Molecular epidemiology of human papillomavirus genotypes in oral rinses from HIV-positive and HIV-negative Jamaican patients.

AIM: Human papillomavirus (HPV) has been reported to be associated with oral and oropharyngeal cancer. However, little information is available about the epidemiology of oral HPV infection in Jamaica. The purpose of the present study was to assess the prevalence of oral HPV strains using the oral rinse method in HIV and non-HIV Jamaican patients, as well as to determine the association of HPV with sexual practices, smoking, and alcohol use. METHODS: A cross-sectional study was conducted on patients attending The University of the West Indies Mona Dental Polyclinic and the Centre for HIV/AIDS Research and Education Services. Salivary samples were tested through molecular analysis for 37 HPV genotypes using the linear array HPV genotyping test. A survey questionnaire was used to obtain demographic details, smoking history, alcohol practice, sexual practice, and history of HPV testing. RESULTS: The HPV prevalence was 8.65% in 18-64 y olds (N = 104), with a slight female predilection (55%). No high-risk HPV types were found. HPV-84 was the most common type in both HIV and non-HIV patients; 66.7% of HPV-positive participants reported that they had six or more lifetime sexual partners. CONCLUSION: The prevalence of oral HPV was similar to that in other countries. No statistically-significant relationship was observed between the prevalence of HPV and either the number of sexual partners, smoking, or alcohol history. A nationwide study on oral HPV detection might be helpful in developing a HPV vaccination policy in Jamaica.

Antibiotic susceptibility of clostridium difficile isolates from adult patients at two Jamaican hospitals. Clinical and epidemiological implications

The susceptibility of 39 toxin producing Clostridium difficile isolates from stools of hospitalized patients was determined, by disc diffusion, to six antibiotics. All but one isolate (toxin A negative) produced toxin A and Toxin B. A wide variation in susceptibility to clindamycin, tetracycline and chloramphenicol was noted. Erythromycin and cotrimoxazole showed a clear-cut discrimination in resistance and susceptibility, while all isolates were sensitive to vancomycin. Erythromycin sensitive isolates demonstrates a significant association with diarrhoea (60.9 percent, 14/23, p<0.001). These strains were predominantly found at the University Hospital of the West Indies (UHWI, 94.1 percent, 16/17). Strains resistant to erythromycin and clindamycin together were commonly found at the National Chest Hospital (NCH, 68.2 percent, 15/22). All erythromycin sensitive strains found at the NCH were from patients transfered to that hospital. These findings suggest that there is a common strain of C difficile (erythrmycin resistant) at the NCH different from that found at the UHWI; the resistant pattern seen with isolates from the NCH was typical of toxigenic serogroup C strain and could be typed by the disc diffusion method. Patients at the NCH who were colonized with either of the two strains of C difficile were likely to get diarrhoea, once there suppression of the normal microflora by antibiotics and colonic over growth with C difficile. (AU)

A sonographic study of kidney dimensions in a sample of healthy Jamaicans

A sonographic study of 49 randomly selected healthy Jamaicans was conducted to establish a guide for renal dimensions in the population. The mean length of the right kidney was 9.7 ñ 0.7 cm and the left 10 ñ 0.7 cm. The left kidney was longer than the right in the overall group and in males. There was no difference in width between right or left kidneys in the groups as a whole or within either gender. There was a significant association between the weight of males and the width of their kidneys; however, this association was not seen in females. The lone association between weight of the participants and renal length occurred in females and only with respect to the left kidney. Lengths and widths of kidneys were not associated with height in either gender. Renal surface area (RSA) was similar between the genders and also between right and left kidneys. Similarly, there was no significant association between renal length and body surface area (BSA) overall or within the genders. Renal index (RI) which is more reliable at assessing renal parenchymal mass than renal length alone was 20.92 and 22.86 for the right and left kidneys, respectively in males. Similarly, RI for the right and left kidneys in females was 23.76 and 25.54, respectively.

