Adenomatous polyposis in a young jamaican male of african descent.

We report a case of adenomatous polyposis in a 20-year old African Jamaican male. This is to highlight the importance of aggressively investigating unexplained recurrent anaemia in the young and the impact of psychosocial issues that arise in managing such a patient.

Guillain-Barré syndrome and its variants: a case of acute motor-sensory axonal neuropathy in Jamaica / Síndrome de Guillain-Barré y sus variantes: un caso de la neuropatía axonal sensorial motor aguda en Jamaica

This paper reports a case of a Jamaican young woman who experienced flaccid quadriparesis and bulbar weakness over a three-week period after a gastrointestinal illness. Nerve conduction studies confirmed an axonal type neuropathy consistent with the acute motor-sensory axonal neuropathy variant of the Guillain-Barré syndrome. Recovery, although evident, was slow and was augmented after a course of intravenous immunoglobulin. The patient was discharged from hospital after three months but was re-admitted one week later and eventually succumbed to complications of the illness. This case serves as a reminder that Guillain-Barré syndrome is now the most common cause of acute flaccid paralysis and should be considered early in all patients presenting with flaccid quadriparesis.

El presenta trabajo reporta el caso de una joven jamaicana que experimentó debilidad bulbar y cuadriparesiaflácida por un período de tres semanas después de una enfermedad gastrointestinal. Los estudios de conducción nerviosa confirmaron una neuropatía de tipo axonal en correspondencia con la variante de la neuropatía axonal sensorial motora aguda del síndrome de Guillain-Barré. La recuperación, aunque evidente, fue lenta, y aumentó después de que se le aplicara inmunoglobulina intravenosa. La paciente fue dada de alta del hospital después de tres meses, pero fue ingresada de nuevo una semana más tarde, falleciendo finalmente a causa de las complicaciones de la enfermedad. Este caso sirve como recordatorio de que el síndrome de Guillain-Barré es ahora la causa más común de parálisis flácida aguda, y debe tenerse en cuenta temprano en todos los pacientes que acuden con cuadriparesia flácida.

Guillain-Barré syndrome and its variants: a case of acute motor-sensory axonal neuropathy in Jamaica.

This paper reports a case of a Jamaican young woman who experienced flaccid quadriparesis and bulbar weakness over a three-week period after a gastrointestinal illness. Nerve conduction studies confirmed an axonal type neuropathy consistent with the acute motor-sensory axonal neuropathy variant of the Guillain-Barré syndrome. Recovery, although evident, was slow and was augmented after a course of intravenous immunoglobulin. The patient was discharged from hospital after three months but was re-admitted one week later and eventually succumbed to complications of the illness. This case serves as a reminder that Guillain-Barré syndrome is now the most common cause of acute flaccid paralysis and should be considered early in all patients presenting with flaccid quadriparesis.

The prevalence and significance of oestrogen receptor (ER) positivity in breast cancer at the University Hospital of the West Indies, Jamaica / Prevalencia y significación de la positividad del receptor de estrógeno (RE) en el cáncer de mama en el Hospital Universitario de West Indies, Jamaica

OBJECTIVE: To identify the prevalence of oestrogen receptor (ER) positivity, and determine the relationship of ER status with patient and tumour characteristics, in patients with breast cancer. SUBJECTS AND METHODS: A retrospective review was conducted regarding the prevalence and clinical significance of ER in patients with breast cancer at the University Hospital of the West Indies (UHWI). Oestrogen receptor status results of 243 patients treated at UHWI were collected for the period January 1, 2002 to December 31, 2009. One hundred and ninety-nine were available for review. RESULTS: Oestrogen receptor status was positive in 125 (63%) and negative in 74 (37%) patients. Mean age at diagnosis was 52.6 ± 13.0 years for the ER positive group and 58.5 ± 14.23 years for the ER negative group. Postmenopausal women accounted for 55.2% and 64.9% of the ER positive and negative groups, respectively. Mean BMI was 28.0 kg/m² and 29.6 kg/m² for the ER positive and negative groups, respectively. Menarche occurred mainly between ages 12 and 13 years for both groups. Mean age at 1st parity was 23.4 years for the ER positive and 21.4 years for the ER negative group with median parity of two for both groups. The most prevalent risk factors were oral contraceptive pill (OCP) use (24.3% for the ER positive group, 17.1% for the ER negative group), family history of breast cancer (12.0%; 13.4%) and previous smoking (8.4%; 6.9%). Tumour node metastasis (TNM) stage was Stage II in most cases (46%; 49%). Infiltrating ductal histology was most common (81.5%; 87.7%). Her 2/ neu status was negative for most patients (91.3%; 91.5%). Most patients were disease free (77.6%; 70.0%) after an average follow-up period of 3.5 years. More persons in the ER negative group had locoregional recurrence (8%) and metastases (22%). CONCLUSIONS: Oestrogen receptor positive cohort was more prevalent. The ER negative group was older (p = 0.003).

