The beta thalassaemia trait in Jamaica.

The objective of this study was to review the prevalence and features of the beta thalassaemia trait in Jamaican populations. Screening of 221,306 newborns over the last 46 years has given an indication of the distribution and prevalence of beta thalassaemia genes, and screening of 16,612 senior school students in Manchester parish, central Jamaica, has provided their haematological features. The prevalence of the beta thalassaemia trait predicted from double heterozygotes was 0.8% of 100,000 babies in Kingston, 0.9% of 121,306 newborns in southwest Jamaica, and 0.9% of school students in Manchester. Mild beta+ thalassaemia variants (-88 C>T, -29 A>G, -90 C>T, polyA T>C) accounted for 75% of Kingston newborns, 76% of newborns in southwest Jamaica, and 89% of Manchester students. Severe beta+ thalassaemia variants were uncommon. Betao thalassaemia variants occurred in 43 patients and resulted from 11 different variants of which the IVSII-849 A>G accounted for 25 (58%) subjects. Red cell indices in IVSII-781 C>G did not differ significantly from HbAA, and this is probably a harmless polymorphism rather than a form of beta+ thalassaemia; the removal of 6 cases in school screening had a minimal effect on the frequency of the beta thalassaemia trait. Red cell indices in the beta+ and betao thalassaemia traits followed established patterns, although both were associated with increased HbF levels. The benign nature of beta+ thalassaemia genes in Jamaica means that cases of sickle cell-beta+ thalassaemia are likely to be overlooked, and important clinical questions such as the role of pneumococcal prophylaxis remain to be answered.

Who moves in vulnerable Caribbean neighborhoods? Positive deviance for physical activity: Findings from the Jamaica health and Lifestyle Survey 2017 (JHLS III).

Decreased physical activity (PA) has been associated with residents living in neighborhoods perceived as being disordered or having high crime levels. What is unknown are the characteristics of individuals who engage in moderate to vigorous levels of PA (MVPA) despite living in these vulnerable neighborhoods, or who may be referred to as positive deviants (PD). We examined the factors associated with PD for PA among Jamaicans. Between 2016 and 2017 the Jamaica Health and Lifestyle Survey, a cross-sectional nationally representative survey (n = 2807), was conducted on individuals aged 15 years and older. Regression analyses were performed to identify associations with PD, defined using engagement in MVPA among persons living in vulnerable neighborhoods (N = 1710). Being female (odds ratio [OR]a = 0.64 (0.48, 0.86); p = 0.003), obese while living in an urban area (ORa = 0.39; 95 % CI = 0.26, 0.59; p < 0.0001), unemployed (ORa = 0.53; 95 % CI = 0.39, 0.73; p < 0.0001), or a student (ORa = 0.62; 95 % CI = 0.39, 0.98); p = 0.041) was associated with a significantly lower likelihood of PD, while having a personal medical history of at least one chronic disease significantly increased likelihood (ORa = 1.43; 95 % CI = 1.08, 1.90; p = 0.014). Taking a PD approach may be one angle to consider in trying to determine what is working and for whom, so that this may be harnessed in policy, prevention and intervention programming to increase PA.

The Ability of Family Physicians in the Caribbean to Promote Planetary Health Concepts and the Challenges of Implementing Changes in Practice

The global environment is rapidly changing and the subsequent effects on human health are devastating. Planetary Health is a field focused on characterizing the human health impacts of human-caused disruptions of Earth's natural systems. It has been determined that Family Physicians (FPs) are the best suited to advocate and raise awareness of Planetary Health. The purpose of this research is to assess FPs in the Caribbean, their knowledge of planetary health, their ability to implement planetary health concepts in their practice, and the challenges that may impede implementation.

Staff and participant perceptions of optimal recruitment and retention strategies for biomedical cohort studies in the Caribbean.

