The efficacy of acarbose in type 2 diabetes mellitus in Jamaica

The efficacy and tolerability of acarbose was studied in type 2 diabetic patients eating a typical Jamaican diet. The study was an open label parallel group study without placebo control. Of the 51 subjects recruited, five (9.8 percent) did not complete the study and were excluded from further analysis. Six (13 percent) of the remaining 46 had adverse side effects and did not complete the protocol. Of the remaining 40 (Gp A), acarbose was added to their previous regime of diet alone (n=15), [Gp B], oral hypoglycaemic agents, OHAs (n=17), [Gp C], or insulin (n=8), Gp D]. In addition, during the run in period all subjects had one session each with a dietitian and a diabetes educator. Over a 3 month period, significant reductions in average glucose (mmol) were observed in Gp B 10.5 ñ 1.1 to 8.4 ñ 0.9 (p<0.027) and, from 11.0 ñ 1.0 to 8.7 ñ 0.7 (p<0.01) in Gp C. Similarly, total glycosylated haemoglobin fell from 14.8 ñ 1.1 percent to 12.2 ñ 1.0 percent (p<0.016) in Gp B, from 14.8 ñ 1.1 to 11.9 ñ 1.1 percent (p<0.002) in Gp C, and from 14.1 ñ 1.4 to 11.8 ñ 1.4 (p<0.02) in Gp D. Twenty-three per cent (23 percent) of the patients experienced flatulence; 7.5 percent changes in bowel habits and 5 percent, abdominal cramps and discomfort. Acarbose is effective as monotherapy and as combination therapy with oral hypoglycaemic agents or insulin. Side effects were common, but tolerable.(Au)

Growth and development four years after treatment for the Trichuris dysentery syndrome

A follow-up study is reported of 18 children 4 y after treatment for the Trichuris dysentery syndrome (TDS) and matched control children. The TDS children were initially severely stunted and had extremely low developmental levels. They showed catch-up in height of 1.9 z-scores even though they remained in very poor environments. Their intelligence quotients, school achievement and cognitive function remained significantly lower than those of the controls. Controlling for their earlier developmental levels, the TDS children showed a small improvement in mental development relative to the controls (Au)

Treatment of trichuris trichiura infections improves growth, spelling scores and school attendance in some children

The effects of treating Trichuris trichiura infections were investigated in 407 Jamaican children age 6 to 12 years. The children were randomly assigned to receive treatment (albendazole) or a placebo. The outcome variables included growth, tests of reading, spelling and arithmetic, and school attendance. After 6 months of treatment, there was no significant main effect on any of the outcomes. However, there were significant treatment-by-infection intensity interactions with spelling (P < 0.05) and body mass index (P < 0.01), and a significant treatment-by-stunting interaction with school attendance (P < 0.01). In spelling, the children with heavy infections showed improvements with treatment that approached significance d(P = 0.06), whereas those with lower intensities did not. However, the children with lower infection intensities had increased body mass index with treatment (P = 0.02), although there was no difference in children with heavy infections. In school attendance, the stunted children improved with treatment (P < 0.04), whereas there was no difference in the nonstunted children. These findings suggest that in the sample of Jamaican children examined, the treatment of T. trichiura was more likely to benefit school performance in children of poor nutritional status and those with heavy infections, and to improve weight gain in children with lighter infection intensities (AU)

Treatment of mild to moderate trichuris trichiura infections in children: effects on school performance and growth - abstract

The effects of treating mild to moderate infections of Trichuris trichiura were investigated in 407 Jamaican children, aged 6 to 12 years. The children were randomly assigned to receive treatment (albendazole) or a placebo which were given at approximately 4-month intervals. The study lasted 17 months and the outcome variables included tests of reading, spelling and arithmetic, school attendance and growth. There was no significant treatment effect in the school achievement tests or in height gain. However, a significant treatment-by-infection intensity effect for body mass index (BMI) (p = 0.03) and a significant treatment-by-stunting effect in school attendance (p = 0.002) were found. Among the children with lower infection intensities, BMI improved with treatment (p = 0.08) after six months of the study but there was no treatment effect in the final 11 months of the investigation. On the other hand, the children with higher infection intensities were not affected during the first six months but had improved BMIs with treatment in the final 11 months of the study (p < 0.002). During the first year of the study, the school attendance of the stunted children improved with treatment (p < 0.001) while there was no effect in the non-stunted children. However, during the second year, there was an improvement in attendance in the non-stunted children with treatment (p = 0.06) while the stunted children who were treated did worse than those who received placebos (p < 0.05). These findings indicate that benefits from the treatment of T.trichiura infections depend on the nutritional status of the children, their infection intensities as well as the duration of treatment (AU)

