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1.
Trop Doct ; 52(1): 104-106, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-34427133

RESUMEN

There is still no organised national screening programme for colorectal cancer in Jamaica. We sought to evaluate the detection of colorectal cancer precursor lesions in patients who underwent opportunistic screening over three years. Patients with colorectal polyps were selected for further study. In 431 procedures, there were 84 (19.5%) patients with colorectal polyps identified at screening colonoscopy, which gave a 19.5% sensitivity to identify patients with polyps at risk of developing colorectal cancer, 9.5% being <50 years of age. At the time of examination, 16.7% had already developed invasive adenocarcinoma. We conclude that it is time for policy makers to develop a national colorectal cancer screening programme to diagnose patients early and improve their therapeutic outcomes.


Asunto(s)
Colonoscopía , Neoplasias Colorrectales , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/epidemiología , Neoplasias Colorrectales/prevención & control , Detección Precoz del Cáncer/métodos , Humanos , Jamaica/epidemiología , Tamizaje Masivo/métodos
2.
Trop Doct ; 45(1): 15-20, 2015 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-25315239

RESUMEN

BACKGROUND: Patients with sickle cell disease (SCD) demand special attention during clinical interventions because they are predisposed to acute chest syndrome (ACS), vaso-occlusive crises, intra-vascular haemolysis and immune paresis. Although SCD is endemic in the Caribbean, there has been no report on endoscopic retrograde cholangio-pancreatography (ERCP) outcomes in these patients from this region. STUDY: The records of patients with SCD who underwent ERCP between 1 January 2005 and 1 June 2010 were analysed retrospectively. Parameters assessed included patient demographics, procedural details, ERCP-related and SCD-related morbidity. Data were analysed using SPSS version 12.0. RESULTS: Fifty-four patients with SCD were subjected to ERCP during the study period. There were 37 women and 17 men at a mean age of 28 years (SD +/-12.05). There was 29% (16) overall morbidity, with 10 (18.5%) SCD-related complications and six (11.1%) ERCP-specific complications. More common complications were: pancreatitis (9.3%); cholangitis (1.9%); ACS (9.3%); pneumonia (3.7%); and painful crises (5.6%). There was one death (1.9%) due to multiple organ failure secondary to severe pancreatitis. CONCLUSIONS: This study suggests that the SCD cohort requires special perioperative attention to minimise the inordinately high morbidity, many of which are SCD-related. We propose a perioperative management protocol that may minimise morbidity in these patients.


Asunto(s)
Anemia de Células Falciformes , Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Coledocolitiasis/cirugía , Pancreatitis/cirugía , Complicaciones Posoperatorias/mortalidad , Adolescente , Adulto , Anciano , Coledocolitiasis/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pancreatitis/complicaciones , Neumonía , Estudios Retrospectivos , Resultado del Tratamiento , Trinidad y Tobago/epidemiología
3.
J Multidiscip Healthc ; 7: 227-30, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24920917

RESUMEN

INTRODUCTION: By providing a structured forum to exchange information and ideas, multidisciplinary team meetings improve working relationships, expedite investigations, promote evidence-based treatment, and ultimately improve clinical outcomes. METHODS: This discursive paper reports the introduction of a multidisciplinary team approach to manage hepatobiliary diseases in Jamaica, focusing on the challenges encountered and the methods used to overcome these obstacles. CONCLUSION: Despite multiple challenges in resource-limited environments, a multidisciplinary team approach can be incorporated into clinical practice in developing nations. Policy makers should make it a priority to support clinical, operational, and governance aspects of the multidisciplinary teams.

4.
Case Rep Gastrointest Med ; 2013: 942832, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-24377052

RESUMEN

Although surgical drainage of pancreatic pseudocysts has been superseded by less invasive options, the requirement for specialized equipment, technical expertise, and consumables limits the options available in low resource settings. We describe the challenges experienced during endoscopic transmural drainage in a low resource setting and the methods used to overcome these barriers. Despite operating in a low resource environment, endoscopic drainage of pancreatic pseudocysts can be incorporated into our armamentarium with minimal change to the existing hardware. Careful patient selection by a dedicated multidisciplinary team should be observed in order to achieve good outcomes.