PURPOSE: To identify staff and participants perspectives of best practices that facilitate achieving enrollment and retention targets in biomedical cohort studies in Caribbean populations. METHODS: Eight focus group discussions (FGDs) were held with research stakeholders including research (i) nurses/study supervisors, (ii) field staff/data collectors, and (iii) rural and urban participants of the Third Jamaica Health and Lifestyle Survey (a national NCD risk factor survey with biospecimen collection) to capture qualitative data on experiences with recruitment, training, retention challenges and potential solutions or strategies for strengthening future efforts. RESULTS: Our findings indicate that trained, experienced study staff with good interpersonal communication skills enhanced the proficiency of field operations and attracted study participants. Targeted community and stakeholder engagement alongside strong support from the coordinating center increased the reach and efficiency of the data collectors. Timely participant feedback, gender-appropriate approaches, and socioeconomic balance enhanced equitable enrollment and retention of participants of cohort studies particularly the hard to reach groups. CONCLUSION: Well-functioning research teams using traditional and social media promotion, applying gender-appropriate and personalized approaches together with strategies for reaching the less accessible socioeconomic groups, are effective for recruiting and retaining members of a Caribbean cohort. These strategies may also enhance the recruitment of other Black populations in the Diaspora including the US and Caribbean into biomedical studies including cancer research.

Improving patient outcomes with inguinal hernioplasty-local anaesthesia versus local anaesthesia and conscious sedation: a randomized controlled trial.

PURPOSE: Conscious sedation is regularly used in ambulatory surgery to improve patient outcomes, in particular patient satisfaction. We hypothesized that the addition of conscious sedation would provide greater patient satisfaction with inguinal hernioplasty compared to local anesthesia alone. METHODS: This trial was a single-centre, randomized, placebo-controlled, double-blinded trial where patients undergoing inguinal hernioplasty using local anaesthesia were randomized to receive local anaesthesia alone versus local anaesthesia and conscious sedation. The primary outcome of patient satisfaction was assessed using the Iowa Satisfaction with Anesthesia Scale (ISAS). The study was powered to detect a significant difference in ISAS scores between groups. Comparisons were made using T test and Chi square tests. A p value of less than 0.05 was considered significant. RESULTS: There were 149 patients randomized: 78 to the local anesthesia (LA) group and 71 to the local anaesthesia and conscious sedation (LACS) group. For the primary outcome measure of patient satisfaction, the mean ISAS score was significantly greater in the LACS group (p = 0.009). The experience of pain and pain severity was greater in the LA group (p = 0.016; p = 0.0162 respectively). No statistically significant difference was found between groups with respect to operative time, time to discharge or postoperative complications. CONCLUSION: The use of conscious sedation with local anesthesia for inguinal hernioplasty is safe, results in less pain experience and severity and is associated with better patient satisfaction. The use of conscious sedation does not delay patient discharge.

Inferring introgression using RADseq and DFOIL : Power and pitfalls revealed in a case study of spiny lizards (Sceloporus).

Introgression is now commonly reported in studies across the Tree of Life, aided by recent advancements in data collection and analysis. Nevertheless, researchers working with nonmodel species lacking reference genomes may be stymied by a mismatch between available resources and methodological demands. In this study, we demonstrate a fast and simple approach for inferring introgression using RADseq data, and apply it to a case study involving spiny lizards (Sceloporus) from northeastern México. First, we find evidence for recurrent mtDNA introgression between the two focal species based on patterns of mito-nuclear discordance. We then test for nuclear introgression by exhaustively applying the "five-taxon" D-statistic (DFOIL ) to all relevant individuals sampled for RADseq data. In our case, this exhaustive approach (dubbed "ExDFOIL ") entails testing up to ~250,000 unique four-taxon combinations of individuals across species. To facilitate use of this ExDFOIL approach, we provide scripts for many relevant tasks, including the selection of appropriate four-taxon combinations, execution of DFOIL tests in parallel and visualization of introgression results in phylogenetic and geographic space. Using ExDFOIL , we find evidence for ancient introgression between the focal species. Furthermore, we reveal geographic variation in patterns of introgression that is consistent with patterns of mito-nuclear discordance and with recurrent introgression. Overall, our study demonstrates that the combination of DFOIL and RADseq data can effectively detect introgression under a variety of sampling conditions (for individuals, populations and loci). Importantly, we also find evidence that batch-specific error and linkage in RADseq data may mislead inferences of introgression under certain conditions.

