Beta-thalassaemia of clinical significance in adult Jamaican negroes

Over a 9-year period, three adult Negro patients with á-thalassaemia of clinical significance were recognized out of approximately 185,000 new adult patients attending the University Hospital. These patients, ages 15-58 years, have clinical and haematological characteristics within the spectrum of á-thalassaemia intermedia; which in this paper refers to phenotypes resulting from defects in á-chain synthesis clinically intermediate between classical Cooley's anaemia and á-thalassaemia trait, genetic classification being dependent on family study. Family studies established the presence of two á-thalassaemia genes conclusively in one case (proposita, family A); presumptively in another(propositus, family C); while in the remaining subject (proposita, famaily B), who has two similarly affected siblings, homozygosity is suspected, but not proven by family study. In simultaneous Fe and Cr studies, estimates of effective erythropoiesis are in reasonable agreement with measurements of red cell destruction.(Summary)

Diabetic retinopathy, its incidence and relationship to diabetic control - abstract

Four hundred and twenty patients with diabetes mellitus were randomly selected from the Diabetic Clinic. The sex ratio M:F was 1:3. One hundred and thirty-five patients or 32.1 percent had some form of retinopathy. Retinopathy was classified as follows: Minor - Microaneurysms or exudates or small haemorrhages alone: Moderate - Any two of the minor lesions occurring together plus Neo vascularization: severe - Full blown picture with proliferating retinitis and/or blindness. Results: Cateracts 101 patients or 24 percent of all patients, Retinopathy 135 patients or 32 percent of all patients (a) Minor - 44 patients or 32 percent of 135 patients (b) Moderate - 41 patients or 32 percent of 135 patients (c) Severe 50 patients or 37 percent of 135 patients (d) Poliferating - 12 patients or 8.8 percent of 135 patients (e) Blind - 20 patients or 4.9 percent of all patients. The duration of diabetes ranged from 6 months to 28 years. Figures for the incidence of retinopathy in relationship to the duration of diabetes are presented. The relationship of retinopathy to control of diabetes showed that twenty patients considered as being well controlled showed minor or moderate degree of retinopathy, where as 30 and 80 patients with fair and poor control respectively showed moderate and severe retinopathy. A further analysis of the 20 patients with good diabetic control - showed that if control was assessed on the basis of 2-hour post prandial blood sugars, rather than on the absence of glycosuria, then all 20 patients who showed minor or moderate retinopathy - were in fact only fairly well controlled using blood sugar levels as a guide to diabetic control. It is concluded that 35 percent of all diabetics attending the Diabetic Clinic at the University Hospital of the West Indies, show some degree of retinopathy. In addition, 24 percent of the patients had cataracts of varying degrees. There was good correlation between control of hyperglycaemia and the incidence of retinopathy (AU)

Histiocytosis X: acute disseminated variant

The clinical course of a 14-year-old girl with the acute disseminated variant of histiocytosis X is described. The aetiology and its relationship to eosinophilic granuloma of bone and to the chronic disseminated variant ("Hand-Schuller-Christian disease") are reviewed and the pathogenesis of the haematological changes is discussed (AU)

A survey of blood glucose and serum lipoprotein in adults in a rural area of Jamaica - abstract

A community survey in Lawrence Tavern was started in October, 1969 in which all 544 perons aged 25-54 living in a particular area were requested to participate. Measurements taken included fasting and 1 hour blood glucose and insulin, serum cholesterol and triglycerides, lipoprotein electrophoresis, heamoglobin concentration, packed cell volume and haemoglobin type as well as blood pressure and anthropometric data. A chest X-ray and ECG were also taken. The aim of the study is to investigate the single joint distributions of the measurements and the relationships existing between glucose tolerance and cardiovascular parameters. Mean fasting blood glucose levels of the first 379 respondents show no trend with age in males and little evidence of any trend in females. However mean 1-hour post-Glucola levels show a striking trend with age. Of the 30 persons qualifying for the diagnosis of diabetes based on a 1-hour blood level of 180 mgm percent or greater, 6 were known diabetics, 13 were confirmed as newly discovered diabetics and 5 confirmed as non-diabetics by a full glucose tolerance test 6 refused the full test. Confirmed diabetic were more common among females than males aged 35-44 (6/92 as against 1/50) but no difference was found in the decade 45-54 (5/65 as against 7/65). Only one case (unconfirmed) eas found below age 35. Results for the other measurements made on blood constituents are not yet available (AU)

Neonatal hypoglycaemia in infants of diabetic mothers given sulphonylurea drugs in pregnancy

Three infants whose diabetic mothers were given chlorpropamide and one infant whose diabetic mother was given acetohexamide up to the time of delivery were studied in the neonatal period because each became severely hypoglycaemic. The sulphonylurea drugs given to the mother crossed the placenta, and fetal plasma concentrations were in the therapeutic range for adults with diabetes mellitus. Each baby had severe hyperinsulinaemia resulting in profound hypoglycaemia. These acutely ill infants needed vigorous and prolonged treatment to correct the hypoglycaemia. In two infants exchange transfusion was performed to remove the drug. These sulphonylurea drugs should not be used to control diabetes mellitus in pregnancy. (AU)