Trichuriasis, academic performance and nutritional status in children - abstract

Severe infections of the geohelminth Trichuris trichiura detrimentally affect young children's growth and development. There is concern that mild to moderate infections may affect older children's school performance and nutritional status. We therefore examined the relationship between varying intensities of infection and school achievement, attendance and nutritional status in 616 schoolchildren. The children were aged 7 to 11 years and were identified from 14 schools. Four hundred and nine children with Trichuris infections of intensities greater than 1200 eggs per gram of stool (EPG) were first identified, then for every two infected children in a class, an uninfected child was selected. Reading, spelling and arithmetic tests were administered by trained testers and the children's weights and heights were measured. School attendance was obtained from class registers while socioeconomic status was measured, using a questionnaire. The infected children were divided into four groups based on their level of infection: 1200-1999, 2000-3999, 4 000-9999 and 10 000EPG and over. The data were analyzed using multiple regression. After controlling for socioeconomic status, gender, age, school, and the presence of Ascaris infections, the uninfected children had higher reading and arithmetic scores than children with infections of over 4000EPG and were taller than those with intensities over 2000EPG. However, there were no significant differences in spelling, school attendance and body mass index. These results suggest that moderate levels of infections have adverse effects on school achievement and growth (AU)

Treatment effects in trichuris dysentery syndrome

Heavy infection with geohelminth trichuris trichiura causes the Trichuris dysentery syndrome (TDS). Growth retardation and anaemia are charcteristic of TDS and both are associated with poor development. We have examined the growth and developmental responses to treatment in 19 children aged 27-84 months with TDS. Development levels (DQ) were measured with the Griffiths mental development scales. Compared with a control group matched for age, gender and neighbourhood, the TDS children initially had serious deficits in DQ (24 points, p < 0.001). After a year of anthelmintic treatment, the TDS children showed improvement in locomotor development (p<0.001) compared with the controls. The TDS children also had initial deficits in height-for-age, weight-for-height, mid upper arm circumference and haemoglobin levels. They caught up rapidly in indices of wasting (weight-for-height and mid-upper arm circumference) and showed steady improvement in height-for-age and haemoglobin levels. Catch-up in height was comparable to that of children recovering from coeliac disease. The importance of continuing prevention after initial treatment is highlighted (AU)

School performance, nutritional status and trichuriasis in Jamaican schoolchildren

Severe infections by the geohelminth Trichuris trichiura detrimentally affect young children's growth and development. There is concern that mild to moderate infections may affect older children's school performance and nutritional status. We therefore examined the relationship between varying intensities of infection and school achievement, attendance and nutritional status in 616 schoolchildren. A total of 409 children with Trichuris infection of intensities greater than 1200 eggs per gram of stool (epg) were first identified, then for every 2 infected children in a class, an uninfected child was selected. After controlling for socioeconomic status, gender, age, school and the presence of Ascaris infections, the uninfected children had higher reading and arithmetic scores than children with infections of more than 4000 epg and were taller than those with intensities greater than 2000 epg. However, there were no significant differences in spelling, school attendance and body mass index. Although a treatment trial is needed to determine causation, these results indicate that moderate levels of infection are associated with poor school achievement and growth (AU)

Treatment effects in trichuris dysentery syndrome

Heavy infection with the geohelminth Trichuris trichiura causes the Trichuris dysentery syndrome (TDS). Growth retardation and anaemia are characteristic of TDS and both are associated with poor development. We have examined the growth and developmental responses to treatment in 19 children aged 27-84 months with TDS. Development levels (DQ) were measured with the Griffiths mental development scales. Compared with a control group matched for age, gender and neighbourhood, the TDS children initially had serious deficits in DQ (24 points, p<0.001). After a year of anthelmintic treatment, the TDS children showed improvement in locomotor development (0.001) compared with the controls. The TDS children also had initial deficits in height-for-age, weight-for-height, mid upper arm circumference and haemoglobin levels. They caught up rapidly in indices of wasting (weight-for-height and mid-upper arm circumference) and showed steady improvement in height-for-age and haemoglobin levels. Catch-up in height was comparable to that of children recovering from coeliac disease. The importance of continuing prevention after initial treatment is highlighted (AU)

The developmental levels of Jamaican children with heavy infections of trichuris trichiuria and their response to treatment - abstract

There is no information available on the mental development of children with trichuriasis. The trichuris dysentery syndrome (TDS) occurs with intense infection and is associated with iron deficiency anaemia, stunting and chronic inflammation, all of which may affect mental development. Nineteen children aged 30-84 months with TDS were tested, using the Griffiths Mental Development scales and three cognitive function tests. Weight, height and haemoglobin concentration (Hb) were also measured. The children were then admitted to the TMRU (as part of an independent study into the pathogenesis of TDS) for 10 days and given anthelminthic and iron treatment. All measurements were repeated seven and a half weeks after initial testing. Nineteen age, sex, and neighbourhood matched controls, without TDS, were tested in a similar manner, but were not hospitalised. Detailed social background information was obtained for all children. Initially, the TDS children showed a marked deficit in Developmental Quotients (DQ), compared with the controls (Table). Multiple regression analysis showed that stimulation in the home (Caldwell), height-for-age, weight-for-height, and the presence of a father, all made significant, independent contributions to the variance in DQ. At the repeat test, the TDS children showed no improvement in development or in cognitive function. Results indicated that children with TDS had a marked developmental lag which remained when symptoms had disappeared (AU)

