Associations of blood pressure with body composition among Afro-Caribbean children in Barbados.

UNLABELLED: Despite complex presentation of adult hypertension and a concomitant obesity epidemic, little is known about overweight in relation to blood pressure among Caribbean children. We examined blood pressure in relation to body size in a cross-sectional study of 573 Barbadian children aged 9-10 years (2010-2011). The United States normative blood pressure percentiles were used to identify children with high (≥95th percentile) or high normal blood pressure (90th-95th percentile). The World Health Organization body mass index cut-off points were used to assess weight status. MAJOR FINDINGS: Thirty percent of children were overweight/obese. Percentage fat mass differed between girls (20.4%) and boys (17.72%) (p<0.05). Mean systolic blood pressure among girls was 106.11 (95% CI 105.05, 107.17) mmHg and 105.23 (104.09, 106.38) for boys. The percentages with high or high-normal mean systolic blood pressure were 14.38% (10.47, 18.29) for girls and 8.08% (4.74, 11.41) for boys. Height and body mass index were independent correlates of systolic and diastolic blood pressure. Mean systolic blood pressure was related to lean mass but not fat mass, while diastolic blood pressure was associated with fat mass index and overweight. PRINCIPAL CONCLUSION: One third of 9-10 year old children in Barbados were overweight/obese and 12% had elevated mean systolic blood pressure. BP was related to body size. These findings signal potential adverse trends in weight gain and BP trends for children growing up in the context of a country that has recently undergone rapid economic transition.

Leptospirosis occurring in two children after fresh water immersion

Leptospirosis is relatively uncommon in children. Two cases of severe leptospirosis occurred in teenaged boys who shared a common exposure via immersion in fresh water. While both patients had laboratory-confirmed leptospirosis, their symptoms differed in many respects.(Au)

A prospective ten year surveillance study of perinatally transmitted HIV infection in Barbados

OBJECTIVE: To analyze the result of the ten years surveillance for the perinatal transmission of Human Immunodeficiency Virus (HIV) between 1990 and 1999,in Barbados. DESIGN AND METHODS: All babies born to HIV-positive mothers were enrolled at birth. They were followed up to 18 months of age with ELISA testing for HIV antibodies, subsequent follow-up being limited to children who remained ELISA positive, and thus HIV-infected. Perinatal history, clinical and investigative findings at follow-up were recorded. RESULTS: 180 babies were born to HIV-positive mothers during 1990-1999. Antenatal HIV screening has increased from one percent in 1990 to >80 percent of pregnant women during 1997-99. The prevalence of HIV positivity among pregnant women has stabilized around 1 percent since 1996. The incidence of babies born to HIV positive mothers has increased from 3.18 (in 1990) to 9.21 per thousand live births in 1999. More babies with low birth weight (15.4 percent) and intra-uterine growth retardation (8.3 percent) were seen among babies exposed to HIV, compared to the general population and these conditions were more frequent among babies who did not recieve prophylactic zidovudine (19.4 percent) and 12.9 percent, respectively) than in those who did (12.8 percent, and 5.3 percent, respectively). The rate of perinatal HIV transmission declined from 34.9 percent during 1990-95 to 4.8 percent during 1996-99 with Zidovudine. The majority (65.9 percent) of fathers were unaware of the mother's HIV-positive status and most (78.9 percent) repeat pregnancies in HIV-positive mothers were by different fathers. CONCLUSION: The incidence of babies born to HIV-positive mothers has been increasing. There has been a significant reduction in the rate of perinatal HIV transmission associated with the use of prophylatic zidovudine. Social circumstances surrounding perinatal HIV transmission need immediate attention in order to reduce rate of perinatal transmission any further. (Au)