A sonographic study of kidney dimensions in a sample of healthy Jamaicans

A sonographic study of 49 randomly selected healthy Jamaicans was conducted to establish a guide for renal dimensions in the population. The mean length of the right kidney was 9.7 ñ 0.7 cm and the left 10 ñ 0.7 cm. The left kidney was longer than the right in the overall group and in males. There was no difference in width between right or left kidneys in the groups as a whole or within either gender. There was a significant association between the weight of males and the width of their kidneys; however, this association was not seen in females. The lone association between weight of the participants and renal length occurred in females and only with respect to the left kidney. Lengths and widths of kidneys were not associated with height in either gender. Renal surface area (RSA) was similar between the genders and also between right and left kidneys. Similarly, there was no significant association between renal length and body surface area (BSA) overall or within the genders. Renal index (RI) which is more reliable at assessing renal parenchymal mass than renal length alone was 20.92 and 22.86 for the right and left kidneys, respectively in males. Similarly, RI for the right and left kidneys in females was 23.76 and 25.54, respectively.(AU)

Dialysis adequacy at two haemodialysis units in Jamaica

A prospective study on adequacy of dialysis was conducted at the haemodialysis units of Kingston Pubic Hospital (KPH) and the University Hospital of the West Indies (UHWI). Dialysis adequacy was better at KPH and morbidity, as measured by patient admission days, was increased at UHWI. Diabetics had a lower mean serum albumin and urea reduction ratio (URR) than non-diabetics. Multiple regression analyses revealed that age of patient (F = 5.30; p = 0.241) and hospital (F = 7.85; p = 0.007) were the variables significantly associated with serum albumin level when the effect of other variables was controlled (F = 2.12; p = 0.34). Similar analyses showed that the hospital at which dialysis was done was the only factor which accounted for significantly higher URR, with KPH having higher rates (F =13; p = 0.006). The differences between hospitals necessitate further investigations, explanations and further intervention strategies. The study provides opportunities for improving patient care and for dialysis health care professionals to assess clinical performance measures and reduce variation between dialysis centres.(Au)

The prophylaxis of acute rheumatic fever in a pair of monozygotic twins: the public health implications

Recurrent acute rheumatic fever and rheumatic heart disease can be prevented by antibiotic intervention. We report the case of genetically identical twins, one of whom had overt rheumatic fever, received penicillin prophylaxis and did not have rheumatic heart disease. The other must have had inapparent rheumatic fever, received no chemotherapy prophylaxis and proceeded to develop rheumatic heart disease. A greater clinical and laboratory vigilance is required for the diagnosis of acute rheumatic fever in the asymptomatic identical twin of a patient with rheumatic fever. This case provides further evidence of a genetic predisposition of rheumatic fever and demonstrates the continued value of penicillin in the prophylaxis of acute rhuematic fever. It emphasises the need to maintain the integrity of preventive programmes against rheumatic fever worldwide. Studies which explores the HLA and other genetic linkages with rheumatic fever should be encouraged.(AU)

Medical admissions of oncology patients to the University Hospital of the West Indies

A prospective study of 80 oncology patients (42 men, 38 women; mean age 50.3 years) admitted to the University Hospital of the West Indies, Jamaica, was conducted over a six month period (August 1, 1995 to January 31, 1996). There were 103 admissions representing 8.7 percent of total admission to the medical wards. Solid tumours and haematological malignancies accounted for equal proportions of admissions. 62 percent were emergency admissions. Investigation of constitutional symptoms, abnormal physical findings, infection and chemotherapy were the commonest reasons for admission. Complications developed in 42.7 percent of admissions, the commonest being renal and/or hepatic impairment: anaemia, leukopaenia and thrombocytopenia; and nosocomial infections. 35 percent of the patients died during the study period. The mean length of stay was 12.9 days (SD 12.8). Mean hospital stay was significantly longer in admissions involving an initial diagnosis of cancer and in those resulting in complications (p < 0.001).(AU)