The role of fathers in overweight prevention: an analysis of a Caribbean cohort.

BACKGROUND: Family-based strategies to reduce the risk of overweight in childhood are needed in the Caribbean. AIM: To investigate the associations between parental characteristics and risk of overweight and explore possible mechanisms. METHODS: Data from a parenting intervention were analysed. Parental characteristics were obtained by questionnaire at enrolment. At 18 months, 501 infants (82.9% of cohort) had weight and length measured using standardized methods. The association of parents' characteristics with risk of infant overweight was assessed using random-effects logistic regression. Four focus groups among mothers in Jamaica were conducted to explore mechanisms. RESULTS: Overall, 20.6% of infants were 'at risk of overweight'. Fathers were present in 52% of households. Fathers' presence [OR (95% CI) 0.60 (0.37-0.96)] was associated with reduced risk of overweight independent of socioeconomic status. Mothers reported that fathers encouraged healthier practices. CONCLUSION: Fathers may be important agents of change in intervention strategies to prevent childhood overweight.

Syncope: Clinical Presentation of Bronchial Asthma / Síncope: presentación clínica del asma bronquial

ABSTRACT Syncope, first described by Hippocrates, can be differentiated into neurological, cardiac and non-cardiac in origin, and this differentiation is of prognostic significance. The cardiac causes of syncope, which can be structural, electrophysiological or infectious, have a relatively poor prognosis and are associated with ethnicity, geographic location and sudden cardiac death. In decreasing frequency, the cardiac causes are hypertrophic cardiomyopathy, anomalous coronary arteries, Marfan Syndrome and dilated cardiomyopathy. Electrophysiological causes include supraventricular causes, Wolf-Parkinson-White syndrome, ion channelopathies, long QT syndrome and Brugada syndrome. The index case with bronchial asthma presented with syncope. There is an increased morbidity and mortality of this specific group of patients, if undiagnosed and not optimally treated; hence the need for a high index of suspicion and early diagnosis, after exclusion of cardiac and more common neurological causes. This is the first documented case of syncope secondary to bronchial asthma in an Afro-Caribbean.

RESUMEN El síncope, primeramente, descrito por Hipócrates, se puede clasificar como neurológico, cardíaco y no cardíaco atendiendo a su origen, y esta diferenciación tiene importancia pronóstica. Las causas cardíacas del síncope - que pueden ser estructurales, electrofisiológicas o infecciosas - tienen un pronóstico relativamente pobre y se asocian con la etnicidad, la localización geográfica y la muerte cardiaca repentina. En frecuencia decreciente, las causas cardíacas son la cardiomiopatía hipertrófica, las arterias coronarias anómalas, el síndrome de Marfan y la cardiomiopatía dilatada. Las causas electrofisiológicas incluyen las causas supraventriculares, el síndrome de Wolf-Parkinson-White, las canalopatías iónicas, el síndrome de QT largo, y el síndrome de Brugada. El caso índice con asma bronquial se presentó con síncope. Hay una mayor morbilidad y mortalidad de este grupo específico de pacientes, si no se diagnostica y no se trata de forma óptima. De ahí, la necesidad de un alto índice de suspicacia y diagnóstico temprano, luego de la exclusión de las causas cardíacas y las causas neurológicas más comunes. Éste es el primer caso documentado de síncope secundario al asma bronquial en un afrocaribeño.

Obstetric Outcomes of an Afro-Caribbean Cohort Following Universal Screening and Treatment of Subclinical Hypothyroidism.

