A serosurvey of hepatitis B virus, hepatitis C virus, human T lymphotropic virus type-1 and syphilis in HIV-1-infected patients in Jamaica.

The seroprevalences of hepatitis B virus (HBV), hepatitis C virus (HCV), human T lymphotropic virus type-1 (HTLV-1) and syphyilis were determined in 129 HIV-1-infected patients using commercially prepared reagents. The seroprevalences were HCV, 0% (0/129); HBV, 37% (48/129); HTLV-1, 5% (6/129) and syphilis, 20% (26/129). Fifteen per cent (19/129) of the patients had active/chronic HBV infection. The seroprevalence of HBV was statistically significantly higher in HIV-1 infected men (24/49, 50% versus 17/80, 21%; p = 0.005), while the seroprevalence of syphilis was statistically significantly increased in HIV-1 infected patients in the over-40 age group (10/31, 32% versus 6/53, 11%; p = 0.05). These findings throw the spotlight on HBV infection and syphilis and suggest that these two sexually transmitted infections should be carefully surveyed in patients with HIV/AIDS in Jamaica. It is essential for management protocols in Jamaica to include screening for evidence of these co-infections.

A serosurvey of hepatitis B virus, hepatitis C virus, human T lymphotropic virus type-1 and syphilis in HIV-1-infected patients in Jamaica

The seroprevalences of hepatitis B virus (HBV), hepatitis C virus (HCV), human T lymphotropic virus type-1 (HTLV-1) and syphyilis were determined in 129 HIV-1-infected patients using commercially prepared reagents. The seroprevalences were HCV, 0 (0/129); HBV, 37 (48/129); HTLV-1, 5 (6/129) and syphilis, 20 (26/129). Fifteen per cent (19/129) of the patients had active/chronic HBV infection. The seroprevalence of HBV was statistically significantly higher in HIV-1 infected men (24/49, 50 versus 17/80, 21; p = 0.005), while the seroprevalence of syphilis was statistically significantly increased in HIV-1 infected patients in the over-40 age group (10/31, 32 versus 6/53, 11; p = 0.05). These findings throw the spotlight on HBV infection and syphilis and suggest that these two sexually transmitted infections should be carefully surveyed in patients with HIV/AIDS in Jamaica. It is essential for management protocols in Jamaica to include screening for evidence of these co-infections

Chronic disease control and compliance--the HOPE worldwide Jamaica experience

HOPE worldwide Jamaica has provided mobile curative and preventative services to fourteen rural government clinics since 1994. The patient records of 1,091 chronic disease patients, aged >30 years between January and December 1999 were reviewed. They were all above 30 years of age with an average age of 64 years; 81were female and 60were hypertensive, 16diabetic and 24had both diabetes and hypertension. There were 2,390 visits for hypertension, with an average of 2 visits per patient. Thirty-four per cent of patients had BP of < or = 140/90 mmHg while 43had BP <160/ 95 mmHg. Compliance was defined as daily consistency in taking prescribed medication. Forty-four per cent of hypertensives were non-compliant at the time of their visit. Anti-hypertensive treatment included thiazide diuretics (65), reserpine (50), ACE inhibitors (30) and alpha-methyldopa (5). There were 1,129 visits for diabetes, with an average of 2 visits per patient. Twenty-four per cent of diabetic patients were controlled to fasting blood glucose FBG levels of <6.7 mmol/l and 38controlled to (FBG) levels <8 mmol/l. Thirty per cent of diabetics were non-compliant at the time of their visit. The most frequently used oral hypoglycaemic agents were metformin (78), glyburide (43) and chlorpropamide (30). Fourteen per cent of diabetics were on treatment with insulin 70/30 (12) and lente insulin (2). Electrocardiograms (ECG) were done on 24(n=267) of patients in the previous two years. Thirty-six per cent had evidence of left ventricular hypertrophy and 15had evidence of ischaemic heart disease. The level of blood pressure and blood glucose control is inadequate, despitethe provision of regular monitoring, surveillance and improved access to pharmaceuticals. It is perceived that poor socioeconomic conditions, lack of education, cultural beliefs, in addition to other factors, continue to militate against improved compliance and control.

