Rat-bite and diabetes mellitus - abstract

Diabetes mellitus is an increasing health problem in the Caribbean, and diabetic foot a major cause of morbidity. Rat-bite is also common but under-recognised by physicians. In the presence of peripheral neuropathy, rat-bite during sleep may be felt and the lesions inflicted, usually upon the feet, may be multiple and extensive. A questionnaire survey of 83 patients consecutively attending diabetic clinics was performed to examine the prevalence of rat-bite in relation to peripheral neuropathy, age, treatment and housing conditions. The data were as follows: No history of rat-bite - 72 (87 per cent); Rat-bite within previous 2 years - 6 (7 per cent); Rat-bite more than 2 years before - 5 (6 per cent). There was no significant difference between the groups in age, sex, presence of peripheral neuropathy, form of treatment, type of housing (block or wood), location of house (village or town) or housing conditions as scored by the patients themselves. Rat-bite is an under-recognised cause of foot lesions in diabetics (AU)

Fibrodysplasia (myositis) ossificans progressiva in Dominica

Fibrodysplasia (myositis) ossifcans progressiva is a rare but severely disabling disease in which ossification forms within muscle and leads to progressive restriction of the movements of the jaw, neck, shoulders and hips. Shortening of the big toes is usually present. It is important to recognise this disease as avoidance of intra-muscular infections, surgery and trauma reduces the risk of further ossification (AU)

Diabetes and cassava in Dominica

A study of 110 non-insulin dependent diabetics and 110 controls failed to find evidence that chronic consumption of cassava flour containing significant amounts of cyanide, predisposes to diabetes mellitus. (AU)

Oral steroids and relapse of typhoid fever - abstract

Between October 1981 and February 1985, the relapse after acute typhoid fever, adequately treated with chloramphenicol (50 mg/Kg/day for 3 days, then 30 mg/Kg/day for 11 days), was 18 percent; this is twice the expected figure of 5-10 percent. On bacteriological confirmation of the diagnosis, adjuvant oral cortico-steroid was given to those cases whose symptoms were slow to resolve, as a tapering course of prednisolone over 5 days with an initial dose of 1 mg/Kg. All patients who relapsed had received cortiosteroids. From March 1985, adjuvant steroids were no longer given. Between March 1985 and September 1987, there were no relapses (p<0.01, Fisher's test). Convalescent carriage was commoner in the no-steroid group. Perhaps oral low-dose steroid converts potential convalescent carriage into relapse which can be a severe illness. Low-dose adjuvant steroids for prolonged "toxicity" in acute typhoid fever should be avoided (AU)

Multiple lentigines syndrome in Dominica

Multiple Lentigines Syndrome with variable penetrance is described in a Dominican family mild skeletal manifestations, including arachnodactyly, were present with low intellect in the propositus. The syndrome is of importance because of the association with various cardiac abnormalities and deafness. It occurs in black people though the lentigines may be difficult to recognise, and relatives without lentigines may have cardiac abnormalities (AU)

Prediction of relapse after acute typhoid fever by oral cholecystogram - abstract

Dominica has the highest incidence of typhoid fever in the Caribbean (44/100,000 in 1983) and a high relapse rate of 20 percent. A prospective study was performed from January 1984 to June 1985 on gallbladder function at oral cholecystography and subsequent relapse, in all patients admitted with acute typhoid fever to the medical unit. Twenty-two patients were studied. All had S. typhi isolated from blood or stool that was fully sensitive to chloramphenicol. Each received chloramphenicol (50mg/kg/day) for 3 days followed by 30 mg/kg/day for 11 days. All the cholecystograms were performed within 3 days of completing the antibiotic. If the gallbladder was not visualised a double-dose study was done, and if this was also abnormal, a further study was done after 3 months. The results were as follows: SUBSEQUENT COURSE: Normal gallbladder, Non-visualised gallbladder; RELAPSE: 3, 2 respectively; CONV. CARRIER: 4, 1 respectively; UNCOMPLICATED: 13, 0 respectively; TOTAL 20, 3 respectively. There were no statistically significant differences. However, the 2 cases with non-functioning gallbladders both experienced severe relapses, and were given adjuvant steroid therapy. The others had very mild illnesses. Both severe relapsers had normally functioning gallbladders 3 months later. Overall, the results are consistent with hypothesis that typhoid fever relapse is due to intracellular persistence of S. typhi rather than to gallbladder involvement. But in 2 cases, temporary loss of gallbladder function at oral cholecystography was associated with severe relapse. Oral cholecystogram may thus detect unresolved S. typhi cholecystitis which leads to severe relapse compared with that due to intracellular persistence elsewhere (AU)

Wilson's disease in the Commonwealth of Dominica: a case report

The first case reported in Dominica of Wilson's disease is described. This is possibly the first successfully treated case in the West Indies. Wilson's disease, though rare, may occur in an unexpected setting.(AU)

The efficacy of initial treatment of paraquat poisoning in Dominica - abstract

This retrospective study assesses the impact of changes in the management of paraquat poisoning presenting within 48 hours. Between November 1981 and October 1984, 17 cases of poisoning with Gramoxone (20 percent solution of paraquat) occurred in Dominica. The incidence is thus 0.25./100,000/yr. Eleven of the cases presented within 48 hrs of ingestion. Their management fell into three groups: (i) analgesics and sedation only, (ii) gastric lavage, (iii) gastric lavage, 4-hourly gastric instillation of Fuller's earth (60-90g), mannitol or magnesium sulphate purgation and forced diuresis. The changes in management have not significantly altered the outcome. All of the 17 patients who took over 20g died within 25 hours. All patients presenting with respiratory symptoms, vomiting or diarrhoea died within 25 hours. The sole survivor, a 17 yr-old male, presented at 4 days and developed renal and hepatic failure but not late respiratory failure. He had had frequent chest X-rays. This may have been significant as radiotherapy has been reported to result in resolution of severe paraquat-induced pulmonary damage. Patients surviving more than 25 hours should probably be referred to a centre where radiotherapy and dialysis facilities are available (AU)