ABSTRACT
Macropolycytes are giant neutrophils found in a variety of benign and neoplastic conditions. Since megaloblastic anaemia is one of the recognised causes of macropolycytes, other blood film features of megaloblastic anaemia should be sought when they harbor hypersegmented nuclei. When they are hypolobulated and hypogranular, the occurrence of a myelodysplastic syndrome must be investigated. Finding macropolycytes in the context of a nonspecific reactive granulopoiesis is more questionable but is often associated with stressed myelopoiesis and/or granulocyte colony-stimulating factor therapy.
Subject(s)
Myelodysplastic Syndromes , Neutrophils , Granulocyte Colony-Stimulating Factor , HumansABSTRACT
BACKGROUND: Leadership development is a strategy for improving national responses to HIV/AIDS. The University of the West Indies offers the Caribbean Health Leadership Institute (CHLI) to enhance leaders' effectiveness and responses to HIV/AIDS through a cooperative agreement with the Centers for Disease Control and Prevention. CHLI enrolls leaders in annual cohorts numbering 20-40. OBJECTIVES: To examine how CHLI influenced graduates' self-understanding, skills, approaches, vision, commitments, courage, confidence, networks, and contributions to program, organizational, policy, and systems improvements. METHODS: Web-based surveys and interviews of graduates. RESULTS: CHLI increased graduates' self-understanding and skills and strengthened many graduates' vision, confidence, and commitments to improving systems. It helped graduates improve programs, policies, and systems by: motivating them and giving them ideas for changes to pursue, encouraging them to share their vision, deepening skills in areas such as systems thinking, policy advocacy, and communication, strengthening their inclusion of partners and team members, and influencing how they interacted with others. Training both HIV-focused and general health leaders can help both kinds of leaders foster improvements in HIV services and policies. DISCUSSION: Learners greatly valued self-assessments, highly interactive sessions, and the opportunity to build a network of professional colleagues. Projects provided opportunities to address substantive issues and immediately apply learning to work. Leadership development evaluations in the United States have also emphasized the complementary benefits of assessment and feedback, skills development, and network development. Global leadership programs should find ways to combine these components in both traditional face-to-face and distance-learning contexts.
Subject(s)
HIV Infections/prevention & control , Leadership , Public Health/education , Caribbean Region/epidemiology , Female , HIV Infections/therapy , Health Policy , Humans , Male , Pandemics/prevention & control , Public Health AdministrationABSTRACT
OBJECTIVE: Research on depression among HIV-positive patients has been limited by the lack of a valid and reliable measure of depression. This project addresses this problem by exploring the internal consistency reliability and the concurrent and discriminant validity of the Beck Depression Inventory- II (BDI-II) using HIV-positive patients in Jamaica. METHOD: Patients from three HIV clinics in Jamaica (n = 191 patients; 61% female, 39% male, mean age 40.5 ± 10 years) were administered the BDI-II along with the Centre for Epidemiological Studies - Depression Scale (CES-D) and the Social Provisions Scale. RESULTS: Overall, the BDI-II was found to have a high degree of reliability (a = 0.89). The scale also had good concurrent validity as evidenced by a high correlation with scores on the CES-D (r = 0.74) and acceptable discriminant validity as demonstrated through a moderate correlation with the Social Provisions Scale (r = -0.42). This pattern of scores suggests that the majority of the variance underlying the BDI-II assesses depression (55%) while a smaller degree of the variability (18%) measures a conceptually similar but distinct concept. CONCLUSION: The BDI-II is a sufficiently reliable and valid measure for assessing depression in HIV-positive patients.