OBJETIVO: Identificar la prevalencia del receptor de la positividad de receptor de estrógeno (RE), y determinar la relación del estatus de RE con el paciente y las características del tumor, en las pacientes con cáncer de mama. SUJETOS Y MÉTODOS: Se realizó un estudio retrospectivo con respecto a la prevalencia e importancia clínica del RE en los pacientes con cáncer de mama en el Hospital Universitario de West Indies (UHWI). Se recogieron los resultados del estatus del receptor de estrógeno de 243 pacientes tratados en UHWI en el periodo del 1 de enero de 2002 al 31 de diciembre de 2009. Ciento noventa y nueve estuvieron disponibles para examen. RESULTADOS: El estatus del receptor de estrógeno fue positivo en 125 (63%) y negativo en 74 (37%) pacientes. La edad promedio al momento del diagnóstico fue 52.6 ± 13.0 años para el grupo de RE positivo y 58.5 ± 14.23 años para el RE grupo negativo. Las mujeres menopáusicas representaron el 55.2% y el 64.9% del RE de los grupos positivos y negativos respectivamente. El índice de masa corporal (IMC) promedio fue 28.0 kg/m2 y 29.6 kg/m2 para el RE de los grupos positivos y negativos respectivamente. La menarquia ocurrió principalmente entre las edades de 12 y 13 años para ambos grupos. La edad promedio en la primera paridad fue 23.4 años para el grupo de RE positivo y 21.4 años para el de RE negativo, siendo la paridad mediana igual a dos para ambos grupos. Los factores de riesgo de mayor preponderancia fueron el uso de anticonceptivos orales (ACO) (24. 3% para el grupo de RE positivo, 17.1% para el grupo RE negativo); historia familiar de cáncer de mama (12.0%; 13.4%); y hábito de fumar con anterioridad (8.4%; 6.9%). De acuerdo con la estadificación tumor-nódulo-metástasis (TNM), se trataba de la Etapa II en la mayor parte de los casos (46%; 49%). La histología ductal infiltrante fue la más común (81.5%; 87.7%). El estatus Her2/neu fue negativo para la mayoría de las pacientes (91.3%; 91.5%). La mayoría de las pacientes se hallaban libres de enfermedad (77.6%; 70.0%) después de un periodo promedio de seguimiento de 3.5 años. En el grupo de RE negativo había más personas con recurrencia locoregional (8%) y metástasis (22%). CONCLUSIONES: La cohorte positiva del receptor de estrógeno positiva fue más prevaleciente. El grupo negativo de RE fue de mayor edad (p = 0.003).

Lateral medullary infarct/Wallenberg Syndrome: Jamaica / Síndrome de Wallenberg/Infarto medular lateral: Jamaica

We describe two cases of lateral medullary syndrome at the University Hospital of the West Indies, Mona, Jamaica. This diagnosis is often missed and not well understood, so we will discuss the underlying pathophysiology.

Se describen dos casos de síndrome medular lateral en el Hospital Universitario de West Indies, Mona, Jamaica. Este diagnóstico pasa a menudo inadvertido y no es bien entendido. Por esa razón se discute aquí la patofisiología subyacente.

The prevalence and significance of oestrogen receptor (ER) positivity in breast cancer at the University Hospital of the West Indies, Jamaica.

