Tetanus: a recurring intensive care problem

A fifteen-year retrospective study of 108 cases of tetanus admitted to the Intensive Care Unit (ICU) at the University Hospital of the West Indies is presented. Males predominated (70 percent), with peak incidence occurring amongst the young and the elderly. In 57 percent the disease was severe enough to require neuromuscular blockade and controlled ventilation. Respiratory complications occurred most commonly (80 percent), predominantly as a result of infection. Dysautonomia, exhibited by 55 percent of patients, presented the greatest difficulty in management. Mortality was high (20 percent), with sudden cardiac arrest being the most common cause of death. The average duration of stay in the ICU was long (27 days). As Jamaica is a Third World country with limited resources, the continued occurrence of this preventable disease represents a drain on existing intensive care funds. This must be brought to the attention of institutions responsible for planning health care programmes for developing countries (AU)

Anaesthesia: the medical students' perspective - abstract

Traditionally the number of doctors specialising in anaesthesia is low, an occurrence even more marked in the Caribbean. This study presents an analysis of the attitude of 219 medical students to anaesthesia at the University Hospital of the West Indies. Three groups of medical students - the preclinical group, the first clinical year group and the final year group were surveyed, using a questionnaire containing 10 knowledge and 15 attitude questions. The mean knowledge scores (out of ten) were 7.29 ñ 1.56 for the preclinical group, 8.52 ñ 1.33 for the first clinical year group and 9.28 ñ 0.86 for the final year group. The score of the final year group was significantly higher (p<0.001) than that of both other groups, this group having completed a five-week mandatory rotation in anaesthesia. Significant differences were found between the responses of the different groups in 3 of the attitude questions, but the overall response in all groups generally indicated a positive attitude to anaesthesia; 25.5 percent of the preclinical group, 32 percent of the first clinical year group and 40.5 percent of the final year group indicated an interest in anaesthesia as a post-graduate speciality (p = 0.13). However, the number of residents entering the anaesthetic postgraduate programme does not reflect such a high level of interest. This may indicate a change in attitude during the internship period resulting in a decreasing level of interest in the specialty. Measures need to be instituted so that this level of interest may be sustained throughout internship and encourage admission into the specialty (AU)

Tetanus: a recurring intensive care problem in Jamaica - abstract

A fifteen-year retrospective study of 108 cases of tetanus admitted to the Intensive Care Unit (ICU) at the University Hospital of the West Indies is presented. Males predominated (70 percent), with peak incidence occurring among the young and the elderly. In 57 percent, the disease was severe enough to require neuromuscular blockade and controlled ventilation. Respiratory complications occurred most commonly (80 percent) as a result of infection. Dysautonomia, exhibited by 55 percent of the patients, presented the most difficulty in management. Mortality was high (20 percent), with unexplained cardiac arrest being the commonest cause of death. The average duration of stay in the ICU was long (27 days). As Jamaica is a Third World country with limited resources, the continued occurence of this preventable disease represents a drain on existing intensive care facilities. This must be brought to the attention of institutions responsible for planning health care programmes for developing countries (AU)

Tetanus requiring intensive care in Jamaica: an eleven year review of cases admitted to the Intensive Care Unit, University Hospital of the West Indies

The Intensive Care Unit (ICU) at the University Hospital of the West Indies continues to receive several cases of tetanus each year. An eleven year retrospective study, conducted by examining the medical records of all cases of tetanus admitted to the ICU during the period 1978-1988 inclusive, is presented. Criteria of severity, clinical patterns and management are outlined, discussed and compared to other studies. Of the 97 patients studied, more than two-thirds were males, with peak incidence occurring amongst the very young and the elderly. Trismus was the commonest presenting symptom, the majority of patients manifesting the generalized form of tetanus. Minor wounds were often the source of infection, although disease occurred as a complication of maturity onset diabetes or haemoglobinopathies in 9 percent of patients. Few patients could provide information on their immunization status. Once the disease manifested, it was associated with considerable morbidity and mortality. In a half of the patients, disease was severe enough to require neuromuscular blocade and controlled ventillation. Complications involving the respiratory system were the commonest, primarily due to infection. However, the cardiovascular instability seen in very severe cases, presented the most difficulty in management. Seventeen patients died while in the ICU, representing a mortality rate of 17.5 percent. Sudden cardiac arrest was the commonest cause of death and was attributed to the disease. The average duration of stay in the ICU was 3 weeks. Treatment was thus expensive in terms of limited staff and resources. However, the introduction of intensive care in the management of tetanus, has resulted in a 50 percent decrease in mortality. As Jamaica is a third world country with limited resources, the continued occurrence of this preventable disease reduces optimum utilization of existing resources. Based on the findings, recommendations are made towards improving preventable measures and areas for further research in terms of curative measures are identified. Overall, this study should provide useful information relevant to an understanding of the health problems presented by tetanus in Jamaica (AU)