OBJECTIVE: Restoration of euthyroidism with l-thyroxine reportedly reduces obstetric complications associated with subclinical hypothyroidism (SCH). The objective was to determine if obstetric outcomes of treated subjects were equivalent to euthyroid subjects. METHODS: This was a prospective cohort study. Subjects were considered euthyroid if serum thyroidstimulating hormone (TSH) was 0.4-3 mIU/L and free thyroxine (FT4) 10.29-17.05 pmol/L with negative thyroid peroxidase antibodies (TPOAb). Subclinical hypothyroidism was diagnosed if FT4 was 10.29-24.45 pmol/L and TSH 2.5-3 mU/L with positive TPOAb, or TSH > 3.0 mU/L regardless of antibody status. Subclinical hypothyroidism subjects were treated with l-thyroxine until TSH < 2.5 mIU/L. Data were analysed with Stata (StataCorp, USA). RESULTS: Seven hundred and sixty-nine singleton pregnancies were screened; 96% at 14 weeks gestation. Five hundred and eleven (66%) were euthyroid by study definition. Prevalence of SCH was 1.9% (15/769); 26% (4/15) were TPOAb positive. Eighty-one per cent were treated according to protocol; compliance was 54%. Mean gestational age (GA) at first endocrinologist visit was 22.7 ± 2.7 weeks. Normal TSH was documented in 36% at GA 33 ± 2.94 weeks. Subjects with SCH had significantly greater pre-existing history of preterm premature rupture of membranes (PPROM) and preterm labour, Caesarean sections for non-reassuring fetal heart rate and neonatal necrotizing enterocolitis. CONCLUSION: L-thyroxine appeared to reduce obstetric complications. However, prevalence of SCH was low and compliance was < 50%.

Prevalence of Chronic Kidney Disease among Patients Attending a Specialist Diabetes Clinic in Jamaica.

OBJECTIVE: To estimate the prevalence of chronic kidney disease (CKD) among patients attending the University Hospital of the West Indies (UHWI) Diabetes Clinic and to determine the proportion of patients at high risk for adverse outcomes. METHODS: We conducted a cross-sectional study among patients attending the UHWI Diabetes Clinic between 2009 and 2010. Trained nurses administered a questionnaire, reviewed dockets, and performed urinalyses. Estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Albuminuria was assessed using urine test strips for protein and microalbumin. Chronic kidney disease was defined as an eGFR < 60 ml/min/1.73m2 or albuminuria ≥ 30 mg/g creatinine. Risk of adverse outcome (all-cause mortality, cardiovascular disease and kidney failure) was determined using the Kidney Disease: Improving Global Outcome (KDIGO) 2012 prognosis grid. RESULTS: Participants included 100 women and 32 men (mean age, 55.4 ± 12.9 years, mean duration of diabetes, 16.7 ± 11.7 years). Twenty-two per cent of participants had eGFR < 60 ml/min/1.73m2. Moderate albuminuria (30-300 mg/g) was present in 20.5% of participants and severe albuminuria (> 300 mg/g) in 62.1%. Overall prevalence of CKD was 86.3% (95%CI 80.4%, 92.2%). Based on KDIGO risk categories, 50.8% were at high risk and 17.4% at very high risk of adverse outcomes. CONCLUSION: Most patients at the UHWI Diabetes Clinic had CKD and were at high or very high risk of adverse outcomes. Further studies to determine the burden of CKD in other clinical settings and to identify the best strategies for preventing adverse outcomes in developing countries need to be conducted.

Opportunities for reducing morbidity and mortality due to leading cancers in a developing country.

BACKGROUND: Malignancies are a leading cause of chronic non-communicable disease deaths in Jamaica. However, little or no data is available on integration of cancer screening guidelines in clinics. METHODS: A cross-sectional survey of 88 consecutive patients with diabetes mellitus (DM) and/or hypertension (HTN) was conducted at major health centers in Jamaica between September and December 2011. RESULTS: Eighty percent respondents were women; 20% were men. The mean age was 57 years old. Forty persons (45.5%) had high cholesterol, 62 (71%) had DM and 62 (71%) had HTN. Of 66 women, 27% reported never having a pap smear and 66% had no pap smear within the last 12 months. 49% women over 40 years never had a mammogram and 74% did not have a mammogram in the last 12 months. Among men over 40 years old, at least 25% never had a prostate examination and 19% never had a prostate-specific antigen blood test. Most participants (>90%) received counseling about diet and exercise, but self-reported compliance with recommendations was low. CONCLUSIONS: Cancer screening among chronic disease patients is suboptimal in our population. Improved implementation of guidelines for cancer in chronic disease clinics have the potential to impact on morbidity and mortality.