OBJETIVO: La investigación sobre la depresión entre los pacientes VIH-positivos ha estado limitada por la falta de una medida válida y confiable de la depresión. Este proyecto aborda este problema explorando la confiabilidad de la consistencia interna, así como la validez discriminate y concurrente del Inventario de la Depresión de Beck II (BDI-II) usando pacientes VIH-positivos en Jamaica. MÉTODO: A los pacientes de tres clínicas de VIH en Jamaica (n = 191 pacientes; 61% hembras, 39% varones, edadpromedio 40.5 ± 10 anos) se les aplicó el BDI-IIjunto con la Escala de Depresión (CES D) y la Escala de Provisiones Sociales - Centro de Estudios Epidemiológicos. RESULTADOS: En general, se halló que el BDI-II posee un alto grado de confiabilidad (a = 0.89). La escala poseía también una buena validez concurrente, como quedó evidenciado por la elevada correlación con las puntuaciones del CES-D (r = 0.74), Igualmente, se constató que posee una validez discriminante aceptable como lo demuestran las correlaciones moderadas con la Escala de Provisiones Sociales (r = -0.42). Este patrón de puntuaciones sugiere que la mayor parte de la varianza que subyace en el BDI-II da la medida de la depresión (55%), en tanto que un grado menor de la variabilidad (18%) mide un concepto de naturaleza similar pero claramente definido. CONCLUSIÓN: El BDI-II constituye una medida suficientemente confiable y válida para evaluar la depresión en pacientes VIH positivos.
Subject(s)
Adult , Female , Humans , Male , Depression/diagnosis , Depression/psychology , HIV Seropositivity/psychology , Psychiatric Status Rating Scales , Depression/epidemiology , Jamaica/epidemiology , Reproducibility of Results , Risk FactorsABSTRACT
OBJECTIVE: To identify the level of depressive symptoms among patients with HIV infection and to examine the reported patterns of depressive symptoms not confounded by the physical manifestations of HIV-infection. METHOD: A total of 191 patients with HIV infection (75 males (39%) and 116 females (61%), mean age 40.48 ± 10 years), from three HIV clinics were administered the Beck Depression Inventory - II as well as a demographic questionnaire as part of a larger study. RESULTS: Moderate to severe depressive symptoms were reported by 17.3% of the HIV-infected patients with females reporting significantly higher levels of depressive symptoms than males. A principal components analysis identified three clusters of depressive symptoms: cognitive-affective, negative cognitions and somatic symptoms. The HIV-infected patients were found to display mainly cognitive-affective symptoms of depression. CONCLUSION: HIV-infected patients, especially female patients, may be at an increased risk of experiencing high levels of depressive symptoms. It is recommended that HIV-infected patients be routinely screened for depression, particularly cognitive-affective symptoms of depression.
OBJETIVO: Identificar el nivel de sintomas depresivos entre pacientes con infección por VIHy examinar los patrones reportados sobre los sintomas de depresión, no confundidos por las manifestaciones físicas de la infección por VIH. MÉTODO: A un total de 191 pacientes con infección por VIH (75 varones (39%) y 116 hembras (61%), con edadpromedio 40.45 ± 10 anos), de tres clinicas de VIH, se les aplicó el Inventario de Depresión de Beck II, asi como una encuesta demográfica como parte de un estudio más grande. RESULTADOS: Un 17.3% de los pacientes infectados por VIH, informaron sintomas depresivos de moderados a severos, reportando las hembras niveles de sintomas de depresión significativamente más altos que los varones. Un análisis de los componentes principales identificó tres grupos de sintomas depresivos: cognitivos afectivos, cogniciones negativas y sintomas somáticos. Se halló que los pacientes infectados por VIHpresentaban principalmente sintomas afectivos cognitivos de depresión. CONCLUSIÓN: Los pacientes infectados con VIH, especialmente las hembras, pueden hallarse en un mayor riesgo de experimentar niveles altos de sintomas depresivos. Se recomienda que los pacientes infectados con VIHsean sometidos deforma rutinaria a tamizajes de depresión, particularmente de los sintomas de depresión cognitivos afectivos.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Depression/diagnosis , Depression/psychology , HIV Infections/psychology , Psychiatric Status Rating Scales , Cross-Sectional Studies , Depression/epidemiology , Interviews as Topic , Jamaica/epidemiology , Principal Component Analysis , Risk FactorsABSTRACT
OBJECTIVE: Research on depression among HIV-positive patients has been limited by the lack of a valid and reliable measure of depression. This project addresses this problem by exploring the internal consistency reliability and the concurrent and discriminant validity of the Beck Depression Inventory-II (BDI-II) using HIV-positive patients in Jamaica. METHOD: Patients from three HIV clinics in Jamaica (n = 191 patients; 61% female, 39% male, mean age 40.5-10 years) were administered the BDI-II along with the Centre for Epidemiological Studies -Depression Scale (CES-D) and the Social Provisions Scale. RESULTS: Overall, the BDI-II was found to have a high degree of reliability (alpha = 0.89). The scale also had good concurrent validity as evidenced by a high correlation with scores on the CES-D (r = 0.74) and acceptable discriminant validity as demonstrated through a moderate correlation with the Social Provisions Scale (r = -0.42). This pattern of scores suggests that the majority of the variance underlying the BDI-II assesses depression (55%) while a smaller degree of the variability (18%) measures a conceptually similar but distinct concept. CONCLUSION: The BDI-II is a sufficiently reliable and valid measure for assessing depression in HIV-positive patients.
