Increasing incidence of admissions to a General Hospital for deliberate self-harm in trinidad / Aumento de la incidencia de ingresos al Hospital General por auto-daño deliberado en trinidad

BACKGROUND: Deliberate self-harm and suicidal behaviour have become an increasingly common form of morbidity in the developing world. Suicidal behaviour is a major public health problem in Trinidad as the country has the second highest completed suicide rate in the English-speaking Caribbean. The objectives of this study were to determine the epidemiology of attempted suicide and self-harm at a specified site (the Port-of-Spain General Hospital) and compare it to previous studies done at the same site. SUBJECTS AND METHODS: This was investigated through a review of one years' admissions to the Port-of-Spain General Hospital for suicidal behaviour. Incidence was compared with a previous study completed at this site and reported in 1974. Comparison of the demographic characteristics of the sample with that of the previous study was also undertaken using chi-square analysis and significance testing through the use of t tests. RESULTS: A total of 368 referrals were made for attempted suicide or deliberate self-harm over the period indicating a fourfold increase in the incidence of this behaviour with a greater increase among males where the female to male ratio has declined from 4 to 1 to 2 to 1, p < 0.001; the mean age of males was 34 years compared to females 22 (p < 0.0001). The males were more likely to use violent means compared to females who were more likely to ingest tablets or bleach. Relationship difficulties were most commonly cited by both males and females as the reason for their attempt. There was a trend to greater propensity for this behaviour among Indo-Trinidadians as compared to Afro-Trinidadians in both females and males. CONCLUSIONS: Increasing numbers of men are engaging in self-harm behaviour and are using more violent and physically harmful methods suggesting a greater degree of suicidal risk while women mainly engage in acts of ingestion with a much lower risk of death. The older mean age of these men suggests that their problems are presenting in middle adulthood while women are engaging in this behaviour in young adulthood. Suicidal behaviour or deliberate self-harm is a major public health problem in Trinidad.

ANTECEDENTES: El auto-daño deliberado y el comportamiento suicida se han convertido cada vez más en una forma común de morbosidad en el mundo en vías de desarrollo. El comportamiento suicida es un serio problema de salud pública en Trinidad, como país que tiene la tasa más alta de suicidios efectuados en el Caribe anglófono. Los objetivos de este estudio fueron determinar la epidemiología del suicidio efectuado y el auto-daño en un lugar específico (el Hospital General de Puerto España) y compararla con estudios previos realizados en el mismo lugar. SUJETOS Y MÉTODOS: Esto fue investigado mediante una revisión de los ingresados de un año al Hospital General de Puerto España por comportamiento suicida. La incidencia fue comparada con un estudio previo terminado en este sitio y reportado en 1974. La comparación de las características demográficas de la muestra con la del estudio previo se llevó a cabo usando un análisis de chi-cuadrado y pruebas de significatividad mediante el uso de tests t. RESULTADOS: Se produjeron un total de 368 casos referidos por intento de suicidio o auto-daño deliberado en el período en cuestión, lo cual indica que la incidencia de esta conducta aumentó en cuatro veces, con un mayor incremento entre los varones, y una disminución de la proporción hembras-varones de 4:1 a 2:1; p < 0.001); la edad promedio de los varones fue 34 años en comparación con la de las hembras, 22 (p < 0.0001). Los varones mostraron una tendencia mayor a usar medios violentos en comparación con las hembras, entre las que había una mayor probabilidad de ingerir tabletas o lejía. Las dificultades en las relaciones constituyeron la explicación más comúnmente dada como causa del intento, tanto por los varones como por las hembras. Hubo tendencia a una mayor propensión a este comportamiento entre los indo-trinitenses en comparación con los afro-trinitenses, tanto en hembras como varones. CONCLUSIONES: Un número cada vez mayor de hombres se involucran en conductas auto-agresivas y están usando métodos más violentos y físicamente dañinos, lo que sugiere un grado mayor de riesgo de suicidio, mientras que las mujeres se entregan principalmente a actos de ingestión con riesgo mucho menor de muerte. La edad promedio mayor de estos hombres sugiere que sus problemas se presentan en medio de su adultez, mientras que las mujeres se entregan a estas conductas como adultos jóvenes. La conducta suicida y el auto-daño deliberado constituyen un problema principal de salud pública en Trinidad.

