Thrombolytic therapy in acute myocardial infarction in Barbados: report of initial experience with intravenous streptokinase - abstract

It has been shown in the last decade, that intravenous throbolytic therapy is associated with a significant reduction in mortality, when given early in the course of an acute myocardial infarction (MI). Streptokinase, a bacterial-derived protein plasminogen activator, was approved for use at the Queen Elizabeth Hospital in June 1990 and thrombolytic therapy for acute MI commenced in October 1990. During the next 13 months, 129 patients were admitted to the Queen Elizabeth Hospital with the diagnosis of acute MI, and 35 of these (27 percent) received intravenous streptokinase. Nine other patients who received streptokinase were subsequently proven not to have infarcted. Forty-three per cent (43 percent) of the patients received thrombolytic therapy within six hours of the onset of symptoms, the ideal window period for treatment. Using non-invasive clinical criteria, reperfusion was suspected in 77 percent of patients. No major complications were seen. Three (3) patients had mild allergic reactions, and mild hypotension and bradycardia were seen in 19 patients. One patient who did not have an acute MI but an acute aortic dissection developed a hemiparesis which resolved within a week. There were 6 deaths recorded, all thought to be unrelated to streptokinase, but rather due to the extensive nature of the infarct. We have reported on a protocol-controlled series of patients given thrombolytic therapy for acute MI in Barbados, and have concluded that it can be given safely and effectively in carefully selected patients (AU)

Life-threatening hyperkalemia associated with postassium-sparing therapy - abstract

The clinical course of four patients with hyperkalemia and symptomatic bradycardia presenting to the Queen Elizabeth Hospital over a six-month period was studied and risk factors assessed. Four patients were seen over a six-month period who presented with symptomatic bradyarrhthymia due to severe hyperkalemia. Patients' ages were 64 (D), 66 (C), 77 (A), and 83 (B) years and had plasma creatinine concentrations of 238, 805, 195 and 129 æmol/respectively. One pateint (C) was a male. All patients were hypertensive and two (C and D) were diabetic. All four were receiving a fixed dose combined diuretic containing amiloride and hydrochlorothiazide (5 mg A/50 mg H). Three patients (A< B and C) were on this combination for several months before presentation, while case D had been treated for just 5 days. In addition, one patient (B) was receiving supplemental postassium "Slow K" 1 tablet daily (8 mmol) for one week before presentation. Two patients (A and B), both of whom survived, were also receiving nadolol 80 mg daily and one (C) was receiving digoxin 0.125 mg daily. Two patients (C and D) arrested and died shortly after admission (serum K+ 9.3 and 10.0 mmol/1 respectively) while patients B and A (serum K= 8.0 and 8.8 mmol/l respectively) were treated in the intensive care unit. Emergency therapy was given to three patients (A, B and D) based on the characteristic ECG changes. Once the diagnosis was made patients received calcium gluconate, dextrose and insulin infusions and calcium resonium resin. No patient required dialysis or pacemaker insertion. The two patients treated in the intensive care unit were discharged uneventfully. We remind clinicians that caution should be exercised in the use of potassium sparing diuretics especially in those with renal insufficiency. It would be worthwhile that all patients receiving K+ sparing diuretics should have renal function and electrolytes measured before and during therapy (AU)

Prevalence of asymptomatic bacteriuria in diabetic females in Barbados - abstract

This study was designed to compare the prevalence of asymptomatic bacteriuria in diabetic and non-diabetic adult females. Sixty stable, asymptomatic female diabetics (mean age 50 years) attending diabetics out-patients clinic and 66 non-diabetic hypertensives (mean age 51 years) attending diabetic, hypertensive out-patient clinic at the Queen Elizabeth Hospital were studied. Mid-stream urines were examined microscopically, tested by dipstick for glucose, protein and nitrite and cultured on the same day, using standardized techniques. Significant bacteriuria (>10 to fifth power cfu/ml) was detected in 7 diabetic patients (11.7 percent) and in 3 control patients (4.5 percent), (xý = 2.18. 0.5 1.0). Pyuria (<5 cells/hpf) was found in 14 diabetics (23 percent) and only 6 (9 percent) patients in the control group (Xý = 4.77, 0.05>p>0.01). Four diabetics had both significant bacteriuria and pyuria, and none of the controls. Three of the diabetics were hospitalized during the past twelve months for UTIs, including one with pyelonephritis, and none of the controls. Treatment of asymptomatic bacteriuria in diabetics may help prevent morbidity, especially of the upper urinary tract (AU)