Subject(s)
Depression/diagnosis , Depression/psychology , HIV Seropositivity/psychology , Psychiatric Status Rating Scales , Adult , Depression/epidemiology , Female , Humans , Jamaica/epidemiology , Male , Reproducibility of Results , Risk FactorsSubject(s)
Anemia, Macrocytic/etiology , Anemia, Refractory, with Excess of Blasts/diagnosis , Anemia, Sideroblastic/diagnosis , Myelodysplastic Syndromes/diagnosis , Aged , Anemia, Macrocytic/diagnosis , Anemia, Refractory, with Excess of Blasts/pathology , Anemia, Sideroblastic/pathology , Biopsy , Bone Marrow/pathology , Diagnosis, Differential , Hemochromatosis/diagnosis , Hemochromatosis/genetics , Hemochromatosis/pathology , Humans , Male , Myelodysplastic Syndromes/pathology , Prognosis , Referral and ConsultationABSTRACT
The subtypes of the human immunodeficiency virus - type 1 (HIV-1) strains from 54 HIV-1 - infected persons including 44 strains which were typed previously by heteroduplex mobility assay (HMA) were determined by DNA sequencing and phylogenetic analysis. Of 54 HIV- infected persons, 92.5% were infected with HIV-1 subtype B and 7.5% with other HIV-1 subtypes including subtypes D (3.7%), A (1.9%) and J (1.9%). In the phylogenetic analysis, the subtype A virus found in the sample clustered with subtype A reference strains and a circulating recombinant form (CRF) reference strain which originates in Central Africa and is circulating in Cuba indicating a close relationship between these viruses. There was 86% concordance between HMA and DNA sequencing in assigning subtype B viruses. For the non-B subtype viruses, there was less concordance between the two methods (67%). The results confirm the predominance of HIV-1 subtype B strains and the high genetic diversity of HIV-1 strains in circulation in Jamaica. The efficacies and some limitations of the HMA as a method of HIV-1 subtyping also were noted. It is important that the HIV/AIDS epidemic in Jamaica be monitored meticulously for possible expansions in non-B subtypes and the emergence of inter-subtype recombinant forms. We recommend that the more expensive DNA sequencing and phylogenetic analysis, including HIV-1 genotyping for antiretroviral drug resistance testing, be used as an adjunct to the more cost-effective HMA to track the HIV/AIDS epidemic in Jamaica.
Los subtipos de cepas de virus de la inmunodeficiencia humana-tipo-1 de 54 personas infectadas con el VIH-1, que incluyeron 44 cepas previamente clasificadas según su tipo mediante ensayo de movilidad de heterodúplex (HMA), fueron determinados mediante secuenciación de ADN y análisis filogenético. De 54 personas infectados con VIH, 92.5% estaban infectadas con VIH-1 subtipo B y 7.5% con otros subtipos de VIH-1 incluidos los subtipos D (3.7%), A (1.9%), J (1.9%). En el análisis filogenético, el virus de subtipo A hallado en la muestra, se agrupa con las cepas de referencias del subtipo A y una cepa de referencia de forma recombinante circulante (CRF), que tienesu origen en África Central y está circulando en Cuba, lo que indica una estrecha relación entre estos virus. Hubo un 86% de concordancia entre el HMA y la secuenciación del DNA en la asignación de virus de subtipo B. Para los virus de subtipo no B, hubo menos concordancia entre los dos métodos (67%). Los resultados confirman el predominio de las cepas del subtipo B del VIH-1, y la alta diversidad genética de las cepas del VIH-1 en circulación en Jamaica. También se señalaron las eficacias y algunas limitaciones del HMA como método de clasificación del VIH-1 en subtipos. Es importante monitorear meticulosamente la epidemia de VIH/SIDA en Jamaica, a fin de detectar posibles expansiones de subtipos no B y la aparición de formas recombinantes inter-subtipos. Recomendamos que por ser ambos métodos más costosos, tanto la secuenciación de ADN como el análisis filogenético - incluyendo el genotipado del VIH-1 para probar la resistencia antiretroviral del medicamento - sean usados como complementos del HMA, el cual es más costo-efectivo, para seguir de cerca el rastro de la epidemia VIH/SIDA en Jamaica.