A Survey of the Pain Management of Acute Painful Crisis among Patients with Sickle Cell Disease at Two Centres in Jamaica.

OBJECTIVES: The aim of this survey was to establish the pain management approaches to acute painful crisis (APC) in sickle cell patients at two healthcare facilities and to compare with available guidelines. METHODS: A multi-centre observational survey of the management of APC in sickle cell patients was conducted. Data were collected at the Sickle Cell Unit (SCU), Tropical Medicine Research Institute (TMRI) and Accident and Emergency Department (A&E), University Hospital of the West Indies. RESULTS: One hundred episodes of uncomplicated APC involving 81 patients managed at the SCU clinic and 64 episodes at the A&E in a total of 28 patients were included in the data set. Drugs used at the SCU included oral morphine, codeine and paracetamol and intramuscular diclofenac. At the A&E, parenteral morphine and pethidine were most commonly used. At the SCU, the mean time to initiation of analgesics was 38 minutes (IQR 25 to 50 minutes); at the A&E, this was 111 minutes (IQR 50 to 150 minutes). At the SCU, the mean duration of stay (DOS) was 2.9 hours (IQR 1.9 to 3.8 hours) with 94% of the patients being discharged home. At the A&E, the mean DOS was 13.0 hours (IQR 8.3 to 16.9 hours) with 93% of the patients being discharged home. The A&E patient group contained multiple high frequency presenters. Documentation of pain severity scores was inconsistent. CONCLUSION: The findings of the survey indicate that the management of APC at the two centres is substantially different. Further study is required to investigate patient satisfaction, centre preference and analgesic therapy efficacy.

Newborn screening for sickle cell disease in Jamaica: a review - past, present and future.

Newborn screening (NBS) for sickle cell disease (SCD) has occurred in Jamaica since 1973 in two periods, the most recent being since 1995. As a result of NBS, significant lessons have been learnt about management of the disease. Additionally, significant improvements in morbidity and mortality of children affected with the disease have occurred because of the implementation of simple interventions. Unfortunately, in a country where the burden of disease is high compared to other countries, only approximately 40% of children born in Jamaica currently benefit from NBS. As such, the future of NBS for SCD in Jamaica lies in island-wide screening. There are challenges including the lack of appropriate governance and policy structures, the technology for high-volume processing and comprehensive care clinics throughout the island. On the other hand, the significant strides made in disease management, the strength and model of care of the Sickle Cell Unit, delicately balancing limited resources and increased survival cannot be disparaged. Therefore, consistent with the World Health Organization's recommendation, we are working toward achieving island-wide screening for SCD, to ensure equitable access to continued improvements in morbidity, mortality and quality of life.

Cognition, academic achievement, and epilepsy in school-age children: a case-control study in a developing country.

We conducted a case-control study of 33 Jamaican children 7 to 12years old with uncomplicated epilepsy and 33 of their classroom peers matched for age and gender to determine whether epilepsy resulted in differences in cognitive ability and school achievement and if socioeconomic status or the environment had a moderating effect on any differences. Intelligence, language, memory, attention, executive function, and mathematics ability were assessed using selected tests from NEPSY, WISCR, TeaCh, WRAT3 - expanded, and Raven's Coloured Progressive Matrices. The child's environment at home was measured using the Middle Childhood HOME inventory. Socioeconomic status was determined from a combination of household, crowding, possessions, and sanitation. We compared the characteristics of the cases and controls and used random effects regression models (using the matched pair as the cluster) to examine the relationship between cognition and epilepsy. We found that there was no significant difference in IQ, but children with epilepsy had lower scores on tests of memory (p<0.05), language (p<0.05), and attention (p<0.01) compared with their controls. In random effects models, epilepsy status had a significant effect on memory (coefficient=-0.14, CI: -0.23, -0.05), language (coefficient=-0.13, CI: -0.23, -0.04), and mathematics ability (coefficient=-0.01, CI: -0.02, -0.00). Adjustment for the home environment and socioeconomic status and inclusion of interaction terms for these variables did not alter these effects. In conclusion, we found that epilepsy status in Jamaican children has a significant effect on performance on tests of memory, language, and mathematics and that this effect is not modified or explained by socioeconomic status or the child's home environment.

