drain on existing intensive care funds. This must be brought to the attention of institutions responsible for planning health care programmes for developing countries (AU)


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Tétano/complicações , Tétano/epidemiologia , Fatores Etários , Causas de Morte , Incidência , Unidades de Terapia Intensiva , Jamaica/epidemiologia , Tempo de Internação , Recidiva , Estudos Retrospectivos , Fatores Sexuais , Tétano/mortalidade
15.
West Indian med. j ; 43(4): 138-9, Dec. 1994.
Artigo em Inglês | MedCarib | ID: med-7685

RESUMO

A survey of the records of 103 consecutive patients who underwent abdominal myomectomy revealed that menorrhagia and infertility were the commonest presenting complaints. The overall successful pregnancy rate was only 28.8 percent, but the procedure was corrective in two-thirds of patients with leiomyomata-related infertility. Intra-operative blood loss, post-operative adhesion formation and recurrence of tumour remain major drawbacks of myomectomy (AU)


Assuntos
Adulto , Feminino , Humanos , Leiomioma/cirurgia , Neoplasias Uterinas/cirurgia , Infertilidade Feminina/etiologia , Estudos Retrospectivos , Perda Sanguínea Cirúrgica , Recidiva , Resultado da Gravidez
16.
West Indian med. j ; 42(2): 65-7, June 1993.
Artigo em Inglês | MedCarib | ID: med-9600

RESUMO

Nine cases treated by surgery for post-hysterctomy vaginal prolapse are reviewed. The mean time between presentation and the antecedent hysterectomy was 12.8 years. Two patients who had abdominal sacral colpopexy alone developed recurrence of prolapse. Additional culdoplasty and colposuspension improved the cure rate but prolonged the mean operating time. Restoration of vaginal anatomy and function is best achieved with the combination operation. (AU)


Assuntos
Humanos , Pessoa de Meia-Idade , Idoso , Feminino , Prolapso Uterino/cirurgia , Histerectomia/efeitos adversos , Prolapso Uterino/etiologia , Recidiva , Fatores de Tempo , Estudos Prospectivos
17.
Br J Surg ; 80(5): 614-5, May 1993.
Artigo em Inglês | MedCarib | ID: med-8504

RESUMO

Recurrence-free repair of midline vntral abdominal wall hernia continues to elude surgeons, despite the abundance of described techniques. Based on the observation that spontaneous herniation through the rectus abdominis muscles is unknown, a new technique of repair was devised. The rectus muscles and their sheaths on either side of the hernial drfect are directly brought together to obliterate the hernia, the intervening linea alba and intact hernia sac being 'keeled' into the abdominal cavity. Using this technique, 85 consecutive midline abdominal hernias were repaired over an 11-year period. Follow-up was from 18 months to 12 years; there was one recurrence. The rectus repair is recommended as an effective method of dealing with ventral midline abdominal wall hernia (AU)


Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Masculino , Feminino , Músculos Abdominais/cirurgia , Hérnia Ventral/cirurgia , Recidiva , Técnicas de Sutura
18.
J Psychosoc Nurs Ment Health Serv ; 30(3): 27-32, Mar. 1992.
Artigo em Inglês | MedCarib | ID: med-15748

RESUMO

This article described a method of patient and family intervention designed for psychotic patients who are prone to relapse. Issues addressed in a monthly group meeting were designed to clarify, inform, and support families on the facts of schizophrenia and bipolar disorder. This format succeeded in improving the rate of recidivism in the population of Caribbean patients because it clarified distortions of the nature of the illnesses and made obvious that medication compliance was separate and did not intrude on the culture and belief systems. Family dynamics were not a focus in this psychoeducation program, but alliances, boundaries, and process did change over the course of the 6 months of the program. Family members were engaged relatively easily and responded when it was clear there was no intention to intrude on culture or personal beliefs. Many expressed anger and fustrations that such a program had not been offered before, especially those families whose relatives had experienced multiple readmissions. The questionnaires clearly illustrated an increase in knowledge and understanding about the illness, and this correlated with reduced recidivism. A major effort is made to maintain contact with patients and their families following discharge from the day hospital for up to 3 years to ensure their follow- through. Follow-up phone calls ensure 100 percent follow-up for the past few years, we have found that on going contact is also useful on a reduced frequency to reinforce the concepts communicated initially.(AU)


Assuntos
Humanos , Pré-Escolar , Criança , Adolescente , Adulto , Masculino , Feminino , Terapia Familiar , Educação em Saúde , Transtornos Psicóticos/terapia , Migrantes/psicologia , Doença Crônica , Hospitalização , Avaliação de Programas e Projetos de Saúde , Transtornos Psicóticos/tratamento farmacológico , Recidiva
20.
Lancet ; 336(8727): 1345-7, Dec. 1, 1990.
Artigo em Inglês | MedCarib | ID: med-12545

RESUMO

In Jamaican children infective dermatitis is chronic eczema associated with refractory nonvirulent Staphylococcus aureus or beta haemolytic streptococcus infection of the skin and nasal vestibule. 14 children between the ages of 2 and 17 years with typical infective dermatitis, attending the dermatology clinic at the University Hospital of the West Indies in Jamaica, were tested for antibody to human T-Lymphotropic virus type 1 (HTLV-1). All were seropositive, whereas 11 children of similar age with atopic eczema were all negative. In 2 of 2 cases of infective dermatitis, the biological mother was HTLV-1 seropositive. None of the 14 patients showed signs of adult T-cell leukaemia/lymphoma, though experience with previous cases of infective dermatitis indicates the possibility of such progression. (AU)


Assuntos
Humanos , Pré-Escolar , Criança , Adolescente , Masculino , Feminino , Dermatite/etiologia , Anticorpos Anti-HTLV-I/análise , Infecções por HTLV-I/complicações , Dermatopatias Infecciosas/etiologia , Doença Aguda , Infecções por HTLV-I/imunologia , Tolerância Imunológica , Jamaica , Recidiva
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