Subject(s)
Humans , HIV-1 , DNA, Viral/chemistry , Genetic Variation , HIV Infections/virology , HIV-1 , Heteroduplex Analysis , Jamaica , Phylogeny , Reproducibility of Results , Sequence Analysis, DNA , env Gene Products, Human Immunodeficiency Virus/genetics , gag Gene Products, Human Immunodeficiency Virus/geneticsABSTRACT
The subtypes of the human immunodeficiency virus - type 1 (HIV-1) strains from 54 HIV-1 - infected persons including 44 strains which were typed previously by heteroduplex mobility assay (HMA) were determined by DNA sequencing and phylogenetic analysis. Of 54 HIV- infected persons, 92.5% were infected with HIV-1 subtype B and 7.5% with other HIV-1 subtypes including subtypes D (3.7%), A (1.9%) and J (1.9%). In the phylogenetic analysis, the subtype A virus found in the sample clustered with subtype A reference strains and a circulating recombinant form (CRF) reference strain which originates in Central Africa and is circulating in Cuba indicating a close relationship between these viruses. There was 86% concordance between HMA and DNA sequencing in assigning subtype B viruses. For the non-B subtype viruses, there was less concordance between the two methods (67%). The results confirm the predominance of HIV-1 subtype B strains and the high genetic diversity of HIV-1 strains in circulation in Jamaica. The efficacies and some limitations of the HMA as a method of HIV-1 subtyping also were noted. It is important that the HIV/AIDS epidemic in Jamaica be monitored meticulously for possible expansions in non-B subtypes and the emergence of inter-subtype recombinant forms. We recommend that the more expensive DNA sequencing and phylogenetic analysis, including HIV-1 genotyping for antiretroviral drug resistance testing, be used as an adjunct to the more cost-effective HMA to track the HIV/AIDS epidemic in Jamaica.
Subject(s)
DNA, Viral/chemistry , Genetic Variation , HIV Infections/virology , HIV-1/genetics , HIV-1/classification , Heteroduplex Analysis , Humans , Jamaica , Phylogeny , Reproducibility of Results , Sequence Analysis, DNA , env Gene Products, Human Immunodeficiency Virus/genetics , gag Gene Products, Human Immunodeficiency Virus/geneticsABSTRACT
Neonatal/newborn haemoglobinopathy screening is being performed in an increasing number of European countries since changing patterns of immigration have led to significant numbers of neonates at risk of sickle cell disease. The purpose of screening is to improve management of sickle cell disease through early parental education and the institution of prophylaxis against infection. Some haemoglobinopathy screening programmes are stand-alone, while others are integrated into a neonatal screening programme for metabolic disorders. Despite the logistic problems and economic constraints, neonatal haemoglobinopathy screening is also being gradually introduced in a number of African countries.
Subject(s)
Hemoglobinopathies/diagnosis , Neonatal Screening/methods , Africa/epidemiology , Anemia, Sickle Cell/diagnosis , Anemia, Sickle Cell/epidemiology , Europe/epidemiology , Hemoglobinopathies/epidemiology , Humans , Infant, Newborn , PrevalenceABSTRACT
We have studied, haemoglobin A(2)' (A(2) prime), a delta chain variant haemoglobin occurring in a small percentage of individuals of African ancestry. In heterozygotes, the percentage of haemoglobin A(2)' was found to be slightly lower then the percentage of haemoglobin A(2), suggesting that the variant delta chain is synthesized at a reduced rate. When quantifying haemoglobin A(2) for the diagnosis of beta thalassaemia heterozygosity, it is essential to add together the A(2) and A(2)' to give 'total haemoglobin A(2)'. However, it not necessary to use a different reference range for total haemoglobin A(2) in A(2)' heterozygotes. When using microcolumn chromatography, A(2)' was found to be measured with A(2). On the high-performance liquid chromatography instrument studied, haemoglobin A(2)' fell in the haemoglobin S window but its retention time differed from that of haemoglobin S.