Increasing incidence of admissions to a general hospital for deliberate self-harm in Trinidad.

BACKGROUND: Deliberate self-harm and suicidal behaviour have become an increasingly common form of morbidity in the developing world Suicidal behaviour is a major public health problem in Trinidad as the country has the second highest completed suicide rate in the English-speaking Caribbean. The objectives of this study were to determine the epidemiology of attempted suicide and self-harm at a specified site (the Port-of-Spain General Hospital) and compare it to previous studies done at the same site. SUBJECTS AND METHODS: This was investigated through a review of one years' admissions to the Port-of-Spain General Hospital for suicidal behaviour. Incidence was compared with a previous study completed at this site and reported in 1974. Comparison of the demographic characteristics of the sample with that of the previous study was also undertaken using chi-square analysis and significance testing through the use of t tests. RESULTS: A total of 368 referrals were made for attempted suicide or deliberate self-harm over the period indicating a fourfold increase in the incidence of this behaviour with a greater increase among males where the female to male ratio has declined from 4 to 1 to 2 to 1, p < 0.001; the mean age of males was 34 years compared to females 22 (p < 0.0001). The males were more likely to use violent means compared to females who were more likely to ingest tablets or bleach. Relationship difficulties were most commonly cited by both males and females as the reason for their attempt. There was a trend to greater propensity for this behaviour among Indo-Trinidadians as compared to Afro-Trinidadians in both females and males. CONCLUSIONS: Increasing numbers of men are engaging in self-harm behaviour and are using more violent and physically harmful methods suggesting a greater degree of suicidal risk while women mainly engage in acts of ingestion with a much lower risk of death. The older mean age of these men suggests that their problems are presenting in middle adulthood while women are engaging in this behaviour in young adulthood. Suicidal behaviour or deliberate self-harm is a major public health problem in Trinidad.

Preliminary bioassay of Neem (Azadirachta indica) bark extract as a phytoacaricide against test species Boophilus microplus

This paper describes the extraction of the Neem (Azadirachta indica) bark and the determination of any statistically significant ascaricidal activity in the extract. The hexane extract of a bark sample, after reconstitution in dimethlysufoxide, was used to perform a bioassay on tick (Boophilus microplus) specimens, which were collected from cattle that had not been exposed to any acaricide for six weeks preceding (tick) collection. The percentage mortality of Boophhilus microplus obtained post administration were 100% for the pyrethroid cypermethrin, 56% for Azadirachta indica bark extract, distilled water- 8% and dimethylsulfoxide-16%. These differences in results were statistically significant at p<0.001.

Preliminary bioassay of Neem (Azadirachta indica) bark extract as a phytoacaricide against test species Boophilus microplus

This paper describes the extraction of the Neem (Azadirachta indica) bark and the determination of any statistically significant ascaricidal activity in the extract. The hexane extract of a bark sample, after reconstitution in dimethlysufoxide, was used to perform a bioassay on tick (Boophilus microplus) specimens, which were collected from cattle that had not been exposed to any acaricide for six weeks preceding (tick) collection. The percentage mortality of Boophhilus microplus obtained post administration were 100% for the pyrethroid cypermethrin, 56% for Azadirachta indica bark extract, distilled water- 8% and dimethylsulfoxide-16%. These differences in results were statistically significant at p<0.001.