Clinical Factors Associated with Morbidity and Mortality in Patients Admitted with Sickle Cell Disease.

OBJECTIVE: To determine the clinical factors associated with the length of hospitalization and mortality in patients with sickle cell disease (SCD). METHODS: All patients with SCD admitted to the medical wards of the University Hospital of the West Indies, Jamaica, over a five-year period, January 1 to December 31, 2010, were reviewed. Data were extracted from hospital charts and comprised demographic and clinical information, investigations, interventions, duration of stay, pathological data and outcomes. RESULTS: There were 105 patients reviewed; 84% were genotype Hb SS. Females accounted for 59% and males 41%. Overall mean age was 32.5 years (SD 13.7, range 12-66 years). The mean length of hospitalization was 10.2 days (SD 10.9, range 1-84 days). The main admission diagnoses were painful crisis, acute chest syndrome, severe anaemia, sepsis, hepatic sequestration, congestive cardiac failure and renal failure. The mean value for the following laboratory investigations were: haemoglobin 7.7 g/dL (SD 2.8), total white blood cell count 21.7 x 109/L (SD 14.2), platelet count 320 x 109/L (SD 191.9), blood urea 9.8 mmol/L (SD 11.9) and serum creatinine 198 umol/L (SD 267.9). Medical interventions included: blood transfusions in 20.9%, 55% received antibiotics and 74% received narcotic analgesia. There were 40 deaths with four autopsies done. The mortality rate for SCD was 38%. There were 189 repeat SCD admissions. CONCLUSION: Sickle cell disease still carries a high morbidity and mortality in patients admitted to hospital. Recurrent admissions are a concern, as they impact on patient's morbidity and quality of life.

Comparison of ultrasonographic estimated fetal weight and actual birthweight performed by residents in training at the University Hospital of the West Indies / Comparación del peso fetal estimado por ultrasonografía y el peso real al nacer realizada por los residentes en formación en el Hospital Universitario de West Indies

OBJECTIVE: To determine the correlation of ultrasonographic estimation of fetal weight and actual birthweight and the impact of the level of resident s training on the results. METHODS: This was a prospective study of 90 women with term pregnancies. Ultrasound estimated fetal weight (EFW) was calculated by a pre-programmed Hadlock formula. Days from ultrasound to delivery were less than seven. The EFW was compared to the actual birthweight at delivery. The year of training of the resident that performed the ultrasound was recorded. Exclusion criteria included diabetes mellitus and known fetal anomalies. RESULTS: Mean age was 28 years, parity was 0 to 4 and mean gestational age was 38 weeks. There was an average over-estimation of 64.8 grams. The difference between mean EFW and mean birthweight was not significant (p = 0.067). The difference between mean EFW and mean birthweight when calculated according to year of residency was not significant, p = 0.075 and 0.402for junior and senior residents, respectively. CONCLUSION: There is good correlation between residents' ultrasonographic estimation of fetal weight and actual birthweight at the UHWI. There was no significant difference in correlation between senior and junior residents. Developments in computer technology might contribute to decrease in the learning curve.