HIV infection among children in Barbados

We studied a cohort of children with human immunodeficiency virus (HIV) infection in Barbados in order to determine the prevalence of HIV infection, the clinical course including morbidity and mortality and the magnitude of the health care and social problems. Forty-seven children were diagnosed with HIV infection during the study period. The number of HIV infected children increased from 5 during 1981-85, to 14 during 1986-90, and 21 during 1991-95 period. The majority (91.5 percent) of infections resulted from perinatal transmission. Six (12.8 percent) cases remained asymptomatic and 41 (87.2 percent) were symptomatic with 19 (46.3 percent) presenting in infancy, while 22 (53.5 percent) presented post-infancy. The median age at diagnosis (class P-2) was 13 months. Generalized lymphadenopathy (47.5 percent), hepatosplenomegaly (40.0 percent), failure to thrive (27.5 percent), persistent recurrent diarrhoea (15.0 percent), oral candidiasis (37.5 percent), Pneumocystis carinii pneumonia (37.5 percent), lymphoid interstitial pneumonia (12.5 percent) and progressive neurological disease (10.0 percent) were common among HIV related conditions. Two children developed non-hodgkin's lymphoma. The median age at death for 23 children was 12 months, whereas the median survival after diagnosis was 4 months. Mortality was higher among those diagnosed in infancy (73.7 percent) as compared to those diagnosed post-infancy (42.8 percent). Pneumocystis carinii pneumonia was the most common (65.2 percent) cause of death. Paediatric HIV infection is rising and contributes considerably to infant mortality. In this study, children took longer to be symptomatic when compared to other reports. However, once symptomatic, they died early.(Au)

HIV infection among children in Barbados

We studied a cohort of children with human immunodeficiency virus (HIV) infection in Barbados in order to determine the prevalence of HIV infection, the clinical course including morbidity and mortality and the magnitude of the health care and social problems. Forty-seven children were diagnosed with HIV infection during the study period. The number of HIV infected children increased from 5 during 1981-85, to 14 during 1986-90, and 21 during 1991-95 period. The majority (91.5 percent) of infections resulted from perinatal transmission. Six (12.8 percent) cases remained asymptomatic and 41 (87.2 percent) were symptomatic with 19 (46.3 percent) presenting in infancy, while 22 (53.5 percent) presented post-infancy. The median age at diagnosis (class P-2) was 13 months. Generalized lymphadenopathy (47.5 percent), hepatosplenomegaly (40.0 percent), failure to thrive (27.5 percent), persistent recurrent diarrhoea (15.0 percent), oral candidiasis (37.5 percent), Pneumocystis carinii pneumonia (37.5 percent), lymphoid interstitial pneumonia (12.5 percent) and progressive neurological disease (10.0 percent) were common among HIV related conditions. Two children developed non-hodgkin's lymphoma. The median age at death for 23 children was 12 months, whereas the median survival after diagnosis was 4 months. Mortality was higher among those diagnosed in infancy (73.7 percent) as compared to those diagnosed post-infancy (42.8 percent). Pneumocystis carinii pneumonia was the most common (65.2 percent) cause of death. Paediatric HIV infection is rising and contributes considerably to infant mortality. In this study, children took longer to be symptomatic when compared to other reports. However, once symptomatic, they died early.

Haemoglobin electrophoresis patterns in Barbados

Despite the extensive data on haemoglobinopathies and their widespread geographic distribution, the number of prospective Caribbean studies which document the prevalence of haemoglobinopathies from birth are few. The purpose of this cohort study was to document the prevalence of haemoglobinopathies in newborn infants in Barbados. One thousand successively collected cord bloods of newborn infants were screened for haemoglobinopathies using the Paragon acid electrophoresis technique. Seventeen infants were retested at 1 year of age to confirm the diagnosis. Three mothers could not be located so their infants' diagnoses could not be confirmed. From the 997 blood samples with conclusive results, a haemoglobinopathy was found in 72 (7 percent) samples. Laboratory analysis revealed: 925 patients (93 percent) with Hb AA, 41 (4 percent) with Hb AS, 27 (2.7 percent) with Hb AC, 2 (0.2 percent) with Hb SS, 1 (0.1 percent) with Hb CC and 1 (0.1 percent) with Hb SC. The prevalence of sickle gene and number of cases of Sickle Cell anaemia in the Barbadian population is less than has been reported from other regional territories.(AU)