The significance of immune disorder in tropical spastic paraparesis

The reports of the occurrence of HTLV-1 infection and/or HTLV-1 associated myelopathy (HAM)/tropical spastic paraparesis (TSP) in patients with certain organ-specific and nonorgan-specific autoimmune diseases prompted us to assess the relationship between TSP and humoral autoimmunity. Blood samples from 76 TSP patients, 60 asymptomatic HTLV-1 carriers and 100 HTLV-1 seronegative blood donors were examined for the presence of organ-specific and nonorgan-specific autoantibodies, reactive serological tests for syphilis, immunoglobulin and complement concentrations as well as immunecomplexes. High prevalences of autoantibodies (39/76, 51 percent), reactive serological tests for syphilis (23/76; 30 percent), hypergammaglobulinaemia (69/76, 90 percent) and the complement fixing immune complexes (44/76, 58 percent) were found in the TSP patients. These indicators of immunological disorder were found in statistically significantly lower prevalences in asymptomatic HTLV-1 carriers (12/60, 20 percent; p < 0.001; 6/60, 10 percent; p < 0.05; 32/60, 53 percent; p < 0.001 and 8/60, 13 percent; p < 0.001, respectively) and HTLV-1 seronegative blood donors (8/100, 8 percent; p < 0.001; 3/100, 3 percent; p < 0.001; 15/100, 15 percent p < 0.001 and 5/100, 5 percent; p < 0.001, respectively). The profiles of autoimmune phenomena observed in the patient and control groups revealed that they were associated with TSP rather than mere HTLV-1 infection and consequently pathogenic significance. The array of immunological features present in TSP was suggestive of autoimmune disease resulting from immune dysfunction. Studies which explore the possible existence of HTLV-1 induced autoantibodies with specificity for antigens of the spinal cord in TSP might be useful in elucidating its pathogenesis.(Au)

Antibodies to cardiolipin and beta2-glycoprotein-1 in HTLV-1-associated myelopathy/tropical spastic paraparesis

Anticardiolipin and anti-beta2GP1 antibodies were measured in 50 patients with HTLV-1-associated Myelopathy-Tropical Spastic Paraparesis (HAM-TSP) and the results were compared with those obtained for 34 HTLV-1-positive and 35 HTLV-1-negative controls, as well as 128 SLE patients. aCL but not anti-beta2GP1 was associated with HTLV-I infection. aCL was more prevalent than anti-beta2GP1 (32 percent vs. 8 percent) and was not associated with anti-beta2GP1 in HAM-TSP. IgA was the dominant isotype of aCL and anti-beta2GP1. The data suggest that tin HAM-TSP, IgA aCL are frequent and are associated with HTLV-1 infection.(Au)

Normal kidney dimensions in healthy Jamaicans: a sonographic study - Poster presentation

A sonographic study of 49 randomly selected healthy adult Jamaicans was conducted to establish a guide for renal dimensions in the population. The mean length of the right kidney was 9.7+/-0.7 cm and the left 10+/-0.7cm. The left kidney was longer than the right in the overall group and in males. There was no difference in width between left or right kidneys in the group as a whole or within either sex. There was a significant association between the weight of males and width of their kidneys; however, this association was not seen in females. The lone association between weight of participants and renal length occurred in females and only with respect to the left kidney. Lengths and widths of kidneys were not associated with height in either gender. Renal surface area (RSA) was similar between the sexes and also between right and left kidneys. Similarly, there was no significant association between renal length and body surface area (BSA) overall or within the sexes. The ratio of renal surface area to body surface area (BSA) which gives an indication of renal mass was positively correlated in males but not in females (AU)

Clostridium difficile infection in immunocompromised patients a three health-care facilities in Jamaica

A cross-sectional study was conducted (April 96 to July 97) to investigate the prevalence of Clostridium difficile infection in immunocompromised patients at 3 health care institutions. Standard bacteriological procedure, tissue culture and enzyme immunoassay were used to investigate faecal specimens from immunocompromised inpatients (N = 113) including 21 patients treated with immunosuppressive drugs, 39 patients had received radiotherapy and 53 patients who were not treated with immunosuppressive drugs. The overall prevalence of C. difficile infections was 14.2 percent (16/113). All the C. difficile isolates were identified as toxigenic strains. The prevalence of C. difficile infection in patients who had received immunosuppressive drugs (23.8 percent, 5/21) did not differ significantly from those who had not (20.7 percent, 11/53), but was significantly lower in patients who received radiotherapy (p<0.01). The occurrence of C. difficile was not significantly associated with antibiotics in patients who were on immunosuppressive drugs (2/13, 15.4 percent vs 3/8, 37.5 percent) or patients who were not (7/32, 21.8 percent vs 4/21, 19.0 percent). Eighty percent (4/5) of C. difficile isolates from patients on immunosuppressive drugs were from those whose regimens include cytotoxic drugs. Similarly, anti-tubercolosis drugs were the antibiotics most frequently associated with C. difficile infections (4/8, 50 percent). C. difficile infections are likely to occur in patients treated with cytotoxic drugs and certain antibiotics.(AU)