5.
West Indian med. j ; 46(2): 63-4, June 1997.
Artículo en Inglés | MedCarib | ID: med-2057

RESUMEN

A post menopausal female with severe vomiting and weight loss in association with elevated hormone levels is presented. Signs and symptoms of thyrotoxicosis were not evident at presentation. Possible pathophysiological mechanisms and treatment are discussed. Antithyroid therapy with carbimazole and propranlol induced rapid resolution of her symptoms and marked improvement in well-being. Radioactive iodine ablation of her thyroid gland was performed later and she has remained asymptomatic.(AU)


Asunto(s)
Femenino , Humanos , Persona de Mediana Edad , Informes de Casos , Tirotoxicosis/complicaciones , Vómitos/etiología , Tirotoxicosis/terapia , Radioisótopos de Yodo/uso terapéutico , Pérdida de Peso
6.
West Indian med. j ; 46(2): 63-4, June 1997.
Artículo en Inglés | LILACS | ID: lil-193512

RESUMEN

A post menopausal female with severe vomiting and weight loss in association with elevated hormone levels is presented. Signs and symptoms of thyrotoxicosis were not evident at presentation. Possible pathophysiological mechanisms and treatment are discussed. Antithyroid therapy with carbimazole and propranlol induced rapid resolution of her symptoms and marked improvement in well-being. Radioactive iodine ablation of her thyroid gland was performed later and she has remained asymptomatic.


Asunto(s)
Femenino , Humanos , Persona de Mediana Edad , Tirotoxicosis/complicaciones , Vómitos/etiología , Radioisótopos de Yodo/uso terapéutico , Tirotoxicosis/terapia , Pérdida de Peso
7.
West Indian med. j ; 43(3): 84-6, Sept. 1994.
Artículo en Inglés | MedCarib | ID: med-7760

RESUMEN

One hundred and two consecutive patients undergoing upper gastrointestinal endoscopy were tested for H. pylori by a rapid urease test, using antral biopsy specimens. There were 60 men (mean age 54 yrs) and 42 women (mean age 49 yrs). Fifty-six patients (55 percent) were positive for H. pylori. Of male patients, 36 (60 percent) and of female patients, 20 (48 percent) tested positive. Sixty-eight per cent of patients with antral gastritis, 65 percent with duodenal ulcer and 60 percent with gastric ulcer had H. pylori. Thirty-nine patients (70 percent) positive for H. pylori were from major urban areas, and 17 (30 percent) were from rural areas of Jamaica. In patients without H. pylori, 61 percent and 39 percent were from urban and rural areas respectively. Forty-four patients (79 percent) with H. pylori and 40 (87 percent) without H. pylori had piped water in their homes. Ninety-three per cent of all patients had electricity and 88 percent had refrigeration. There was no difference between patients positive or negative for H. pylori with regard to the use of alcohol, marijuana or tobacco. There was also no difference between both groups in exposure to domestic animals in the home environment. H. pylori is associated with antral gastritis and peptic ulcer disease in Jamaican patients. There are no specific environmental or social factors that seem to predispose to infection (AU)


Asunto(s)
Humanos , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Masculino , Femenino , Enfermedades Gastrointestinales/microbiología , Helicobacter pylori , Gastritis , Jamaica , Endoscopía , Infecciones por Helicobacter
8.
West Indian med. j ; 43(3): 84-6, Sept. 1994.
Artículo en Inglés | LILACS | ID: lil-140346

RESUMEN

One hundred and two consecutive patients undergoing upper gastrointestinal endoscopy were tested for H. pylori by a rapid urease test, using antral biopsy specimens. There were 60 men (mean age 54 yrs) and 42 women (mean age 49 yrs). Fifty-six patients (55//) were positive for H. pylori. Of male patients, 36 (60//) and of female patients, 20 (48//) tested positive. Sixty-eight per cent of patients with antral gastritis, 65//with duodenal ulcer and 60//with gastric ulcer had H. pylori. Thirty-nine patients (70//) positive for H. pylori were from major urban areas, and 17 (30//) were from rural areas of Jamaica. In patients without H. pylori, 61//and 39//were from urban and rural areas respectively. Forty-four patients (79//) with H. pylori and 40 (87//) without H. pylori had piped water in their homes. Ninety-three per cent of all patients had electricity and 88//had refrigeration. There was no difference between patients positive or negative for H. pylori with regard to the use of alcohol, marijuana or tobacco. There was also no difference between both groups in exposure to domestic animals in the home environment. H. pylori is associated with antral gastritis and peptic ulcer disease in Jamaican patients. There are no specific environmental or social factors that seem to predispose to infection.


Asunto(s)
Humanos , Adolescente , Adulto , Persona de Mediana Edad , Masculino , Femenino , Enfermedades Gastrointestinales/microbiología , Helicobacter pylori , Endoscopía , Gastritis , Infecciones por Helicobacter , Jamaica
9.
West Indian med. j ; 43(1): 27-9, Mar. 1994.
Artículo en Inglés | MedCarib | ID: med-8351

RESUMEN

A case of the primary antiphospholipid syndrome (PAPS) in a 21-year-old Jamaican female is described. Recurrent abortions, thrombocytopenia and neurological complications as well as lupus anticoagulant positivity in the absence of features of systemic lupus erythematosus (SLE) were the main clinical findings. Diagnostic criteria, treatment and prognosis are discussed. When the antiphospholipid syndrome (APS) is present in the primary form, the diagnosis may be difficult but its recognition may prevent those vascular events which can lead to significant morbidity and foetal wastage (AU)


