Contact investigation in the prevention of mother-to-child transmission of HIV comparing urban and rural outcomes in Jamaica / Investigación de contactos en la prevención de la transmisión del VIH de madre a hijo comparando los resultados urbanos y rurales en Jamaica

BACKGROUND AND PURPOSE: The contact investigators played a significant role in the decline of infectious syphilis in Jamaica and are likely important players in the prevention of mother-to-child transmission (PMTCT) in the HIV programme. A brief evaluation was done comparing the outcomes of contact investigation in Kingston and St Andrew (KSA) with that of the contact investigation in two rural parishes? METHODS: The interview and field records for the seropositive antenatal clinic attendees for the period October 2004 to September 2005, in urban KSA, were compared with those for rural Clarendon and Portland. RESULTS: HIV seropositive pregnant women (n = 88) were notified and/or referred to the parish contact investigators: 36 in KSA, 9 in Portland and 43 in Clarendon. The time from test date to interview date was almost twice as long for KSA (mean 27 days) than Portland (mean 15.7 days) and thrice that of Clarendon (mean 9 days). Mean disposition (case closure) times were for KSA: 19 days; Portland: 28 days and Clarendon: 15 days. Only 40% of the contacts were located for KSA and 48% of these tested positive for HIV. For Portland, 73% were located and 8% tested positive. For Clarendon, 45% were located and 35% of these tested positive. CONCLUSIONES: On site same day HIV rapid testing is not always available so the contact investigator is an essential member of the pMTCT team in Jamaica. One of the programme outcomes (time to interview) was longer in the urban than the rural parishes while others (time to resolution of the case and percentage of contacts located and tested) had no consistent urban-rural differences.

ANTECEDENTES Y PROPÓSITO: Los investigadores de contactos desempeñaron un papel significativo en el disminución de la sífilis infecciosa en Jamaica, y son probablemente agentes importantes en la prevención de la transmisión del VIH de madre a hijo dentro del programa de VIH. Se realizó una breve evaluación comparando los resultados de las investigaciones de contactos en Kingston y Saint Andrew (KSA) con los de la investigación de contactos en dos provincias rurales. MÉTODOS: Los datos de entrevistas y de campo de los asistentes seropositivas a la clínica de atención prenatal para el período comprendido desde octubre de 2004 a septiembre de 2005 en el perímetro urbano KSA, fueron comparados con los de las rurales Clarendon y Pórtland. RESULTADOS: Las mujeres embarazadas VIH seropositivas (n = 88) fueron notificadas y/o referidas a los investigadores de contactos de las provincias: 36 en KSA, 9 en Portland y 43 en Clarendon. El tiempo de la fecha de prueba a la fecha de la entrevista fue casi el doble para KSA (promedio 27 días) en comparación con Pórtland (promedio 15.7 días) y tres veces mayor que el de Clarendon (promedio 9 días). Los tiempos de disposición promedio (cierre de caso) fueron como sigue: KSA, 19 días; Port-land, 28 días; y Clarendon, 15 días. Sólo el 40% de los contactos fueron localizados para KSA y el 48% de estos resultaron VIH positivos a las pruebas. Para Pórtland, 73% fueron localizados y 8% resultaron positivos. Para Clarendon, 45% fueron localizados y 35% de estos resultaron positivos. CONCLUSIONES: No siempre hay pruebas de VIH rápidas disponibles para su realización en el mismo lugar el mismo día, de manera que el investigador de contactos es un miembro esencial del team PMTCT en Jamaica. Uno de los resultados del programa (tiempo de entrevista) tuvo mayor duración en las provincias urbanas que en las rurales, en tanto que otros (tiempo de solución del caso y porcentaje de contactos localizados y sometidos a prueba) no mostraron diferencias consistentes urbano-rurales.

Contact investigation in the prevention of mother-to-child transmission of HIV comparing urban and rural outcomes in Jamaica.

BACKGROUND AND PURPOSE: The contact investigators played a significant role in the decline of infectious syphilis in Jamaica and are likely important players in the prevention of mother-to-child transmission (PMTCT) in the HIV programme. A brief evaluation was done comparing the outcomes of contact investigation in Kingston and St. Andrew (KSA) with that of the contact investigation in two rural parishes. METHODS: The interview and field records for the seropositive antenatal clinic attendees for the period October 2004 to September 2005, in urban KSA, were compared with those for rural Clarendon and Portland. RESULTS: HIV seropositive pregnant women (n=88) were notified and/or referred to the parish contact investigators: 36 in KSA, 9 in Portland and 43 in Clarendon. The time from test date to interview date was almost twice as long for KSA (mean 27 days) than Portland (mean 15.7 days) and thrice that of Clarendon (mean 9 days). Mean disposition (case closure) times were for KSA: 19 days; Portland: 28 days and Clarendon: 15 days. Only 40% of the contacts were located for KSA and 48% of these tested positive for HIV For Portland, 73% were located and 8% tested positive. For Clarendon, 45% were located and 35% of these tested positive. CONCLUSIONS: On site same day HIV rapid testing is not always available so the contact investigator is an essential member of the pMTCT team in Jamaica. One of the programme outcomes (time to interview) was longer in the urban than the rural parishes while others (time to resolution of the case and percentage of contacts located and tested) had no consistent urban-rural differences.

