Management of acute myocardial infarction in the public sector in the Bahamas

In 1996 and 1997, 52 patients were admitted to the Princess Margaret Hospital, Nassau, Bahamas, with a confirmed diagnosis of acute myocardial infarction (AMI). The average time to presentation after the onset of symptoms was 18 hours, with 56 percent of patients presenting within 12 hours. Risk factors identified for ischaemic heart disease were hypertension (77 percent), obesity (62 percent), diabetes mellitus (35 percent), tobacco smoking (25 percent), a family history of coronary heart disease (17 percent) and hypercholesterolaemia (8 percent). Medications administered in the treatment of AMI included oral nitrates (96 percent), intravenous heparin (90 percent), beta-blockers (65 percent), morphine (15 percent) thrombolytic agents (8 percent) and lignocaine (4 percent). In hospital post myocardial infarction complications were angina (23 percent), arrhythmias (12 percent) and cardiac failure (10 percent). The average hospital stay was eight days, with a mortality rate of 19 percent. These results show that there is considerable room for improvement, particularly in the use of thrombolytic therapy, to ensure that all patients receive optimal acute and post myocardial infarction care.

Management of acute myocardial infarction in the public sector in the Bahamas

In 1996 and 1997, 52 patients were admitted to the Princess Margaret Hospital, Nassau, Bahamas, with a confirmed diagnosis of acute myocardial infarction (AMI). The average time to presentation after the onset of symptoms was 18 hours, with 56 percent of patients presenting within 12 hours. Risk factors identified for ischaemic heart disease were hypertension (77 percent), obesity (62 percent), diabetes mellitus (35 percent), tobacco smoking (25 percent), a family history of coronary heart disease (17 percent) and hypercholesterolaemia (8 percent). Medications administered in the treatment of AMI included oral nitrates (96 percent), intravenous heparin (90 percent), beta-blockers (65 percent), morphine (15 percent) thrombolytic agents (8 percent) and lignocaine (4 percent). In hospital post myocardial infarction complications were angina (23 percent), arrhythmias (12 percent) and cardiac failure (10 percent). The average hospital stay was eight days, with a mortality rate of 19 percent. These results show that there is considerable room for improvement, particularly in the use of thrombolytic therapy, to ensure that all patients receive optimal acute and post myocardial infarction care. (AU)

Therapeutic alternatives for the hirsute woman

A retrospective analysis of 21 hirsute women seen at a gynecological endocrine clinic revealed a high incidence of infertility, menstrual irregulaties and abnormal androgen profile. Polycystic ovarian syndrome (PCOS) was the underlying abnormality in the majority of cases. Cyproterone acetate (CPA) with ethinyl oestradiol in a reverse sequential regime was more effective and better tolerated but much more expensive than the combination of spironolactone and the oral contraceptive pill (OCP). (AU)

What happens to the diabetic amputee after leaving hospital? - abstract

Very little known of the background, long-term functioning and survival of the amputee, especially in a West Indian setting. A questionnaire was designed to assess the social, domestic and economic effects of amputation in the diabetic. Statistics from the Department of Surgery, General Hospital, Port-of-Spain revealed that 126 patients with above- or below-knee (AK/BK) amputations were discharged from hospital from 1985 to 1988. Eighteen patients were not diabetic and were excluded and 11 could not be located. Data on the remaining 97 amputees were obtained by interviews with patients or relatives of those who had died. Most (76 percent) patients were >60 years old, and the majority were Negroes (66 percent). Sixty-six patients had AK while 31 had BK amputations. At the time of the survey, 36 (37 percent) patients had died, more than two-thirds (69 percent) of deaths occurring within 6 months after discharge. Only 5 percent used prosthesis, and 20 percent remained permanently bed-ridden. Over 90 percent of those employed experienced a fall in income. Only 6 percent were visited by a social worker. About one-quarter (24 percent) felt quite despondent since amputation. Lower limb amputation results in great psychological, social and economic disability and is associated with a high mortality. Much effort is required to prevent limb loss in the diabetic. Aggressive rehabilitation with early prosthetic fitting should improve the outcome for amputees (AU)