An epidemic of the congenital rubella syndrome in Barbados

Rubella and congenital rubella syndrome (CRS) are largely preventable diseases. The occurrence of epidemics of rubella and CRS are not infrequent in the Caribbean and other developing countries. A surveillance system was initiated after a epidemic of rubella in Barbados during 1996 and suspected cases of CRS were identified and investigated. A total of 7 cases of CRS were proven to be IgM positive for rubella. Affected infants were found to have a mean birth weight of 2578 g and a mean gestational age of 38 weeks. All infants who were identified with clinical stigmata compatible with CRS and who had a positive rubella IgM test were followed for their clinical outcomes. The acute care hospital costs for each patient were also recorded. Ophthalmological complications (cataracts) in 4 (55.5 percent) infants, congenital heart disease in 3 (42.8 percent) infants, and central nervous systems abnormalities in 5 (71.4 percent) patients were the major clinical abnormalities. Two or more clinical systems were affected in all but 3 patients. Total hospitalisation stay was 105 days (mean 15 days). A national effort to immunise all at risk persons in the population and a strict surveillance programme are essential to prevent the likelihood of future epidemics. It would probably lead to a significant reduction in the number of rubella and CRS cases and savings in acute care costs.(AU)

A clino-epidemiological study on HIV infected children in Barbados

Human immunodeficiency virus (HIV) infection in children is fast emerging as a public health problem in Barbados as it is throughout the world. The natural history of this condition has not been as well documented in the Caribbean as in the developed countries. This report describes the prevalence, clinical presentation, disease progression and survival pattern of HIV infected children diagnosed in Barbados. Forty-seven children infected with HIV were diagnosed during the period 1985 to 1995. The number of newly diagnosed HIV infected children increased as the period progressed. The patients comprised 28 (59.6 percent) males and 19 (40.4 percent) females, predominantly (80.8 percent) black with the majority (91.5 percent) resulting from perinatal transmission. There was 6 (12.8 percent) asymptomatic and 41 (87.2 percent) symptomatic cases with 19 (46.3 percent) presenting during infancy, while 22 (53.5 percent) presented in the post-infancy period. The median age at diagnosis was 13 months. The first manifestations among those presenting in infancy were Pneumocystis carinii pneumonia (63.1 percent), hepatosplenomegaly (47.4 percent), and persistent oral candidiasis (42.1 percent). Generalised lymphadenopathy (71.4 percent) and failure to thrive (38.1 percent) were the most common presenting features in children diagnosed post infancy. The median survival after diagnosis was 10 weeks. Mortality was higher among those diagnosed in infancy (73.7 percent) than among those diagnosed post infancy (42.8 percent). Pneumocystis carinii pneumonia was the most common (65.2 percent) cause of death. Paediatric HIV infection is on the increase and contributes significantly to infant mortality.(AU)