Dialysis adequacy at two haemodialysis units in Jamaica

A prospective study on adequacy of dialysis was conducted at the haemodialysis units of Kingston Public Hospital (KPH) and the University Hospital of the West Indies (UHWI). Dialysis adequacy was better at KPH and morbidity, as measured by patient admission days, was increased at UHWI. Diabetics had a lower mean serum albumin and urea reduction ration (URR) than non-diabetics. Multiple regression analyses revealed that age of patient and hospital were the variables significantly associated with serum albumin level when the effect of other variables was controlled (F=2.12; p=0.34). Similar analyses revealed that the hospital at which dialysis was done was the only factor which accounted for significantly higher URR, with KPH having higher rates (F=13; p=0.006). The differences between hospitals necessitate further investigations, explanations and intervention strategies. The study provides opportunities for improving patient care and for dialysis health care professionals to assess clinical performance measures and reduce variation between dialysis centres (AU)

Clinical usefulness of thyroid autoantibodies in patients with Graves' disease

The prevalence of thyroid antibodies varies with the population studied. It has been suggested that the presence of anti-thyroid microsomal (TMAb)/thyroid peroxidase (TPO) antibodies and anti-thyroglobulin antibodies (TgAB) may predict clinical parameters including anti-thyroid drug therapy outcome in Graves' disease. Commercially available kits were used to measure anti-TPO and Tgab titres. Antibody titres were compared in the following clinical groups: newly diagnosed (n=21), treated with radioactive iodine (n=2), remission (n=22), relapse (n=27), chronic (n=44). Anti-thyroglobulin antibodies were present in 10.3 percent (10/97) of the patients with titres ranging from 40 to 320 with a geometric mean titre of 80. Ant-TPO antibodies were found in 49.4 percent (48/97) with titres ranging from 100 to 102, 400 and a geometric mean titre of 1,800. The presence and titres of thyroid antibodies did not correlate with age at diagnosis, duration of disease, cardiac complications, other concommitant autoimmune diseases, antithyroid drug therapy or the relapse or remission rate. The results of this study did not indicate any clinical usefulness of thyroglobulin and thyroid peroxidase beyond diagnosis in Graves' disease.(AU)

Limited usefulness of antithyroperoxidase and antithyroglobulin assays in Jamaicans with Graves' disease

The clinical usefulness of commercially prepared haemagglutination kits for thryro peroxidase (TPO) antibody and thyroglobulin (TG) antibody was evaluated in 145 consecutive Jamaicans with Graves' disease. Sixty two (43 percent) of the patients were newly diagnosed, 12 (8 percent) were in remission and 71 (49 percent) had relapsed. Sera from 65 (45 percent) patients were positive for thyroid antibodies. The TPO antibodies were found in 43 percent (63/145), thyroglobulin antibodies in 12 percent (17/145) fifteen (10 percent) patients had both anti-TPO and TG antibodies. Similar prevalences of TPO antibody were found in newly diagnosed patients and those who had relapsed (44 percent v. 41 percent) but the prevalence in the patients in remission was significantly higher (75 percent; X2 = 4.8, P <0.05). The prevalence of TPO antibody increased significantly with age at onset before age 35 years compared to later onset (56 percent v. 32 percent; X2 = 8.09, P <0.005). The presence of both TPO antibody (64 percent v. 31 percent; X2 = 13.1, P <0.001) and TG antibody (22 percent v. 6 percent; X2 = 8.8, P <0.005) correlated positively with Graves' opthalmopathy. Neither of the tests was adequately sensitive in detecting GD in Jamaicans. (AU)

Antibiotic susceptibility of 39 Clostridium difficile isolates from adult patients at the University Hospital of the West Indies (UHWI) and the National Chest Hospital (NCH)

The antibiotic susceptibility to six antibiotics of 39 C. difficile isolates (38 toxigenic) from stool specimens (14 adult diarrhoeal and 25 adult nondiarrhoeal) was determined by disc diffusion. Susceptibility to clindamycin (CC), cotrimoxazole (SXT), erythromycin (E), vancomycin (VA), tetracycline (TE) and chloramphenicol (C) was correlated with diarrhoeal and nondiarrhoeal cases. With the exception of VA, a wide variation in susceptibility was noted with CC, E, SXT, TE, and C, with a strong correlation between E sensitive isolates in diarrhoeal cases (69.8 percent). Compartively and of equal significance were erythromycin resistant isolates, primarily form NCH (93.8 percent). All erthromycin resistant isolates were simultaneously resistant to clindamycin (no zone) with only one isolate associated with a diarrhoeal case from UHWI. A review of patients' dockets revealed that actual transferrals to hospitals were largely responsible for the differences in erythromycin susceptibility among isolates.(AU)