Asunto(s)
Humanos , Adulto , Femenino , Síndrome Antifosfolípido/diagnóstico , Aborto Habitual/etiología , Trombocitopenia/etiología , Trastornos Cerebrovasculares/etiología , Diagnóstico Diferencial
10.
West Indian med. j ; 43(1): 27-9, Mar. 1994.
Artículo en Inglés | LILACS | ID: lil-130575

RESUMEN

A case of the primary antiphospholipid syndrome (PAPS) in a 21-year-old Jamaican female is described. Recurrent abortions, thrombocytopenia and neurological complications as well as lupus anticoagulant positivity in the absence of features of systemic lupus erythematosus (SLE) were the main clinical findings. Diagnostic criteria, treatment and prognosis are discussed. When the antiphospholipid syndrome (APS) is present in the primary form, the diagnosis may be difficult but its recognition may prevent those vascular events which can lead to significant morbidity and foetal wastage.


Asunto(s)
Humanos , Adulto , Femenino , Síndrome Antifosfolípido/diagnóstico , Aborto Habitual/etiología , Trastornos Cerebrovasculares/etiología , Diagnóstico Diferencial , Trombocitopenia/etiología
11.
West Indian med. j ; 42(3): 115-7, Sept. 1993.
Artículo en Inglés | MedCarib | ID: med-9235

RESUMEN

During the period August, 1979 to December, 1992, 14 patients with the fat embolism syndrome (FES) were admitted to the University Hospital of the West Indies (UHWI). Two were females and 12 males, their ages ranging from 18 to 78 years, with a median age of 23.5 years. All had lower limb long bone fractures. Clinical features included fever, tachypnoea, confusion and drowsiness. They were all hypoxaemic; 9 required Intensive Care Unit (ICU) admission and, of these 4 needed ventilatory support. Five patients became comatose, 4 of whom developed decerebrate posturing. There was one death from Klebsiella septicaemia, and 13 patients recovered fully. The FES is a serious life-threatening complication of long bone fractures whether simple or compound, usually occurring within 72 hours of the injury. A high index of suspicion is needed for its prompt detection, and early attempts at maintaining adequate tissue oxygenation most be instituted if serious neurological complications and death are to be avoided. (AU)


Asunto(s)
Humanos , Masculino , Femenino , Fracturas Óseas/complicaciones , Embolia Grasa/terapia , Cuidados Críticos , Enfermedades del Sistema Nervioso Central/etiología , Embolia Grasa/diagnóstico , Embolia Grasa/etiología , Trastornos Respiratorios/etiología
12.
West Indian med. j ; 42(3): 115-7, Sept. 1993.
Artículo en Inglés | LILACS | ID: lil-130580

RESUMEN

During the period August, 1979 to December, 1992, 14 patients with the fat embolism syndrome (FES) were admitted to the University Hospital of the West Indies (UHWI). Two were females and 12 males, their ages ranging from 18 to 78 years, with a median age of 23.5 years. All had lower limb long bone fractures. Clinical features included fever, tachypnoea, confusion and drowsiness. They were all hypoxaemic; 9 required Intensive Care Unit (ICU) admission and, of these 4 needed ventilatory support. Five patients became comatose, 4 of whom developed decerebrate posturing. There was one death from Klebsiella septicaemia, and 13 patients recovered fully. The FES is a serious life-threatening complication of long bone fractures whether simple or compound, usually occurring within 72 hours of the injury. A high index of suspicion is needed for its prompt detection, and early attempts at maintaining adequate tissue oxygenation most be instituted if serious neurological complications and death are to be avoided.


Asunto(s)
Humanos , Masculino , Femenino , Embolia Grasa/terapia , Fracturas Óseas/complicaciones , Enfermedades del Sistema Nervioso Central/etiología , Cuidados Críticos , Embolia Grasa/diagnóstico , Embolia Grasa/etiología , Trastornos Respiratorios/etiología
13.
West Indian med. j ; 41(2): 81-3, June 1992.
Artículo en Inglés | MedCarib | ID: med-9631

RESUMEN

A case of thyrotoxic periodic paralysis occurring in a Black Jamaican male patient is described. Diagnosis is based on history and confirmed by evaluation of serum electrolyte during attacks and thyroid function studies. The physiopathology, associations, therapy and prognosis are discussed. It is important that clinicians recognise the condition as all forms of periodic paralysis are amenable to treatment, and progressive weakness can be prevented or even reversed. (AU)


Asunto(s)
Humanos , Adulto , Masculino , Tirotoxicosis/diagnóstico , Parálisis Periódicas Familiares/diagnóstico , Parálisis Periódicas Familiares/fisiopatología , Parálisis Periódicas Familiares/terapia , Pronóstico , Jamaica , Pruebas de Función de la Tiroides , Pronóstico , Tirotoxicosis/fisiopatología
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