Preliminary determination of median lethal dose of Azadirachta indica (A. ) Juss bark extract against Boophilus microplus

The study was carried out in order to determine the effective dose of Azadirachta indica as an acaride. From a range of effective doses, nine (9) test doses ranging from zero (0) parts per million to one hundred and fifty parts (150) per million were selected. The test species Boophilus microplus was subjected to a standard bioassay. A dose response curve was plotted of percentage mortality of B. microplus against logarithmic dosage of A indica. The lethal dose, LD50 and LD100 were also determined. The LD50 was 30.20 parts per million and LD100 was found to lie between 80 and 100 parts per million. Regression analysis was performed to verify correlation of data. The data proved to be linear with a correlation coefficient of 0.89. The results of this study indicate that when the dose required to achieve 50 percent mortality is compared to average yield of A. indica bark extract obtained in previous studies (Maharaj et al 2003), the extract appears to be feasible with respect to production for use as a prospective pesticide. This is an important point for consideration as the failure in the commercialization of many plant products is often due to the yields being too low. The bark extract of Azadirachta indica has thus far proven to be worthy of consideration for further development as a phytoacaricide

A retrospective study of the treatment of toad poisoning in dogs in Trinidad.

A retrospective study of 143 cases of dogs poisoned by toads in Trinidad revealed that for the 81 cases for which the clinical signs were recorded, cardiac toxicity may have been missed due to the aggressive use of atropine therapy and/or lack of equipment. The most common clinical signs were hypersalivation and vomiting (31 reports) and convulsive seizures (14) - each ascribed to the effects of certain components present in the toad's glandular secretions (producing irritation and neurotoxicity); and hyperthermia (11). For 42 cases, treatment records indicated that atropine was the favoured pharmacological intervention (30 instances), followed by corticosteroids (20), antibiotics (19), benzodiazepines (15) and fluid therapy (14). These treatment strategies, based on symptomatic support, seemed to be successful even though they appeared to lack coherence. Of the 90 cases for which outcome data were available, 85 dogs recovered fully and 5 died. Early attention to cardiac abnormalities, using electrocardiograms, is required especially in severe cases. The use of propranolol is also warranted in these cases. The standard management of toad poisoning must also include decontamination of the gastrointestinal tract involving the washing of the mouth and the use of adsorbents. The usefulness of corticosteroids and antibiotic therapies should be re-examined.

A retrospective study of the treatment of toad poisoning in dogs in Trinidad.

A retrospective study of 143 cases of dogs poisoned by toads in Trinidad revealed that for the 81 cases for which the clinical signs were recorded, cardiac toxicity may have been missed due to the aggressive use of atropine therapy and/or lack of equipment. The most common clinical signs were hypersalivation and vomiting (31 reports) and convulsive seizures (14) - each ascribed to the effects of certain components present in the toad's glandular secretions (producing irritation and neurotoxicity); and hyperthermia (11). For 42 cases, treatment records indicated that atropine was the favoured pharmacological intervention (30 instances), followed by corticosteroids (20), antibiotics (19), benzodiazepines (15) and fluid therapy (14). These treatment strategies, based on symptomatic support, seemed to be successful even though they appeared to lack coherence. Of the 90 cases for which outcome data were available, 85 dogs recovered fully and 5 died. Early attention to cardiac abnormalities, using electrocardiograms, is required especially in severe cases. The use of propranolol is also warranted in these cases. The standard management of toad poisoning must also include decontamination of the gastrointestinal tract involving the washing of the mouth and the use of adsorbents. The usefulness of corticosteroids and antibiotic therapies should be re-examined.

Forensic analysis of acute fatal poisonings in the southern districts of Trinidad.

A prospective autopsy study was undertaken at General Hospital in San Fernando, Trinidad, to analyze deaths that occurred from poisoning during 1996 and 1997. During that period 105 deaths occurred from acute poisoning. The major poisons used were: paraquat (80 cases), organophosphate/carbamate insecticides (10 cases), and anti-psychotic drugs (6 cases). Much less frequently, battery acid, ETHREL[Ethephon; (2-chloroethyl)phosphonic acid], phenols, ethanol, kerosene and flavine were the agents of choice. Suicide accounted for 99 (94.29%) deaths. Of these, 44.44% occurred in the 10-29 y-age-group. Ingestion of paraquat seems almost always fatal, since the large volumes ingested make treatment universally ineffective. Aspiration pneumonitis (100% of cases), and pneumothorax with pneumomediastinum (18.75% of cases), were remarkable autopsy findings in those dying from paraquat poisoning, while asphyxia due to respiratory paralysis was the mode of death from pesticide ingestion. Efforts to prevent suicide by poisoning may be more useful than treatment protocols.

