Trypanosoma cruzi infection associated with Chagas' heart disease in humans in South Trinidad - abstract

Human infection with Trypanosoma cruzi, the aetiological agent of chagas' heart disease, is believed to be sporadic or non-existent in Trinidad. This study was undertaken to investigate whether human infection with T. cruzi occurs in Trinidad and whether this infection is associated with chagas' heart disease. Peripheral blood was withdrawn aseptically from 192 cardiac patients seen at the General Hospital, San Fernando from May to August, 1992. Sera were tested for T. cruzi IgG antibodies by an ELISA test and Giemsa-stained thick and thin smears of fresh blood examined for trypomastigotes of T. cruzi. Following physical examination, chest X-ray and 12-lead ECG, patients with findings consistent with ischaemic heart disease, hypertension, vavular heart disease, cardiomyopathy, diabetes, alcoholism, cigarette smoking and blood cholesterol > 220 mg/dl were excluded from further study. The remaining patients were subjected to echocardiography. Seventy-two (37.5 per cent) were positive for T. cruzi antibodies and 49 (68 per cent) of these had T. cruzi trypomastigotes in peripheral blood. After further review of 37 of these 49 seropositive parasite-positive patients, 12 were excluded on the basis of findings compatible with other cardiac diseases. Apical aneurysm, a cardinal sign of Chagas' disease, was found in the left and/or right ventricle of the heart in 21 patients. Our results present conclusive evidence that T. cruzi infection occurs in humans in Trinidad and that this infection is associated with cardiac pathology consistent with that of Chagas' heart disease (AU)

Suspected acute myocardial infarction: intravenous beta-blockade outside the coronary care unit: a pilot study

Shortage of Coronary Care Unit (CCU) beds prompted a study (I) to determine the number of patients with a suspected acute myocardial infarction (SAMI) who could not be placed in the CCU, but qualified for intravanous (IV) B-Blocker therapy, and (II) to assess the safety of such therapy in a general medical ward. During a six-month period, 34 patients with chest pain and E.C.G. changes of SAMI could not be placed in the CCU. Criteria for exclusion from B-Blocker therapy were the presence of >= 1 of the following: (1) age > 70 years, (2) Systolic B.P. < 100 mmHg, (3) Heart rate < 60 /min., (4) Cardiac failure, (5) Heart block, (6) Poor peripheral circulation, (7) Asthma or chronic bronchitis, and (8) Prior therapy with B-Blocker or calcium antagonists. 15 (44 percent) patients were excluded from therapy based on the above criteria. 19 (56 percent) received 5-10 mg atenolol IV within 3-10 hours of onset of chest pain and atenolol 100 mg daily was started immediately and continued indefinitely. 12 of these patients had an anterior wall, and 3 an inferior wall infarction. 3 developed congestive cardiac failure and none required anti-arrhythmic therapy. There were 2 deaths - 1 from ventricular asystole, and the other from cardiogenic shock 8 and 12 hours respectively after IV atenolol. While this small-scale study highlights the need for more CCU beds for optimum care, our results suggest that selected patients with SAMI managed in the general medical wards can still safely obtain the benefits of IV B-Blockade. (AU)

Acute porphyria in Trinidad - abstract

Prompted by reports of acute porphyria in continental Africa and India, and in African populations in the U.S.A., a prospective study was undertaken to determine prevalence and characteristics of acute porphyria amongst emergency admissions to the medical wards of a West Indian general hospital over a 30-month period. The population surveyed was about 500,000 persons mainly from African and Indian (Asian) descent. Criteria for diagnosis were suggestive clinical features, past medical history and the presence of excess of urinary porphobilinogen as determined by the Watson Schwartz test. Six unrelated cases of typical acute porphyria were identified from among 25,000 admissions. Sixty controls matched for age, sex and ethnic origin had a negative Watson Schwartz test. Patients ranged in age from 13 to 26 years and none had a family history of porphyria-type illness. Ethnic origin was not a distinctive feature and there was considerable morbidity due to non-recognition that acute porphyria is more common in West Indians than hitherto suspected and there should be greater efforts to diagnose the disease (AU)

ACTH - inosine pranobex in the treatment of AIDS: encouraging results

Twenty patients with acquired immune deficiency syndrome (AIDS) received treatment with inosine pranobex and specific antibacterial andanti-parasitic therapy. Five died shortly after hospitalization, but a further fifteen who also received ACTH, survived, gained weight and improved clinically, biochemically and haematologically (AU)

Monosodium acid methanearsonate (M.S.M.A.) poisoning in man

A case of self-poisoning by the weed-killer monosodium acid methanearsonate is reported. Complications observed included gastritis, deafness, myocarditis, hepatitis, nephritis, peripheral neuropathy and eosinophilia. Transverse white bands (Aldrich Mee's lines) appeared on the finger nails eight weeks later, and severe bilateral sensorineural deafness, an hitherto undescribed complication, was still present after one year. There is need for an increased awareness of the toxic effects of this arsenical used locally (AU)

Congenital heart disease in the adult - abstract

This study is an analysis of eighty (80) cases of congenital heart disease seen in adults at the San Fernando General Hospital. This diagnosis was based on history, physical examination, chest X-Ray, electrocardiography, M-mode echocardiography, two-dimensional echocardiography and contrast two-dimensional echocardiography. Seventy per cent (70 percent) of the cases had septal defect, thirty-five per cent (35 percent) atrial and thirty-five per cent (35 percent) ventricular. Patent ductus arteriosus accounted for 12.5 per cent and cyanotic congenital heart disease 10 per cent. There were two cases of coarctation of the aorta, two of pulmonary stenosis and one each of aortic stenosis and anolamous pulmonary venous return. Females exceeded males by 2:1. Fifty-two per cent (52 percent) of the cases were in the age group 12 - 20 years and twenty-five per cent (25 percent) were older than age 30. Moderate to severe pulmonary hypertension was present in 23 cases - two patent ductus arteriosus, nine atrial septal defect and twelve ventricular septal defect. Shunt reversal was demonstrated with contrast two-dimensional echocardiography in five cases of ASD and six cases of ventricular septal defect. Two patients had corrective surgery - one closure of ASD at age 32 and the other repair of Fallot's tetralogy at age 17. After cardiac catherization two patients were considered inoperable because of severe pulmonary hypertension and poor ventricular function. Six patients died from congential heart disease. Three had trial septal defect with severe pulmonary hypertension, one each had ventricular septal defect, coarctation of the aorta and cyanotic congenital heart disease. The majority of our patients have defects which are surgically correctable with low mortality. The introduction of open-heart surgery in Trinidad in the near future should improve the prognosis of these patients (AU)

Early discharge after myocardial infarction

A pilot study of early discharge after acute myocardial infarction was conducted on 50 consecutive admissions to a general medical ward. 7 patients died in hospital. Of the survivors 51 percent were discharged by the seventh day, 74 percent by the ninth day and 90 percent by the twelfth day. At 3 months after discharge all but 1 of the seventh day discharges were alive and 93 percent of those previously employed had resumed their former occupation. Early discharge of selected patients after myocardial infarction is strongly advocated in developing countries to enhance optimum usage of limited resources of hospital beds, health personnel and health care funds. (AU)