Congenital rubella syndrome associated with calcific epiphyseal stippling and peroxisomal dysfunction.

An infant girl had the clinical and immunologic findings of congenital rubella syndrome but also had arthrogryposis multiplex and calcific epiphyseal stippling. Spastic quadriparesis developed, and both physical and behavioral development were slow. Increased spasticity of the legs at 5 1/2 years was related not to progressive rubella encephalomyelopathy but to spinal cord compression by abnormal cartilaginous tissue. The presence of a peroxisomal disorder was demonstrated by a greatly increased level of phytanic acid and slightly increased levels of hexacosanoate in serum and by reduced activity of peroxisomal dihydroxyacetone phosphate acyltransferase and a slightly increased ratio of cytosolic to peroxisomal catalase activity in cultured fibroblasts. A reduction in the number and size of peroxisomes was demonstrated in cultured fibroblasts, and a needle biopsy specimen of the liver also showed the peroxisomes to have a smaller diameter than usual. We recommend that any child with epiphyseal stippling be assessed for peroxisomal disease and that the potential for spinal cord compression by dysplastic bone or cartilage be recognized. The association of peroxisomal dysfunction with congenital rubella has not been described previously. The interaction between rubella virus infection and peroxisomal function may need further investigation.

Lens neutral endopeptidase occurs in other bovine and human tissues.

Lens neutral endopeptidase (EC 3.4.24.5) was previously thought to be unique to the eye lens. We report here the finding of a neutral endopeptidase, in a variety of bovine and human tissues, which is very similar both biochemically and immunologically to the lens endopeptidase. SDS/polyacrylamide-gel electrophoresis of partially purified enzyme fractions from various bovine tissues shows the characteristic pattern of at least eight bands with Mr values ranging from 24,000 to 32,000 which was described for the bovine-lens neutral endopeptidase. The relative activity of the enzyme varies from tissue to tissue with lung having the highest activity. Partially purified enzyme fractions from these tissues cross-react with antiserum raised in rabbit against bovine lens endopeptidase showing apparent identity when examined side by side in Ouchterlony double-diffusion tests. The human enzyme also cross-reacts with the antiserum but when tested by double-diffusion against the bovine enzyme the precipitin lines show spurring at the joining edges indicating a structural difference between the human and the bovine enzymes. It was also found by Western blot experiments, after denaturing polyacrylamide-gel electrophoresis of the enzyme, that the polypeptide components of the human and bovine enzymes show somewhat different banding patterns.

Paediatric head injury - abstract

All paediactric head injury cases admitted to the Port-of-Spain General Hospital, Trinidad in the 12 months from August 1981- July 1982 were studied. There were 306 cases of which 187 (61 percent) were males and 119 (39 percent) females. Causes of injury were falls 221 (72 percent), road traffic accidents 71 (23 percent) other accidents 12(3 percent) and child abuse (2 cases). The commonest clinical features were loss of consciousness 124 (40 percent), nausea and vomiting 114 (37 percent), scalp haematomas 102 (33 percent), scalp lacerations 57 (19 percent), headaches 39 (13 percent), bleeding from ear or nose 19 (6 percent), seizures 18 (6 percent), focal deficits 6 (2 percent). Skull fractures were present in 29 (9 percent). Surgical interventions was necessary in 9 cases. Elevation of compound depressed fractures 3, craniotomy for evacuation of acute subdural haematomas 1 and multiple exploratory burr holes 5 showing cerebral contusions 3, and cerebral oedema 2 cases. Mortality was only 3, all with brain stem injuries. Regarding mobidity, 2 patients had hemiparesis 1 abnormal mental state and 5 continued treatment for seizures. These figures compare well with studies done in UK the United States and Canada regarding sex incidence, causes of injury and symptomatology; however, they differ considerably from the adult head injury in Trinidad where males account for 90 percent, road traffic accidents 59 percent, fights 27 percent, and other causes only 14 percent. These figures also indicate that paediatric head injury demands vigorous treatment despite the initial findings, as the result may be much better than initially predicted (AU)