Leptospirosis in Barbados: a clinical study

A 39-month clinical study of leptospirosis was undertaken at the Queen Elizabeth Hospital, Barbados. Eighty-eight patients had a confirmed diagnosis of the disease during the period. The major serogroups identified were autumnalis (including a new serovar bim), icterohaemorrhagiae, ballum and canicola. The majority of patients presented with jaundice (95 percent), anorexia and headaches (85 percent), fever (76 percent) and conjunctival suffusion (54 percent). While abnormal creatinine levels were seen in 49 percent of patients on admission, only 16 percent were judged to have renal failure. The urine to plasma urea ratio showed high sensitivity and specificity in the diagnosis of pre-renal azotemia. Cardiac arrthymias and myocarditis occurred in 18 percent of patients and pericarditis in 6 percent. An elevated serum amylase was found in 65 percent of cases. The bilirubin level took 5.5 weeks to return to normal. Thrombocytopenia was shown not to be due to a disseminated intravascular coagulation, and a randomised trial dose penicillin did not reveal any benefit to jaundiced patients. The overall mortality during the study was 5.7 percent (AU)

Urinary diagnostic indices in the management of leptospirosis: selection of patients for dialysis therapy

Cases of leptospirosis admitted to the Queen Elizabeth Hospital (QEH), Barbados, were assessed for the presence of "pre-renal azotaemia" (NON-ARF) as opposed to "acute renal failure" (ARF). Distiction between the two diagnoses was made on the basis of clinical course. Peritoneal dialysis was inappropriately utilised in 26 percent of patients receiving such therapy. This study evaluates diagnostic tests for pre-renal azotaemia, and acute renal failure in leptospirosis, and indicates guidelines for the management of azotaemia in such patients. U/P urea and osmolar ratios show high sensitivity and specificity in diagnosing pre-renal azotaemia. While "early" dialysis is essential for patients with acute leptospiral renal failure, in those with plasma creatinines less than 600 umol/litre on entry and indices indicating NON-ARF, decisions regarding dialysis can safely be delayed for 48-72 hours while the effect of rehydration is assessed (AU)

Penicillin therapy in icteric leptospirosis

A prospective, controlled randomized study of penicillin therapy in icteric human leptospirosis was carried out between 1 October 1983 and 31 December 1986. Thirty-eight patients received intravenous crystalline penicillin for 5 days, while 41 assigned tests made on the day of admission revealed no significant differences between the 2 groups. There was no significant difference in time for defervescence, return of biochemical parameters to normal, incidence of iritis, or mortality in the 2 groups. Three patients (7.3 percent) in the control group and 1 patient (2.6 percent) in the treatment group died. The overall mortality rate was 5.9 percent. Leptospira were recovered from urine cultures in 6 control patients but from none of the treated patients' post-treatment cultures. We conclude that penicillin has little effect on clinical outcome in icteric leptospirosis (AU)

Renal failure indices in the management of leptospirosis selection of patients for dialysis therapy - abstract

Renal failure indices were analysed for applicability in the maangement of patients with azotaemia due to leptospirosis. Urine/plasma (U/P) urea, U/P creatinine and U/P osmolar ratios, urinary sodium concentration, renal failure index and fractional excretion of sodium were measured on days 1, 2 and 3 after admission. Only cases with plasma creatinine > 200 micromol/l and those treated by dialysis were analysed. Patients were designated "pre-renal azotaemia" (NON-ARF) or"acute renal failure" (ARF) on the basis of the clinical course and by comparison of renal failure indices with values conventionally used to distinguish pre-renal from intrinsic renal failure. U/P urea ratio > 8 and U/P creatinine ratio 20 discriminated well between patients with NON-ARF and those with ARF. Of 12 patients satisfying both these criteria for pre-renal azotaemia, 7 also had U/P osmolar ratios > 1.2. As might be predicted by the "indices"' all responded to rehydration with a decline in plasma creatinine concentration. Among 14 patients with ARF, ten out of 11 had a U/P urea ratio <7 while only 7 of 11 had a U/P creatinine < 20. However, all nine patients assessed had a U/P osmolar ratio <1.2. The renal failure index and the fractional excretion of sodium were both >1 in 8 out of 10 patients. A U/P urea ratio < 7 and U/P osmolar ratio <1.2 were therefore the most consistent discriminators in the presence of acute renal failure. Our results suggest that renal failure indices can predict resolution of azotaemia with rehydration, identify patients with acute intrinsic renal failure and prevent inappropriate dialysis in those whose azotaemia is due to dehydration (AU)

Thrombocytopenia in leptospirosis: the absence of evidence for disseminated intravascular coagulation

In a prospective study of human leptospirosis, thrombocytopenia was demonstrated in 54 percent of 24 cases. The only additional laboratory evidence suggestive of disseminated intravascular coagulation lay in a mild elevation of fibrinogen degradation products, but this occurred with equal frequency in nonthrombocytopenic patients. There is therefore no causal relationship between disseminated intravascular coagulation and the thrombocytopenia of human leptospirosis. (AU)