Subject(s)
Hemoglobin A2/analysis , beta-Thalassemia/diagnosis , Hemoglobin A2/genetics , Heterozygote , Humans , beta-Thalassemia/geneticsABSTRACT
BACKGROUND: We hypothesized that voluntary counselling and testing during pregnancy are necessary but not sufficient to provide the holistic psychosocial support needed by Jamaican women living with HIV and/or AIDS. Based on this hypothesis, we investigated a range of coping methods and support systems used by HIV-infected women and a group of their HIV-negative counterparts before, during and immediately after their pregnancies. METHODS: Women attending obstetric clinics in urban Jamaica completed a quantitative survey aimed at discovering coping behaviours, social and spiritual support systems. Presurvey focus group studies and key informant interviews contributed to the design of the questionnaire while post-survey focus groups were used to probe the validity of the data gleaned from the questionnaire survey. Survey data were analyzed using non-parametric tests for trend with independent univariate tests. RESULTS: Fifty-five HIV-infected women and 51 HIV-negative women completed the survey. Compared with HIV-negative women, more HIV-infected women reported both feeling depressed (p = 0.07) and having difficulty concentrating (p = 0.05) during the month immediately prior to the study. Other statistically significant differences included: HIV-infected women were more likely to pray, to sleep and to change eating habits in response to worry and stress (p = 0.001 in each instance). Although several women declared religious faith, significantly fewer HIV-infected women were willing to talk to a religious leader about their problems compared to their HIV-negative counterparts (p < 0.001). CONCLUSIONS: Participation of HIV-infected women in post-survey focus groups augmented the survey findings. Many of the women reported negative emotions and some indicated serious challenges in accessing social support. The results point to the need for systematic documentation of psychosocial profiles as part of the approach to caring for these women. In addition, in the Jamaican sociocultural context, we recommend improved training of religious leaders and healthcare providers in psychosocial issues.
ANTECEDENTES: Planteamos la hipótesis de que someterse al asesoramiento y prueba voluntarios durante el embarazo es necesario, pero no suficiente para el apoyo psicosocial holístico que necesitan las mujeres jamaicanas que viven con VIH y/o SIDA. Sobre la base de esta hipótesis, investigamos una serie de métodos de afrontamiento y sistemas de apoyo usados por las mujeres infectadas por el VIH y un grupo de sus contrapartes VIH negativas antes, durante e inmediatamente después de sus embarazos. MÉTODOS: Mujeres que asistían a clínicas obstétricas en áreas urbanas de Jamaica, completaron una encuesta cuantitativa, encaminada a descubrir conductas de afrontamiento, y sistemas de apoyo social y espiritual. Estudios de grupos focales mediante encuestas y entrevistas a informantes claves, contribuyeron al diseño del cuestionario, mientras que grupos focales de post-encuesta fueron usados para investigar la validez de los datos recogidos de la encuesta-cuestionario. Los datos de la encuesta fueron analizados usando tests no paramétricos para tendencia con tests univariados independientes. RESULTADOS: Cincuenta y cinco de las mujeres infectadas con VIH y 51 de las mujeres VIH negativas, completaron la encuesta. En comparación con las mujeres VIH negativas, más mujeres infectadas con VIH reportaron sentirse deprimidas (p = 0.07) y tener dificultades con la concentración (p = 0.05) durante el mes inmediatamente anterior al estudio. Otras diferencias estadísticamente significativas fueron las siguientes: las mujeres infectadas con el VIH mostraron una mayor tendencia a orar, dormir y cambiar sus hábitos alimentarios en respuesta a la preocupación y el estrés (p = 0.001 en cada caso). Aunque varias mujeres declararon tener fe religiosa, significativamente pocas mujeres infectadas con VIH estuvieron dispuestas a hablar a un líder religioso acerca de sus problemas, en comparación con sus contrapartes VIH negativas (p < 0.001). CONCLUSIONES: La participación de mujeres infectadas con VIH en grupos focales de post-encuesta aumento marcadamente los hallazgos de la encuesta. Muchas de las mujeres reportaron emociones negativas y algunas indicaron serios desafíos en cuanto a tener acceso a algún apoyo social. Los resultados apuntan a la necesidad de poseer una documentación sistemática de los perfiles psicosociales como parte del abordaje del cuidado a estas mujeres. Además, en el contexto sociocultural de jamaica, recomendamos mejorar el entrenamiento de los líderes religiosos y los proveedores de salud en cuanto a las problemáticas psicosociales.