OBJETIVO: Determinar la correlación de la estimación ultrasonográfica del peso fetal y el peso real al nacer, y el impacto del nivel de formación del residente en los resultados. MÉTODOS: Se trató de un estudio prospectivo de 90 mujeres con embarazos a término. El peso fetal estimado (PFE) por ultrasonido fue calculado mediante una fórmula de Hadlock preprogramada. Los días transcurridos desde el ultrasonido hasta el parto fueron menos de siete. Se comparó el PFE con el peso real en el parto. Se registró el año de formación del residente que realizó el ultrasonido. Los criterios de exclusión criterios incluyeron diabetes mellitus y anomalías fetales conocidas. RESULTADOS: La edad promedio fue 28 años; la paridad fue de 0 a 4; la edad gestacional fue de 38 semanas. Hubo una sobreestimación promedio de 64.8 gramos. La diferencia entre el PFE promedio y el peso promedio al nacer no fue significativa (p = 0.067). La diferencia entre el PFE promedio y el peso promedio al nacer calculada según el año de residencia no fue significativa, siendo p = 0.075 y 0.402 para médicos en la primera y última etapa de su residencia, respectivamente. CONCLUSIÓN: Existe una buena correlación entre la estimación ultrasonográfica del peso fetal, realizada por los residentes, y el peso real al nacer en el HUWI. No hubo ninguna diferencia significativa en la correlación entre los residentes en sus primeras y últimas etapas. Los desarrollos en la tecnología informática pueden contribuir a la disminución de la curva de aprendizaje.

Bone mineral density in Jamaican black women after hysterectomy and bilateral oophorectomy: an observational study / Densidad mineral osea en mujeres negras jamaicanas después de histerectomía y ooforectomía bilateral: un estudio observacional

OBJECTIVE: To see if black Jamaican postmenopausal women who had hysterectomy were at increased risk of osteoporosis. To assess the risk of osteoporosis in hysterectomized Jamaican postmenopausal patients. METHOD: We reviewed 809 women (403 hysterectomized and 406 controls) for cardiovascular disease risk. We did a demographic history and examination looking at blood pressure, waist hip ratio and body mass index and investigations done included fasting blood glucose and total and high density lipoprotein (HDL) cholesterol. We also measured bone density at the heel in all women using the Achilles ultrasound bone densitometer looking at T-score and Z-score. RESULTS: There was a significant association of hysterectomy status and bone mineral density (BMD) status with a smaller than expected proportion of women with osteoporosis in the hysterectomy group (χ2 = 18.4; p = 0.001). The mean T-score was significantly higher in the hysterectomized women, adjusting for age, waist circumference and sociodemographic factors. The relationship between the various predictors and BMD was explored by stepwise regression modelling. The factors that were significantly related to low BMD were hysterectomy status, age, waist circumference and being employed. CONCLUSION: Hysterectomy was not found to be a significant risk factor for osteoporosis. The osteoporosis risk among menopausal women in Jamaica appears to be due to other risk factors which probably existed prior to the operation.

OBJETIVO: Determinar si mujeres negras jamaicanas postmenopáusicas sometidas a histerectomía corrían mayor riesgo de osteoporosis. Evaluar el riesgo de osteoporosis en pacientes jamaicanas postmenopáusicas histerectomizadas. MÉTODO: Se examinaron 809 mujeres (403 histerectomizadas y 406 controles) para evaluar el riesgo de enfermedad cardiovascular. Hicimos una historia demográfica y un examen para obtener información sobre la presión arterial, el índice cintura/cadera ratio, y el índice de masa corporal. Asimismo, realizamos investigaciones que incluyeron pruebas de glucemia en ayunas, colesterol total, y colesterol de lipoproteínas de alta densidad (HDL). También medimos la densidad ósea en el talón de todas las mujeres, usando el densitómetro óseo ultrasónico modelo Achilles para obtener el T-score y el Z-score. RESULTADOS: Hubo una asociación significativa entre el estado de histerectomía y el estado de la densidad mineral ósea (DMO) con una proporción de mujeres con osteoporosis en el grupo de histerectomía (χ2 = 18.4; p = 0,001) más pequeña de lo esperada. El T-score promedio fue significativamente mayor en las mujeres histerectomizadas, ajustando por edad, circunferencia de la cintura y factores sociodemográficos. La relación entre los distintos factores predictivos y DMO fue explorada mediante regresión gradual stepwise modelado. Los factores que estuvieron significativamente relacionados con baja DMO fueron estado histerectomía, edad, circunferencia de la cintura y siendo empleado. CONCLUSIÓN: Se halló que la histerectomía no es un factor de riesgo significativo para la osteoporosis. El riesgo de osteoporosis entre las mujeres menopáusicas de Jamaica parece deberse a otros factores de riesgo que probablemente existían antes de la operación.

