RESUMO
The clinical characteristics, autoantibody profiles and seroprevalence of human T lymphotropic virus Type 1 (HTLV-1) were assessed in 30 Jamaican patients with Type 1 diabetes mellitus. Two hundred and fifty-two blood donors and 108 patients with Graves' disease were included as controls for the HTLV-1 component of the study. The mean age of onset of diabetes mellitus was 20.5 +/- 9.2 years and the mean duration of diabetes mellitus was 10.5 +/- 6.1 years. The remarkable clinical data included an absence of other associated organ-specific autoimmune diseases, and clinical evidence and history of congenital rubella in one patient. Islet cell cytoplasmic antibodies (ICA) were absent but 17% (5/30) of the diabetic patients tested positive for glutamic acid decarboxylase (GAD) antibodies. No other organ-specific autoantibodies were detected but non-organ-specific autoantibodies were present in 9 (30%) of the sera of diabetic patients. The seroprevalence of HTLV-1 in the patients with diabetes mellitus was significantly higher than that in the healthy controls (17% (5/30) versus 4% (11/252), p = 0.05). Autoantibodies were found in the sera of 4/5 (80%) of the diabetic patients who were positive for HTLV-1. None of the patients with onset of diabetes mellitus below age 15 years was HTLV-1 positive. The likely polyaetiological nature of Type 1 diabetes mellitus in Jamaicans is being further investigated at the molecular level.
Assuntos
Autoanticorpos/sangue , Diabetes Mellitus Tipo 1/imunologia , Anticorpos Anti-HTLV-I/sangue , Adulto , Diabetes Mellitus Tipo 1/virologia , Feminino , Doença de Graves/imunologia , Doença de Graves/virologia , Humanos , Jamaica , Leucemia-Linfoma de Células T do Adulto/complicações , Masculino , Pessoa de Meia-Idade , Paraparesia Espástica Tropical/complicações , Estudos SoroepidemiológicosRESUMO
Paroxysmal nocturnal haemoglobinuria may be complicated by life-threatening thrombosis. A patient who presented with the classical clinical picture of cerebral sinus thrombosis is described. Management of the condition is discussed.
Assuntos
Trombose dos Seios Intracranianos/complicações , Hemoglobinúria Paroxística/complicações , Trombose dos Seios Intracranianos/etiologia , Trombose dos Seios Intracranianos , Trombose dos Seios Intracranianos/terapia , Punção Espinal , Transtornos da Visão/etiologia , Hemoglobinúria Paroxística/terapiaRESUMO
Chronic arsenic poisoning is an uncommon cause of peripheral neuropathy in Jamaica. A patient with this disorder is described. The insidious nature of chronic arsenic poisoning, with its disabling complications, is emphasised.
Assuntos
Arsênio/intoxicação , Doenças do Sistema Nervoso Periférico/etiologia , Neurite (Inflamação)/etiologia , Intoxicação/diagnóstico , Dimercaprol/uso terapêutico , Ceratose/etiologiaRESUMO
Clinical, immunological and genetic parameters were studied in 73 Jamaican patients with myasthenia gravis (Mg). The reported biomodal clinical distribution of females with early onset of disease and males with late onset was not observed. The female to male ratio was 2:1. The most frequent manifestations of disease were ptosis (84.9%), general muscle weakness (68.5%), bulbar symptoms (41.1%) and diplopia (32.9%). Unusual presenting features such as unilateral ptosis, recurrent chest infection and stumbling while walking resulted in diagnosis being missed in 5.8%of cases. The sensitivity of radiommunoassay in detecting acetylcholine receptor antibody (AchR-Ab) in sera from a subgroup of 35 MG patients was 71.4%whilst that of the ELISA was only 14.2%. There was no correlation between HLA-type, thymic pathology and course of disease. HTLV-I could not be implicated in the pathogenesis of this disease. There was a paucity of other associated autoimmune conditions among MG patients. Thymectomy was an important therapeutic modality in that improvement was observered in 22 cases and remission in 11.