Subject(s)
Adolescent , Adult , Female , Humans , Young Adult , HIV Infections/psychology , Infectious Disease Transmission, Vertical/prevention & control , Social Support , Stress, Psychological , Adaptation, Psychological , Age Factors , Case-Control Studies , Data Collection , Focus Groups , HIV Infections/prevention & control , HIV Infections/transmission , Health Behavior , Qualitative Research , Surveys and Questionnaires , Risk Factors , Risk-TakingABSTRACT
OBJECTIVES: Skin disorders are thought to occur frequently in persons with HIV/AIDS. To our knowledge, there are no studies in the literature reporting on the spectrum and prevalence of skin disorders in HIV-positive patients in the Caribbean. This study focused on the prevalence and spectrum of skin disorders seen in a population of HIV-positive patients in Jamaica. METHODS: A 5-year retrospective study was conducted by reviewing the records of patients attending a HIV out-patient clinic at the University Hospital of the West Indies in Kingston, Jamaica. RESULTS: Two hundred and eighty-six (286) patients were included in the study. Skin and mucous membrane disorders were documented in 74% of the patients in this series. Inflammatory disorders comprised the largest category of skin disorders followed by fungal infections. The most frequently diagnosed dermatological disorders were papular prurigo, oral candidiasis, dermatophyte infections, herpes simplex infections and seborrhoeic dermatitis. Kaposi's sarcoma was rare. This pattern is similar to those reported from the African continent and other tropical countries. CONCLUSIONS: Dermatological disorders contribute significantly to the morbidity of HIV-positive patients and patterns of skin disorders are similar to those seen in other tropical settings.
OBJETIVOS: Se piensa que trastornos cutáneos ocurren con frecuencia en personas con VIH/SIDA. Hasta donde sabemos, no hay en la literatura estudios que reporten sobre el espectro y prevalencia de los trastornos cutáneos en enfermos VIH positivos en el Caribe. Este estudio centra su atención en la prevalencia y espectro de trastornos de la piel observados en una población de pacientes VIH positivos en Jamaica. MÉTODOS: Se llevó a cabo un estudio retrospectivo a fin de revisar las historias clínicas de pacientes que asisten a una consulta externa para enfermos de VIH en el Hospital Universitario de West Indies en Kingston, Jamaica. RESULTADOS: Doscientos ochenta y seis (286) pacientes fueron incluidos en el estudio. En el 74% de los pacientes en esta serie, se documentaron trastornos de la membrana mucosa y la piel. Los trastornos inflamatorios abarcaron la categoría mayor de los desórdenes de la piel, seguidos de las infecciones fúngicas. Los trastornos dermatológicos diagnosticados con mayor frecuencia fueron el prurigo papular, la candidiásis oral, las infecciones por dermatofitos, infecciones por herpes simplex y la dermatitis seborreica. El sarcoma de Kaposi rara vez se presentó. Este patrón es similar a los reportados desde el Continente Africano y otros países tropicales. CONCLUSIONES: Los desórdenes dermatológicos contribuyen significativamente a la morbilidad de los pacientes VIH positivos, y los patrones de los trastornos de la piel son similares a los observados en otros escenarios tropicales.