Cord blood sickle-cell screening in Barbados - abstract

The incidence of the sickle-cell and other haematoglobinopathies in a population has been shown to be significantly related to its racial ethnic composition. Despite the extensive documentation of cases and their widespread geographic distribution, the number of prospective studies which documents the incidence of this disease from birth, is few within the Caribbean. The purpose of this cohort study was to document the incidence of haemoglobinopathies in Barbados from birth, and to follow the outcome of infants affected by sickle-cell anaemia over the first five years of life. The hypothesis for the study is that if there is an incidence of sickle-cell disease similar to that in Jamaica, or among blacks in the USA, affected patients die soon after birth or have mild haplotypes; alternately that there is a lower incidence, with or without "mild" haplotypes. One thousand successively collected cord bloods of newborn infants were screened for haemoglobinopathies by using the Paragon acid electrophoresis technique. Seventeen infants were recalled for repeat electrophoresis at one year of age and three mothers could not be located. Of the 997 specimens with conclusive results, a haemoglobinopathy trait was found in 71 (7 percent ). Nine hundred and twenty five patients (93 percent) had Hb AA, 41(4 percent) Hb AS, 27 (2.7 percent) Hb AC, one (0.1 percent) Hb CC, two (0.2 percent) Hb SS and one (0.1 percent) Hb SC. We conclude from then study so far that the incidence of the sickle-cell gene in the Barbadian population is low in comparison with that found in Jamaica. (AU)

Congenital solitary non-parasitic cyst of the liver

Although non-parasitic cysts of the liver have often been described in adults, solitary non-parasitic cysts are rare in infants. We report a 17-month-old child with a large hepatic cyst(AU)

Congenital solitary non-parasitic cyst of the liver

Although non-parasitic cysts of the liver have often been described in adults, solitary non-parasitic cysts are rare in infants. We report a 17-month-old child with a large hepatic cyst

Accidental childhood injuries and trauma - abstract

Paediatric (<15 years of age) admissions for accidental injuries at the Queen Elizabeth Hospital, Barbados, were studied retrospectively for the period 1982-1991. Notes were retrieved according to the International Classification of Diseases. The objectives of the study were to evaluate the spectrum, incidence and trends of injury occurring during the period. There was a declining trend of admissions, with the most significant decrease in the 1-2-year-olds. The 5-12-year-old group had the most admissions (45 percent), followed by the 1-4-year-olds (37 percent), 13-14 years (13 percent) and <1 year (5 percent). Falls were the most prevalent cause for admission (36 percent), followed by motor vehicle accidents (MVA) (19 percent) and poisoning (14 percent). Poisoning, burns and foreign bodies were the most common in the 1-4-year-old age group. Falls, MVAs, being stuck with an object and machinery-related injuries were the most common in the 5-12-year-old age group. There was an overall decreasing trend in falls, being stuck with objects and poisonings, but there was an increasing trend in burns until 1986, but declining thereafter. There was an initial downward trend in the machinery-related injuries until 1985, but an increase thereafter. Despite the general declining trend in admissions for trauma, preventable trauma from machinery in the 5-12-year-old age group and burns in the 1-4-year-old age group showed no appreciable decrease in incidence (AU)

Acute purulent pericarditis in children caused by haemophilus influenzae

Acute purulent pericarditis caused by haemophilus influenzae is an unusual condition, especially in childhood. In most cases, respiratory symptoms are the presenting features, and children aged less than 4 years are most often affected. A high index of suspicion and aggresive microbiological and cardiological evaluation are often warranted to make an early diagnosis. We herein report two cases of pericarditis caused by H.influenzae in children aged less than two years. Pericardiocentesis was performed in each case. Early recognition, rapid diagnosis and aggressive medical and surgical therapy are paramount in the successful treatment of this condition (AU)

Acute purulent pericarditis in children caused by haemophilus influenzae

Acute purulent pericarditis caused by haemophilus influenzae is an unusual condition, especially in childhood. In most cases, respiratory symptoms are the presenting features, and children aged less than 4 years are most often affected. A high index of suspicion and aggresive micorbiological and cardiological evaluation are often warranted to make an early diagnosis. We herein reported two cases of pericarditis caused by H. influenzae in children aged less than two years. Pericardiocentesis was performed in each case. Early recognition, rapid diagnosis and aggressive medical and surgical therapy are paramount in the successful treatment of this condition.