OBJECTIVE: To identify the prevalence of oestrogen receptor (ER) positivity, and determine the relationship of ER status with patient and tumour characteristics, in patients with breast cancer SUBJECTS AND METHODS: A retrospective review was conducted regarding the prevalence and clinical significance of ER in patients with breast cancer at the University Hospital of the West Indies (UHWI). Oestrogen receptor status results of 243 patients treated at UHWI were collected for the period January 1, 2002 to December 31, 2009. One hundred and ninety-nine were available for review. RESULTS: Oestrogen receptor status was positive in 125 (63%) and negative in 74 (37%) patients. Mean age at diagnosis was 52.6 +/- 13.0 years for the ER positive group and 58.5 +/- 14.23 years for the ER negative group. Postmenopausal women accounted for 55.2% and 64.9% of the ER positive and negative groups, respectively. Mean BMI was 28.0 kg/m2 and 29.6 kg/m2 for the ER positive and negative groups, respectively. Menarche occurred mainly between ages 12 and 13 years for both groups. Mean age at 1st parity was 23.4 years for the ER positive and 21.4 years for the ER negative group with median parity of two for both groups. The most prevalent risk factors were oral contraceptive pill (OCP) use (24.3% for the ER positive group, 17.1% for the ER negative group), family history of breast cancer (12.0%; 13.4%) and previous smoking (8.4%; 6.9%). Tumour node metastasis (TNM) stage was Stage II in most cases (46%; 49%). Infiltrating ductal histology was most common (81.5%; 87.7%). Her 2/ neu status was negative for most patients (91.3%; 91.5%). Most patients were disease free (77.6%; 70.0%) after an average follow-up period of 3.5 years. More persons in the ER negative group had locoregional recurrence (8%) and metastases (22%). CONCLUSIONS: Oestrogen receptor positive cohort was more prevalent. The ER negative group was older (p = 0.003).

Lateral medullary infarct/Wallenberg syndrome--Jamaica.

We describe two cases of lateral medullary syndrome at the University Hospital of the West Indies, Mona, Jamaica. This diagnosis is often missed and not well understood, so we will discuss the underlying pathophysiology.

Acute limb ischaemia in a septic patient with diabetic ketoacidosis.

This is a patient with septicaemia and diabetic ketoacidosis who developed an acute ischaemic lower limb from an arterial thrombus. The patient had decreased protein S function.

Acute limb ischaemia in a septic patient with diabetic ketoacidosis / Isquemia aguda de miembros en un paciente septico con cetoacidosis diabetica

This is a patient with septicaemia and diabetic ketoacidosis who developed an acute ischaemic lower limb from an arterial thrombus. The patient had decreased protein S function.

Se trata de un paciente con septicemia y cetoacidosis diabética que desarrolló una isquemia aguda en un miembro inferior a partir de un trombo arterial. El paciente presentaba función disminuida de la proteína S.

A case of lupus-associated pancreatitis in Jamaica / Un caso de pancreatitis asociada con lupus en Jamaica

Pancreatitis complicating a diagnosis of systemic lupus erythematosus (SLE) is rarely reported in the literature and there are no known published cases thus far in the Caribbean. A 50-year old female diagnosed with SLE and discoid lupus erythematosus (DLE) since 1990, presented in February, 2009, to the University Hospital of the West Indies (UHWI), Kingston, Jamaica, with symptoms suggestive of lupus pancreatitis. Serum amylase level was 2341 IU/L and serum lipase was 203 IU/L. Pancreatitis has a 3-8% rate of occurrence in adult patients with SLE. Aetiology and management of this entity remains controversial in these cases, but one must bear the diagnosis in mind, when faced with a SLE patient presenting with abdominal pain, vomiting and diarrhoea.

La pancreatitis que complica el diagnóstico del lupus eritematoso sistémico (LES), raramente se reporta en la literatura, y hasta hoy no se conoce de caso alguno publicado en el Caribe. Una mujer de 50 años de edad, a quien se le diagnosticara lupus eritematoso sistémico (LES), y lupus eritematoso discoide (LED) desde 1990, acudió en febrero de 2009 al Hospital Universitario de West Indies, Kingston, Jamaica, con síntomas que sugerían una pancreatitis por lupus. El nivel de amilasa sérica fue 2341 IU/L y el de lipasa sérica fue 203 IU/L. La pancreatitis tiene una tasa de ocurrencia de 3-8% en pacientes adultos con LES. La etiología y el tratamiento de esta entidad siguen siendo controversiales en estos casos, pero se debe tener presente el diagnóstico frente a pacientes de SLE que presenten dolor abdominal, vómito y diarrea.

A case of lupus-associated pancreatitis in Jamaica.

Pancreatitis complicating a diagnosis of systemic lupus erythematosus (SLE) is rarely reported in the literature and there are no known published cases thus far in the Caribbean. A 50-year old female diagnosed with SLE and discoid lupus erythematosus (DLE) since 1990, presented in February, 2009, to the University Hospital of the West Indies (UHWI), Kingston, Jamaica, with symptoms suggestive of lupus pancreatitis. Serum amylase level was 2341 IU/L and serum lipase was 203 IU/L. Pancreatitis has a 3-8% rate of occurrence in adult patients with SLE. Aetiology and management of this entity remains controversial in these cases, but one must bear the diagnosis in mind, when faced with a SLE patient presenting with abdominal pain, vomiting and diarrhoea.