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , AIDS-Related Opportunistic Infections/epidemiology , Skin Diseases, Infectious/epidemiology , Jamaica/epidemiology , Prevalence , Retrospective Studies , Skin Diseases, Infectious/complicationsABSTRACT
OBJECTIVES: Skin disorders are thought to occur frequently in persons with HIV/AIDS. To our knowledge, there are no studies in the literature reporting on the spectrum and prevalence of skin disorders in HIV-positive patients in the Caribbean. This study focused on the prevalence and spectrum of skin disorders seen in a population of HIV-positive patients in Jamaica. METHODS: A 5-year retrospective study was conducted by reviewing the records of patients attending a HIV out-patient clinic at the University Hospital of the West Indies in Kingston, Jamaica. RESULTS: Two hundred and eighty-six (286) patients were included in the study. Skin and mucous membrane disorders were documented in 74% of the patients in this series. Inflammatory disorders comprised the largest category of skin disorders followed by fungal infections. The most frequently diagnosed dermatological disorders were papular prurigo, oral candidiasis, dermatophyte infections, herpes simplex infections and seborrhoeic dermatitis. Kaposi's sarcoma was rare. This pattern is similar to those reported from the African continent and other tropical countries. CONCLUSIONS: Dermatological disorders contribute significantly to the morbidity of HIV-positive patients and patterns of skin disorders are similar to those seen in other tropical settings.
Subject(s)
AIDS-Related Opportunistic Infections/epidemiology , Skin Diseases, Infectious/epidemiology , Adolescent , Adult , Aged , Female , Humans , Jamaica/epidemiology , Male , Middle Aged , Prevalence , Retrospective Studies , Skin Diseases, Infectious/complications , Young AdultABSTRACT
BACKGROUND: We hypothesized that voluntary counselling and testing during pregnancy are necessary but not sufficient to provide the holistic psychosocial support needed by Jamaican women living with HIV and/or AIDS. Based on this hypothesis, we investigated a range of coping methods and support systems used by HIV-infected women and a group of their HIV-negative counterparts before, during and immediately after their pregnancies. METHODS: Women attending obstetric clinics in urban Jamaica completed a quantitative survey aimed at discovering coping behaviours, social and spiritual support systems. Pre-survey focus group studies and key informant interviews contributed to the design of the questionnaire while post-survey focus groups were used to probe the validity of the data gleaned from the questionnaire survey Survey data were analyzed using non-parametric tests for trend with independent univariate tests. RESULTS: Fifty-five HIV-infected women and 51 HIV-negative women completed the survey Compared with HIV-negative women, more HIV-infected women reported both feeling depressed (p = 0.07) and having difficulty concentrating (p = 0.05) during the month immediately prior to the study. Other statistically significant differences included: HIV-infected women were more likely to pray, to sleep and to change eating habits in response to worry and stress (p = 0.001 in each instance). Although several women declared religious faith, significantly fewer HIV-infected women were willing to talk to a religious leader about their problems compared to their HIV-negative counterparts (p < 0.001). CONCLUSIONS: Participation of HIV-infected women in post-survey focus groups augmented the survey findings. Many of the women reported negative emotions and some indicated serious challenges in accessing social support. The results point to the need for systematic documentation of psychosocial profiles as part of the approach to caring for these women. In addition, in the Jamaican sociocultural context, we recommend improved training of religious leaders and healthcare providers in psychosocial issues.
Subject(s)
HIV Infections/psychology , Infectious Disease Transmission, Vertical/prevention & control , Social Support , Stress, Psychological , Adaptation, Psychological , Adolescent , Adult , Age Factors , Case-Control Studies , Data Collection , Female , Focus Groups , HIV Infections/prevention & control , HIV Infections/transmission , Health Behavior , Humans , Qualitative Research , Risk Factors , Risk-Taking , Surveys and Questionnaires , Young AdultABSTRACT
Monitoring upper-limb activity in a free-living environment is important for the evaluation of rehabilitation. This study is a validation of the Strathclyde Upper-Limb Activity Monitor (SULAM) which records the vertical movement and position of each wrist, and assesses bimanual movement. Agreement between the SULAM and two independent video observers was assessed using interclass correlation coefficients (ICC) and the Bland and Altman method. Concurrent validity was very good for movement of each upper-limb (ICC > 0.9), and good for the vertical position of the wrist (ICC > 0.8 for wrist positions below the shoulder, ICC > 0.6 otherwise). The ICC was good (>0.8) for bimanual movement, however the SULAM systematically underreported this by approximately 15%. The SULAM could be a useful tool to assess upper-limb activity of clinical populations in their usual environment.