Fatal cardiac toxicity temporally related to poly-drug abuse.

An 18-y-old male suffered sudden cardiac death following the use of cocaine, cannabis and ethanol. The pathophysiology of cardiac toxicity temporally related to the use of cocaine, cannabinoids and ethanol is reviewed.

Suicide by poisoning.

An epidemiological evaluation was conducted on 270 patients who died at the General Hospital, Port-of-Spain after presenting with deliberate self-poisoning between January, 1986 and June, 1990. The cause of death was confirmed by autopsy and toxicological analysis. Epidemiological variables of age, sex, race, precipitating factors and types of poison used were assessed. It was found that the male to female ratio was 2.7:1. East Indians accounted for 54.4%, Africans 42.0%, people of mixed ethnic origin 3% and Caucasians 0.6%. The majority of cases (52.6%) were seen in the age group 11-34 years. "Lovers' quarrels" (35.4% of cases), psychiatric illness (27.8% of cases) and family disputes (27% of cases) were reported as the most frequent precipitating events in suicide. East Indians predominated in those suicides precipitated by "lovers' quarrels" and family disputes, accounting for 63.2% and 58.9% of these cases, respectively; while for those suicides in which psychiatric illnesses were the main precipitating event. Africans were represented by 53.3% and East Indians 45.3%. Depression was the most common psychiatric illness diagnosed. Paraquat was the most popular poison used in 63.7% of the suicidal cases, and other agrochemicals were used in 20% of cases.

Suicide by poisoning

An epidemiological evaluation was conducted on 270 patients who died at the General Hospital, Port-of-Spain after presenting with deliberate self-poisoning between January, 1986 and June, 1990. The cause of death was confirmed by autopsy and toxicological analysis. Epidemiological variables of age, sex, race, precipitating factors and types of poison used were assessed. It was found that the male to female ratio was 2.7:1. East Indians accounted for 54.4percent , Africans 42.0 percent, people of mixed ethnic origin 3 percent and Caucasians 0.6 percent. The majority of cases (52.6 percent) were seen in the age group 11-34 years. "Lovers' quarrels" (35.4 percent of cases), psychiatric illness (27.8 percent of cases) and family disputes (27 percent of cases) were reported as the most frequent precipitating events in suicide. East Indians predominated in those suicides precipitated by "lovers' quarrels" and family disputes, accounting for 63.2 percent and 58.9 percent of these cases, respectively; while for those suicides in which psychiatric illnesses were the main precipitating event, Africans were represented by 53.3 percent and East Indians 45.3 percent. Depression was the most common psychiatric illness diagnosed. Paraquat was the most popular poison used in 63.7 percent of the suicidal cases, and other agrochemicals were used in 20 percent of the cases. (AU)

Suicide by poisoning

An epidemiological evaluation was conducted on 270 patients who died at the General Hospital, Port-of-Spain after presenting with deliberate self-poisoning between January, 1986 and June, 1990. The cause of death was confirmed by autopsy and toxicological analysis. Epidemiological variables of age, sex, race, precipitating factors and types of poison used were assessed. It was found that the male to female ratio was 2.7:1. East Indians accounted for 54.4%, Africans 42.0%, people of mixed ethnic origin 3% and Caucasians 0.6%. The majority of cases (52.6%) were seen in the age group 11-34 years. "Lovers' quarrels" (35.4% of cases), psychiatric illness (27.8% of cases) and family disputes (27% of cases) were reported as the most frequent precipitating events in suicide. East Indians predominated in those suicides precipitated by "lovers' quarrels" and family disputes, accounting for 63.2% and 58.9% of these cases, respectively; while for those suicides in which psychiatric illnesses were the main precipitating event, Africans were represented by 53.3% and East Indians 45.3%. Depression was the most common psychiatric illness diagnosed. Paraquat was the most popular poison used in 63.7% of the suicidal cases, and other agrochemicals were used in 20% of the cases.