Descriptive epidemiology of cases of acute myocardial infarction in Tobago / Epidemiología descriptiva de casos de infarto agudo del miocardio en Tobago

OBJECTIVES: The goal of this study is to identify co-morbidities associated with acute myocardial infarction in Tobago. METHODS: This was a longitudinal retrospective study of myocardial infarction at the Tobago Regional Hospital in two selected periods: January 2007 to April 2007 and January 2008 to April 2008. Data were retrieved from the patients' medical records. These included co-morbid conditions eg hypertension, diabetes mellitus, dyslipidaemia, ESRD, whether history of smoking or cocaine use and if any prior care. In the former period, 11 cases were confirmed as having myocardial infarction and 27 cases in the latter period. RESULTS: In 2007 and 2008, all cases had dyslipidaemia (LDL > 100 mg/dL) and were hypertensive. There were 36.4% of cases in 2007 that had diabetes mellitus, compared to 33.3% cases in 2008 and 9.1% had chronic kidney disease in 2007, compared to 25.9% in 2008. CONCLUSION: The most common co-morbidities associated with acute myocardial infarction in Tobago are dyslipidaemia, hypertension and diabetes mellitus, with ESRD, smoking and cocaine use less so. Many of these patients had never received prior care.

OBJETIVOS: El objeto de este estudio fue identificar las comorbilidades asociadas con el infarto agudo del miocardio en Tobago. METÓDOS: Se realizó un estudio retrospectivo longitudinal del infarto del miocardio en el Hospital Regional de Tobago, en dos períodos: enero de 2007 a abril de 2007, y enero de 2008 a abril de 2008. Los datos fueron obtenidos a partir de las historias clínicas de los pacientes. Estos datos incluyeron condiciones co-mórbidas, por ejemplo, hipertensión, diabetes mellitus, dislipidemia, ERFT, historia de hábito de fumar o uso de cocaína, y cualquier atención previa del caso, si la hubiese. En el primero de estos períodos, se confirmó que 11 casos tenían infarto del miocardio, en tanto en el último caso se confirmaron 27 casos. RESULTADOS: En 2007 y 2008, todos los casos padecían de dislipidemia (LDL > 100 mg/dL) y eran hipertensos. El 36.4% de los casos en 2007 sufría de diabetes mellitus, en comparación con el 33.3% de los casos en 2008. El 9.1% tenía la enfermedad renal crónica en 2007, en comparación con el 25.9% en 2008. CONCLUSIÓN: Las comorbilidades más comunes asociadas con el infarto agudo del miocardio en Tobago son la dislipidemia, la hipertensión y la diabetes mellitus, y en menor grado la ERET, el hábito de fumar, y el consumo de cocaína. Muchos de estos pacientes no habían recibido nunca atención con anterioridad.

Descriptive epidemiology of cases of acute myocardial infarction in Tobago.

OBJECTIVES: The goal of this study is to identify co-morbidities associated with acute myocardial infarction in Tobago. METHODS: This was a longitudinal retrospective study of myocardial infarction at the Tobago Regional Hospital in two selected periods: January 2007 to April 2007 and January 2008 to April 2008. Data were retrieved from the patients' medical records. These included co-morbid conditions eg hypertension, diabetes mellitus, dyslipidaemia, ESRD, whether history of smoking or cocaine use and if any prior care. In the former period, 11 cases were confirmed as having myocardial infarction and 27 cases in the latter period. RESULTS: In 2007 and 2008, all cases had dyslipidaemia (LDL > 100 mg/dL) and were hypertensive. There were 36.4% of cases in 2007 that had diabetes mellitus, compared to 33.3% cases in 2008 and 9.1% had chronic kidney disease in 2007, compared to 25.9% in 2008. CONCLUSION: The most common co-morbidities associated with acute myocardial infarction in Tobago are dyslipidaemia, hypertension and diabetes mellitus, with ESRD, smoking and cocaine use less so. Many of these patients had never received prior care.