Urea kinetic modelling in two groups of patients on continuous ambulatory peritoneal dialysis

Dialysis adequacy (Kt/V) was investigated in two groups of patients on continuous ambulatory peritoneal dialysis (CAPD). Group I consisted of patients with serum creatinine concentration above 1200 umol/l and Group II comprised patients with serum creatinine concentration of 600 umol/l and less. The mean Kt/V was significantly higher in Group II (Kt/V, 2.0) than in Group I (Kt/V, 1.59; p < 0.01) patients. The mean duration of CAPD was significantly longer in Group I (3.12 years) than in Group II (1.32 years); (p < 0.01) patients, and the mean total creatinine clearance of Group II patients was significantly higher than for Group I (p < 0.001) patients. There was good correlation between Kt/V and total creatinine clearance (r = 0.73; p < 0.001); and between Kt/V and normalized protein catabolic rate (NPCR, r = 0.6; p < 0.001). There was weak correlation between Kt/V and duration on dialysis, but this was statistically significant. There was no significant difference between Kt/V and duration on dialysis, but this was statistically significant. There was no significant difference between mean NPCR and mean mid-arm muscle circumference (MAMC) in the two groups and no significant association between Kt/V and dietary inventory. Group II patients had a significantly better residual renal clearance (p < 0.0001). Pruritus was a troublesome feature in Group I patients but in both groups patients were distressed by loss of libido, insomnia and tiredness. This study revealed that Group II patients with lower creatinine concentrations had better dialysis adequacy but were on CAPD for a shorter duration than Group I and had significantly better residual renal clearance and total clearance. Muscle mass does not appear to have contributed significantly to the differences in creatinine concentration between the groups. Additional studies on peritoneal membrane function vis-a-vis solute transfer are in progress.

Urea kinetic modelling in two groups of patients on continuous ambulatory peritoneal dialysis

Dialysis adequacy (Kt/V) was investigated in two groups of patients on continuous ambulatory peritoneal dialysis (CAPD). Group I consisted of patients with serum creatinine concentration above 1200 umol/l and Group II comprised patients with serum creatinine concentration of 600 umol/l and less. The mean Kt/V was significantly higher in Group II (Kt/V, 2.0) than in Group I (Kt/V, 1.59; p < 0.01) patients. The mean duration of CAPD was significantly longer in Group I (3.12 years) than in Group II (1.32 years); (p < 0.01) patients, and the mean total creatinine clearance of Group II patients was significantly higher than for Group I (p < 0.001) patients. There was good correlation between Kt/V and total creatinine clearance (r = 0.73; p < 0.001); and between Kt/V and normalized protein catabolic rate (NPCR, r = 0.6; p < 0.001). There was weak correlation between Kt/V and duration on dialysis, but this was statistically significant. There was no significant difference between Kt/V and duration on dialysis, but this was statistically significant. There was no significant difference between mean NPCR and mean mid-arm muscle circumference (MAMC) in the two groups and no significant association between Kt/V and dietary inventory. Group II patients had a significantly better residual renal clearance (p < 0.0001). Pruritus was a troublesome feature in Group I patients but in both groups patients were distressed by loss of libido, insomnia and tiredness. This study revealed that Group II patients with lower creatinine concentrations had better dialysis adequacy but were on CAPD for a shorter duration than Group I and had significantly better residual renal clearance and total clearance. Muscle mass does not appear to have contributed significantly to the differences in creatinine concentration between the groups. Additional studies on peritoneal membrane function vis-a-vis solute transfer are in progress.(AU)

Angiotensin converting enzyme inhibiting and anti-dipsogenic activities of euphorbia hirta extracts

The methanol extract obtained from the leaves and stems of Euphorbia hirta inhibited the activity of angiotensin converting enzyme (ACE) by 90 percent and 50 percent at 500 ug and 160 ug respectively using enzyme linked immunosorbent assay (ELISA). The effect of the extract on thirst was examined using Wistar rats. Intraperitoneal administration of 10mg/100mg body wt of the extract significantly (p<0.05) decreased the amount of water consumed by rats. This effect lasted for 2 h.(AU)