Emergency medicine in the Bahamas.

The Bahamas is an archipelago of 700 islands with the majority of the population concentrated on just 2 islands: New Providence and Grand Bahama. Most emergency medical services are provided by Princess Margaret Hospital and Rand Memorial Hospital located respectively on those 2 islands. A detailed description of the delivery, training, and organization of emergency medicine, as well as out-of-hospital care, is provided. Furthermore, disaster preparedness and the future direction of emergency medicine are discussed.

Growing pains: status of emergency medicine in Nicaragua.

Nicaragua is one of the poorest nations in the Western Hemisphere. The health of the population suffers as a result of poor nutrition, epidemic diseases, natural and manmade disasters, sporadic violence, urban industrial growth, and inadequate government funding for even basic medical equipment and supplies. Within this environment, emergency services development has been recognized as an important and cost-effective public health intervention. In recent years, government and nongovernmental agencies working together have had a dramatic positive impact on the quality of emergency care provided.

Gastric emptying in Mexican Americans compared to non-Hispanic whites.

Mexican Americans, a group at high risk for type II diabetes mellitus, have higher postprandial insulin and glucose levels when compared to non-Hispanic whites. A rapid rate of gastric emptying contributes to an increased rate of nutrient absorption and subsequent greater elevation of postprandial glucose and insulin levels. A more rapid rate of gastric emptying and hyperinsulinemia have been observed in patients with recently diagnosed type II diabetes mellitus. In this study, we examined whether Mexican Americans have a more rapid rate of gastric emptying than non-Hispanic whites. Gastric emptying studies were performed on 32 nondiabetic Mexican Americans and on 31 nondiabetic non-Hispanic whites. The rate of gastric emptying following a liquid glucose meal was measured. Serum insulin, plasma glucose, and GIP levels were measured in fasting and postprandial blood samples collected at 15-min intervals for 2 hr. Adjusting for age, body mass index, and gender, the gastric half-emptying time of a glucose meal was significantly (P < 0.05) more rapid for the Mexican American subjects (56.5 +/- 3.4 min) compared to the non-Hispanic white subjects (66.4 +/- 3.5 min). Nondiabetic Mexican Americans empty a liquid glucose meal more rapidly from their stomachs than nondiabetic non-Hispanic whites. Rapid gastric emptying is associated with hyperinsulinemia as a normal physiologic response to increased nutrient availability. The rapid gastric emptying observed in nondiabetic Mexican Americans is associated with hyperinsulinemia and could be a contributing factor for the increased risk of obesity and type II diabetes in this population.

Ethnicity and polycystic ovary syndrome are associated with independent and additive decreases in insulin action in Caribbean-Hispanic women.

This study was conducted to determine the impact of polycystic ovary syndrome and ethnicity on insulin action. Thirteen Caribbean-Hispanic and 10 non-Hispanic white polycystic ovary syndrome women were compared with 5 Caribbean-Hispanic and 8 non-Hispanic white normal women matched for age, weight, and body composition. All subjects underwent a 2-h 75 g oral glucose tolerance test and euglycemic glucose clamp study with a 40 mU.m-2 x min-1 insulin dose. Hepatic glucose production was determined basally and throughout the euglycemic clamp study. Polycystic ovary syndrome was associated with significant increases in fasting insulin levels (P < 0.05) and in 2-h postglucose-load glucose and insulin levels (P < 0.001). Ethnicity was not associated with any changes in these parameters. Polycystic ovary syndrome but not ethnicity was also associated with hepatic insulin resistance, because significant (P < 0.05) residual hepatic glucose production occurred during the euglycemic clamp in the polycystic ovary syndrome women. However, significant independent effects existed for both polycystic ovary syndrome (P < 0.01) and ethnicity (P < 0.05) that resulted in decreased insulin-mediated glucose disposal. Similarly, significant independent effects of polycystic ovary syndrome (P < 0.005) and ethnicity (P < 0.05) occurred, resulting in increased steady-state insulin levels during the euglycemic clamp. This appeared to be, in part, secondary to a decrease in the metabolic clearance rate of insulin associated with ethnicity (P < 0.05). We conclude that polycystic ovary syndrome and ethnicity result in independent and additive decreases in insulin sensitivity in Caribbean-Hispanic women.(ABSTRACT TRUNCATED AT 250 WORDS)

Nailfold capillary abnormalities in childhood rheumatic diseases.

The nailfold capillary patterns of 84 patients with a variety of childhood rheumatic diseases and 34 normal control subjects were observed. Distinctive morphologic abnormalities with capillary dilation and dropout of surrounding structures were noted in two groups: patients with childhood dermatomyositis and with scleroderma (P less than 0.001). Among those with scleroderma, capillary abnormalities were found in all nine patients with systemic disease and in none of 10 patients with cutaneous disease only (Fisher's exact P less than 0.001). Of 25 patients with dermatomyositis for whom muscle biopsies were available for analysis, abnormal nailfold capillary pattern was found with highest prevalence in patients with two or more specific vascular lesions noted on biopsy (Fisher's exact P = 0.041). Nailfold capillary abnormalities are present in distinct populations of childhood rheumatic diseases, reflect the underlying vasculopathy of childhood dermatomyositis, and may be of diagnostic value in distinguishing localized from systemic scleroderma.