Genital ulcers: etiology, clinical diagnosis, and associated human immunodeficiency virus infection in Kingston, Jamaica

Individuals presenting consecutively with genital ulcers in Kingston, Jamaica, underwent serological testing for human immunodeficiency virus (HIV) infection , chlamydial infection, and syphilis. Ulcer material was analyzed by the multiplex polymerase chain reaction (M-PCR) analysis DNA from herpes simplex virus (HSV), Haemophilus ducreyi, and Treponema pallidum was detected in 158 (52.0 percent), 72 (23.7 percent), and 31 (10.2 percent) of 304 ulcer specimens. Of the 304 subjects, 67 (22 percent) were HIV-seropositive and 64 (21 percent) were T. pallidum-seroactive. Granuloma inguinale was clinically diagnosed in nine (13.4 percent) of 67 ulcers negative by M-PCR analysis and in 12 (5.1 percent) of 237 ulcers positive by M-PCR analysis (P = .03). Lymphogranuloma venereum was clinically diagnosed in eight patients. Compared with M-PCR analysis, the sensitivity and specificity of a clinical diagnosis of syphilis, herpes, and chancroid were 67.7 percent, 53.8 percent, and 75 percent and 91.2 percent, 83.6 percent, and 75.4 percent, respectively. Reactive syphilis serology was 74 percent sensitive and 85 percent specific compared with M-PCR analysis. Reported contact with a prostitute in the preceding 3 months was associated with chancroid (P = .009), reactive syphilis serology (P = .011), and HIV infection (P = .007). The relatively poor pleads for syndromic management of genital ulcers in Jamaica. Prevention efforts should be intensified.(Au)

HDV 16 antibody prevalence in Jamaica and the United States reflects differences in cervical cancer rates

Human papillomavirus (HPV) is widely accepted as the primary etiologic agent in the development of cervical cancer. DNA of a particular HPV type, HPV 16, is found in about half of tumors tested. Inconsistent with this causal relationship, however, population-based studies of HPV DNA prevalence have often failed to find high rates of anogenital HPV infection in countries with high cervical cancer rates. To examine this issue, we used serology to compare HPV 16 exposure in healthy volunteer blood donors in the United States (n = 278) and similar subjects from a country with 3-fold higher cervical cancer rates, Jamaica (n = 257). Jamaican sexually transmitted disease (STD) patients (n = 831) were also studied to examine in detail the relation of HPV 16 antibodies with sexual history. Serology was conducted using an ELISA employing HPV 16 virus-like particles (VLPs). Age-adjusted seroprevalence rates were greatest among male (29 percent) and female (42 percent) STD patients, intermediate in male (19 percent) and female (24 percent) Jamaican blood donors and lowest among male (3 percent) and female (12 percent) U.S. blood donors. The higher seroprevalence in women was significant, and prevalence tended to increase with age. In multivariate logistic regression, controlling for age and gender, Jamaican blood donors were 4.2-fold (95 percent CI 2.4 - 7.2) and STD patients 8.1-fold (95 percent CI 5.0 - 13.2) more likely to have HPV 16 VLP antibodies than U.S. blood donors. Among STD patients, HPV 16 antibodies were associated with lifetime number of sex partners and years of sexual activity, as well as other factors. Our data suggest that HPV 16 VLP antibodies are strongly associated with sexual behavior. Moreover, exposure to HPV 16 appears to be much greater in Jamaica than in the United States, consistent with the high rate of cervical cancer in Jamaica (Au)

HIV/STD control in Jamaica

Reported AIDS case rates in the Caribbean, with the notable exception of Cuba, tend to be relatively high. While the pattern of HIV spread does vary among the different Caribbean countries, the HIV/AIDS epidemic in Jamaica appears to be less developed than that found in most other Caribbean territories, except Cuba. Jamaica has a comprehensive HIV/STD control programme which, since the late 1980s, pioneered the integration of HIV and STD, contact tracing of persons with HIV/AIDS, syndromic management of STDs, a variety of innovative behaviour change communications programmes, the promotion of condom use for all sexual encounters and a policy of dual method use, i.e., an effective family planning method and the condom. A unique National AIDS Committee was established in 1988 and research had been used widely to guide the development of the HIV/AIDs control programme and evaluate its progress. The annual AIDS case rate in Jamaica has increased only marginally in the past 3 years from 18.5 per 100 000 population in 1995 to 21.4 in 1997. HIV prevalence in the general population groups tested has been about 1 percent or less, 6.3 percent in STD clinic attenders, around 10 percent and 20 percent in female prostitutes in Kingston and Montego Bay, respectively, and approximately 30 percent among homosexuals. Syphilis rates have declined and condom use has increased considerably. HIV/AIDS control measures have apparently slowed the HIV/AIDS epidemic in Jamaica; however, a significant minority of persons continue to have unprotected sex in high risk situations.(AU)