Chronic diseases management in the Jamaican setting: HOPE worldwide Jamaica's experience.

The prevalence of hypertension and diabetes in Jamaica is very high. Hypertension is present in 3 out of 10 Jamaicans over the age of 30 years while the prevalence of diabetes mellitus varies between 13% and 18% for Jamaicans over 15 years. HOPE worldwide Jamaica is a 7-year-old private voluntary organization that collaborates with the government of Jamaica to provide a mobile medical service to poor rural communities. The records between January 1999 and December 1999 of 1091 chronic disease patients aged > 30 years were reviewed. The average recorded age of the patients was 64 years and 82% among them were females. 60% had hypertension, 16% had diabetes and 24% had both diabetes and hypertension. There were 2390 visits for hypertension, with an average of 2 visits per patient. 34% of patients had a blood pressure of < or = 140/90 mmHg while 43% had a blood pressure < 160/95 mmHg. Compliance was defined as daily consistency in taking prescribed medication. 44% of the patients with hypertension were non-compliant at the time of their visit. Antihypertensive treatment included thiazide diuretics (65%), reserpine (50%), angiotensin converting enzyme (ACE) inhibitors (30%) and alpha-methyldopa (5%). There were 1122 visits for diabetes, with an average of 2 visits per patient. Among the diabetic patients 23% were controlled to a fasting blood glucose (FBG) level of less than 6.7 mmol/l and 38% to below 8 mmol/l. 30% of the diabetic patients were non-compliant at the time of their visit. The most frequently used oral hypoglycaemic agents were metformin (78%), glyburide (43%) and chlorpropamide (30%). 14% of the diabetic patients were on treatment with insulin: insulin 70/30 (12%) and lente insulin (2%). Electrocardiograms (ECGs) were done in the previous two years on 267 patients (29%), among whom 38% had evidence of left ventricular hypertrophy and 16% of ischaemic heart disease. The level of blood pressure and blood glucose control was inadequate despite the provision of regular monitoring, surveillance and improved access to medication. It is perceived that poor socioeconomic conditions, lack of education, cultural beliefs and some other factors continue to militate against improved compliance and control. HOPE worldwide Jamaica is currently implementing programs to improve patient education, especially in compliance, to provide access to more effective medication with convenient once-daily dosage regimens, and to develop support groups among chronic disease patients in order to improve compliance and control.

Chronic disease control and compliance--the HOPE worldwide Jamaica experience.

HOPE worldwide Jamaica has provided mobile curative and preventative services to fourteen rural government clinics since 1994. The patient records of 1,091 chronic disease patients, aged >30 years between January and December 1999 were reviewed. They were all above 30 years of age with an average age of 64 years; 81% were female and 60% were hypertensive, 16% diabetic and 24% had both diabetes and hypertension. There were 2,390 visits for hypertension, with an average of 2 visits per patient. Thirty-four per cent of patients had BP of < or = 140/90 mmHg while 43% had BP <160/ 95 mmHg. Compliance was defined as daily consistency in taking prescribed medication. Forty-four per cent of hypertensives were non-compliant at the time of their visit. Anti-hypertensive treatment included thiazide diuretics (65%), reserpine (50%), ACE inhibitors (30%) and alpha-methyldopa (5%). There were 1,129 visits for diabetes, with an average of 2 visits per patient. Twenty-four per cent of diabetic patients were controlled to fasting blood glucose FBG levels of <6.7 mmol/l and 38% controlled to (FBG) levels <8 mmol/l. Thirty per cent of diabetics were non-compliant at the time of their visit. The most frequently used oral hypoglycaemic agents were metformin (78%), glyburide (43%) and chlorpropamide (30%). Fourteen per cent of diabetics were on treatment with insulin 70/30 (12%) and lente insulin (2%). Electrocardiograms (ECG) were done on 24% (n=267) of patients in the previous two years. Thirty-six per cent had evidence of left ventricular hypertrophy and 15% had evidence of ischaemic heart disease. The level of blood pressure and blood glucose control is inadequate, despitethe provision of regular monitoring, surveillance and improved access to pharmaceuticals. It is perceived that poor socioeconomic conditions, lack of education, cultural beliefs, in addition to other factors, continue to militate against improved compliance and control.