Clinical patterns of newly diagnosed children with IDDM, 1981-91 - abstract

Sixteen newly diagnosed, hospitalised (1981-91), insulin-dependent diabetic children aged 12 years were studied. The main objective of the study was to identify clinical characteristics and outcome of these cases. Initial sources of referral and diagnosis were made by a relative in 2 cases (13 per cent), paediatrician/family practitioner in 6 (37 per cent) and at the hospital accident and emergency department in 8 (50 per cent) of cases. The number of girls exceeded the number of boys by 24 per cent with a 1:1.6 male to female ratio. The mean age of initial diagnosis was 7.1 years (range 1.5 to 11 years). Fifty per cent of cases were aged 9 to 12 years and 44 per cent (7 cases) were diagnosed during the latter two years of study. Thirty-one per cent of cases had a diabetic first degree relative. Predominant symptoms/signs were polyuria in 7 (44 per cent) cases, polydipsia and weight loss each in 6 cases (38 per cent), and dehydration in 5 cases (31 per cent). Four (25 per cent) patients had ketoacidosis on admission and 12 patients (75 per cent) an admission blood glucose of >20 mmol/l. Fifty-six per cent of patients (9) were from single parent homes and 50 per cent from low income households. Readmissions (averaging 7.7 per patient) occurred predominantly in patients from single parent homes, with a low socioeconomic status and associated social problems. The majority of readmissions were related to hyperglycaemia and non-compliance or infection. The most frequently observed management problems encountered were Candidal vulvovaginitis in 7 cases (44 per cent), afebrile seizures in 2 (13 per cent) and social problems. After initial admission and discharge, 11 patients (69 per cent) utilised daily home blood sugar monitoring and 11 (73 per cent) patients were monitored by quarterly glycosylated haemoglobin studies. Follow-up periods ranged between 1 and 11.5 years (AU)

Outcome of symptomatic HIV-positive paediatric cases in Barbados - abstract

Fifteen symptomatic children comprising 9 males (60 per cent) and 6 (40 per cent) females, who tested positive for the human immunodeficiency virus (HIV) during a 6-year period, were studied. Patients were classified according to the Communicable Diseases Centre (CDC) epidemiological classification. The ages of patients ranged between 1 day and 7 years (mean 1.3 years). The mean incidence of cases was 3 per annum with a notable increase in annual cases during 1991. Nine cases (60 per cent) were aged < 1 year. Frequent symptoms/signs were lymphadenopathy in 7 patients (47 per cent), hepatosplenomegaly in (33 per cent) and failure to thrive (FTT), recurrent oral candidiasis, pneumocystis carinii pneumonia (PCP), and recurrent skin infections in each of 3 patients (20 per cent). Illnesses characteristic of HIV disease included oral candidiasis, Pneumocystis carinii pneumonia, and recurrent skin infections. Fifty-three per cent of cases were anaemic. Nine (60 per cent) patients had one or more hospitalizations. Seven patients (47 per cent), (mean duration 7.5 months after presentation), died during the period of study. Eleven mothers (73 per cent) tested positive for HIV, and 4 mothers were not tested (abandoned, died, or declined testing). Identified risk factors included contaminated blood transfusions in 2, prostitution in 1 mother, and i.v. drug use and bisexuality in 2 fathers. Eight patients were from low-income families and 6 from the mid-income group. Twelve cases were cared for by a parent up to the present time, 2 are orphans and 1 is abandoned. Data from this study illustrate that children with HIV infection in Barbados most frequently present with persistent adenopathy, hepatosplenomegaly, FTT, opportunistic infections and anaemia; the infection was exclusively acquired perinatally, and the majority of cases were cared for at home (AU)

Eosinophilic granuloma of the cervical and thoracic spine in a child

A case of eosinophilic granuloma affecting a cervical vertebra, thoracic vertebra and pelvis in a child is reported. We present this case because multifocal eosinophilic granuloma lesions of the spine are rare and can present as this case did with both diagnostic and therapeutic problems. Preoperative diagnosis may be made by X-ray, isotope bone scan and needle biopsy, avoiding unnecessary surgical intervention (AU)