Suicide by poisoning: a preliminary epidemiological report - abstract

A preliminary, retrospective, consecutive, epidemiological study was conducted on 270 patients who died in the General Hospital, Port-of-Spain after presenting with deliberate self-poisoning between January, 1986 and June, 1990. The cause of death was confirmed by autopsy and toxicological analysis. Epidemiological variables of age, sex, race, precipitating events/factors and type of poison used were assessed. It was found that the male to female ratio was 2.7:1. East Indians accounted for 54.4 percent, Africans 42.0 percent, people of mixed race 3 percent and Caucasians 0.6 percent. The 11-34 year age group contributed 52.6 percent, the 35-64 year age group 40.7 percent and the over 65 6.7 percent. Lovers' quarrels were most frequently reported as the precipitating event (35.4 percent), followed by a diagnosed psychiatric illness (27.8 percent) and family disputes (27 percent). East Indians predominated in those suicides precipitated by lovers' quarrels (63 percent) and family disputes (58 percent). Among suicides involving a person with a diagnosed psychiatric illness, there were more Africans (53 percent) than East Indians (45 percent). Depression was the most common psychiatric illness diagnosed. Paraquat was the most popular poison used, accounting for 63 percent of the suicide cases (AU)

Alcohol, cannabinoids and cocaine in road traffic fatalities in Trinidad and Tobago - abstract

A prospective study was done on road traffic fatalities occurring during the period Janauary, 1987 to November, 1988. Complete autopsies were performed on all such fatalities and a 20 ml sample of blood from a cardiac chamber in 20 victims was examined at the Forensic Science Centre for ethanol, cannabinoids and CNS narcotics by standard modern methods. Of the 35 fatalities, there was 18 pedestrians, 10 drivers, 5 passengers ( 2 of whom were alighting from the vehicle) and 2 pedal cyclists. The majority of victims were < 40 years old (range 3 - 91 years) and were males (sex ratio 4.8:1). Of the 20 victims whose blood was examined, 8 (40 percent were positive for ethanol, 5 of whom were drivers, 3 were positive for cannabinoids and 3 victims, 1 a driver, was positive for both ethanol and cannabinoids. None of the blood samples was positive for narcotics. Nine victims died instantly in the accidents, 12 were dead on arrival at hospital, and 6 died less than 24 hours after arrival at hospital. Twenty-six victims had cerebral haemorrhage, 8 of the drivers had multiple fractured ribs with haemopneumothorax and 2 had lacerated hearts. The data from this study reinforce the need to introduce the Breathanalyser test and compulsory seat belt usuage and to institute training for paramedics accompanying ambulances (AU)

Preliminary determination of median lethal dose of Azadirachta indica (A.) Juss bark extract against Boophilus microplus

The study was carried out in order to determine the effective dose of Azadirachta indica as an acaride. From a range of effective doses, nine (9) test doses ranging from zero (0) parts per million to one hundred and fifty parts (150) per million were selected. The test species Boophilus microplus was subjected to a standard bioassay. A dose response curve was plotted of percentage mortality of B. microplus against logarithmic dosage of A indica. The lethal dose, LD50 and LD100 were also determined. The LD50 was 30.20 parts per million and LD100 was found to lie between 80 and 100 parts per million. Regression analysis was performed to verify correlation of data. The data proved to be linear with a correlation coefficient of 0.89. The results of this study indicate that when the dose required to achieve 50 percent mortality is compared to average yield of A. indica bark extract obtained in previous studies (Maharaj et al 2003), the extract appears to be feasible with respect to production for use as a prospective pesticide. This is an important point for consideration as the failure in the commercialization of many plant products is often due to the yields being too low. The bark extract of Azadirachta indica has thus far proven to be worthy of consideration for further development as a phytoacaricide (AU)

A retrospective study of the treatment of toad poisoning in dogs in Trinidad

A retrospective study (AU)