Subject(s)
Activities of Daily Living , Monitoring, Physiologic/methods , Upper Extremity/physiopathology , Adult , Biosensing Techniques , Female , Humans , Male , Monitoring, Physiologic/instrumentation , Signal Processing, Computer-Assisted , Stroke/physiopathology , Stroke Rehabilitation , Video RecordingABSTRACT
Increasingly high-performance liquid chromatography is being used for identification and quantification of normal and variant haemoglobins. In many laboratories, the Beta Thal Short programme of the Bio-Rad Variant II instrument is used for this purpose. We noted that a factitious elevation of haemoglobin F was sometimes observed in diabetic patients and therefore carried out a systematic study of this phenomenon. We found discrepant results in 41% of samples from diabetic patients but in no normal volunteers. This factitious elevation could be predicted from a retention time for haemoglobin F of more than 1.15 min, the normal retention time being 1.08-1.15 min. Haemoglobinopathy laboratories need to be alert to the possibility of this erroneous result.
Subject(s)
Fetal Hemoglobin/analysis , Hemoglobins/analysis , Chromatography, High Pressure Liquid/methods , Chromatography, High Pressure Liquid/standards , Glycated Hemoglobin , Humans , Reproducibility of ResultsABSTRACT
Eosinophil-associated conditions, such as asthma and eosinophilic bronchitis, have been associated with chronic persistent cough, usually responding to corticosteroid therapy. This case study reports a case of persistent cough associated with gastro-oesophageal reflux (GOR) and hypereosinophilia. Treatment of GOR with proton pump inhibitors and fundoplication did not control the cough. However, high dose prednisolone, but not inhaled corticosteroids, did. The presence of the FIP1L1-PDGFRA fusion gene in myeloid cells was confirmed by fluorescence in situ hybridisation analysis using CHIC2 deletion as a surrogate marker. The cough and other disease features were subsequently suppressed by the tyrosine kinase inhibitor, imatinib. This is the first case of persistent cough caused by hypereosinophilic syndrome characterised by FIP1L1-PDGFRA fusion gene and aberrant tyrosine kinase activity.
Subject(s)
Cough/genetics , Hypereosinophilic Syndrome/genetics , Oncogene Proteins, Fusion/genetics , Protein-Tyrosine Kinases/genetics , Receptor, Platelet-Derived Growth Factor alpha/genetics , mRNA Cleavage and Polyadenylation Factors/genetics , Amino Acid Sequence , Cough/etiology , Humans , Hypereosinophilic Syndrome/complications , Male , Middle AgedABSTRACT
BACKGROUND: Haemoglobin E is a variant haemoglobin that can lead to considerable morbidity in compound heterozygous states with beta thalassaemia. Therefore, its detection is important because it permits antenatal counselling. The parts of the world where haemoglobin E is prevalent are resource poor and detection can therefore be problematical. A simple visual test using 2,6-dichlorophenolindophenol (DCIP) has been developed in Thailand, but its use has not become widespread. This test has now become available in kit form. AIMS/METHODS: To evaluate the new DCIP test kit for the detection of haemoglobin E. RESULTS: Seventeen of 18 samples from individuals with haemoglobin E gave positive results and one gave an equivocal result. False positive or equivocal results were seen in three of 21 individuals with other disorders of globin chain synthesis but were not seen in normal subjects. CONCLUSIONS: This study evaluated the sensitivity, specificity, and reproducibility of the kit and confirmed the usefulness of the DCIP test as a screening test for haemoglobin E. In countries with limited health resources, its use would reduce the number of samples requiring referral to a central laboratory for definitive tests.
Subject(s)
2,6-Dichloroindophenol , Hemoglobin E/analysis , Indicators and Reagents , False Positive Reactions , Female , Humans , Mass Screening/methods , Observer Variation , Pregnancy , Prenatal Diagnosis/methods , Reagent Kits, Diagnostic , Sensitivity and SpecificityABSTRACT
All developmental stages of Tanystylum bealensis are described. This is the first complete developmental series of a pycnogonid species collected from a natural, rather than a laboratory-reared population. Development proceeds through a series of nine instars from egg to adult, with major defining characteristics of the instars being the addition of walking legs, loss of chelifores, and modification of larval appendages into adult palps and ovigers. All stages are free-living on the hydroid Plumularia setacea, except for the first instar (protonymphon), which remains on the ovigers of the adult male for a short time after hatching. Development in T. bealensis is compared to development in both the closely related species T. orbiculare and to the more distantly related Achelia alaskensis.