Kawasaki syndrome in Jamaica.

OBJECTIVE: To determine the epidemiology, management and outcome of Kawasaki syndrome in patients presenting to the major referral centers in Jamaica (population, 2.5 million) from May, 1986, through June, 1998. DESIGN AND METHODS: Retrospective review of all cases of Kawasaki syndrome in major referral centers island wide. American Heart Association diagnostic criteria were used in case definition. Demographic, clinical diagnostic and laboratory data, management and outcome findings were analyzed. RESULTS: Of 98 probable cases 57 were diagnosed with definite Kawasaki syndrome. The average annual incidence was 2.7 per 100,000 children in the 0- to 5-year age group, in a predominantly black population. Eighty-one percent of cases were from the Kingston Metropolitan area (population, 800,000). Children in the first 3 years of life were represented by 67% of cases, with a mean age of presentation of 32 months (range, 5 to 120 months). There was a male preponderance (M:F ratio, 1.71:1). The mean time between onset of illness and diagnosis was 9.1 days (SD 3.9 days). The most common presenting clinical features included fever, anorexia, vomiting, conjunctivitis, exanthema and oropharyngeal and peripheral extremity changes (>45% of patients). Only 7 children received treatment with intravenous gamma-globulin. Overall 38.8% of patients had cardiovascular changes and 28% had coronary artery abnormalities. Girls (8 of 21, 38.1%) were significantly more likely to have coronary changes than boys (8 of 36, 28.5%) [P < 0.05]. Two (3.5%) patients experienced a recurrence. CONCLUSION: There is a tendency for late recognition and, hence, failure of treatment of Kawasaki syndrome in Jamaica. Greater awareness of the condition needs to be implemented. The finding of female children with an increased occurrence of coronary abnormalities warrants further investigation.

Cutaneous furuncular myiasis in a Jamaican resident.

Data are presented on a case of cutaneous furuncular myiasis in a Jamaican resident. This condition is virtually unknown in the Caribbean, but is endemic in Central and South America. The infection, which was caused by Dermatobia hominis, was acquired in Belize and was misdiagnosed and treated as infected insect bites. Cutaneous furuncular myiasis should be considered in patients with sub-acute inflammatory nodular skin lesions with a history of recent travel to endemic countries.

The origins of supraspinal projections to lumbosacral and cervical levels of the spinal cord in the gray short-tailed Brazilian opossum, Monodelphis domestica.

Retrograde tracing techniques were used to identify supraspinal neurons that project to sacral, lumbar and cervical levels of the spinal cord in the gray short-tailed Brazilian opossum, Monodelphis domestica. Injections of Fast Blue, True Blue or wheat germ agglutinin conjugated to horseradish peroxidase into the sacral or lumbar cord labeled neurons in hypothalamic and brainstem nuclei reported to innervate the same levels in other mammals. Injections at cervical levels produced extensive labeling in the same areas as well as labeling within the isocortex, the medial preoptic area, the central and basomedial amygdaloid nuclei, the medial and interposed nuclei of the cerebellum, and several additional areas of the brainstem. In some of the cases, lumbar injections of wheat germ agglutinin conjugated to horseradish peroxidase were combined with a contralateral hemisection of the thoracic cord in order to determine laterality. The origins of monoaminergic projections were assessed using the retrograde transport of True Blue from the cervical cord and immunofluorescence for serotonin and tyrosine hydroxylase. Our results suggest that the origins of supraspinal projections to the spinal cord of Monodelphis are similar to those described for the North American opossum, Didelphis virginiana. Differences appear to exist, however, particularly in the amount of isocortex containing corticospinal neurons, the existence of spinal projections from the amygdala and preoptic area, the degree of rubrospinal somatotopy, and the origins of certain monoaminergic projections.