Testosterone replacement therapy does not promote priapism in hypogonadal men with sickle cell disease: 12-month safety report.

Hypogonadism, which is highly prevalent in men with sickle cell disease (SCD), affects quality of life and causes great morbidity. The safety of testosterone replacement therapy (TRT) in SCD in relation to priapism episodes is relatively unknown. Our aim was to monitor the safety of TRT in a cohort of seven hypogonadal men with SCD. Testosterone undecanoate (Nebido) 1 g was administered intramuscularly to adult men with homozygous SCD (Hb SS) having hypogonadism [serum total testosterone ≤12.0 nmol/L (346 ng/dL), reference range 12.5-38.1 nmol/L (360-1098 ng/dL)] for 12 months. Serum total testosterone, haemoglobin, haematocrit, renal and liver function tests, glucose and PSA measurements were done at baseline and 12-month follow-up. Trough serum total testosterone, haemoglobin and haematocrit were measured three monthly. Priapism events and adverse drug events were assessed every 3 months. International Index of Erectile Function (IIEF), Androgen Deficiency in the Ageing Male (ADAM) and World Health Organization Quality of Life (WHOQOL) questionnaires were administered at baseline, 6 and 12 months. Seven men with a mean age of 34.4 years were treated. Median total testosterone increased from 10.6 to 11.2 nmol/L (p = 0.46). Median serum lactate dehydrogenase levels decreased from 1445 to 1143.5 IU/L (p < 0.05), while all other laboratory indices remained stable. Injection site pain was the most frequently reported adverse event, with no increases in painful crises, hypersensitivity or oedema. After TRT, there was no significant increase in priapism frequency. Median questionnaire scores were increased for the IIEF (46-68, p = 0.018), reduced for ADAM (5.0-2.0, p = 0.016) and unchanged for WHOQOL (98-103, p = 0.086). TRT using testosterone undecanoate with eugonadal intent for hypogonadism appears to be safe in men with SCD. This treatment does not appear to promote priapism occurrences and rather it possibly improves sexual function. Future prospective evaluations in larger groups of hypogonadal men with SCD are necessary to confirm these findings.

Morinda citrifolia (Noni) as an Anti-Inflammatory Treatment in Women with Primary Dysmenorrhoea: A Randomised Double-Blind Placebo-Controlled Trial.

Introduction. Noni (Morinda citrifolia) has been used for many years as an anti-inflammatory agent. We tested the efficacy of Noni in women with dysmenorrhea. Method. We did a prospective randomized double-blind placebo-controlled trial in 100 university students of 18 years and older over three menstrual cycles. Patients were invited to participate and randomly assigned to receive 400 mg Noni capsules or placebo. They were assessed for baseline demographic variables such as age, parity, and BMI. They were also assessed before and after treatment, for pain, menstrual blood loss, and laboratory variables: ESR, hemoglobin, and packed cell volume. Results. Of the 1027 women screened, 100 eligible women were randomized. Of the women completing the study, 42 women were randomized to Noni and 38 to placebo. There were no significant differences in any of the variables at randomization. There were also no significant differences in mean bleeding score or pain score at randomization. Both bleeding and pain scores gradually improved in both groups as the women were observed over three menstrual cycles; however, the improvement was not significantly different in the Noni group when compared to the controls. Conclusion. Noni did not show a reduction in menstrual pain or bleeding when compared to placebo.