Atlas of prostate cancer heritability in European and African-American men pinpoints tissue-specific regulation.

Although genome-wide association studies have identified over 100 risk loci that explain ∼33% of familial risk for prostate cancer (PrCa), their functional effects on risk remain largely unknown. Here we use genotype data from 59,089 men of European and African American ancestries combined with cell-type-specific epigenetic data to build a genomic atlas of single-nucleotide polymorphism (SNP) heritability in PrCa. We find significant differences in heritability between variants in prostate-relevant epigenetic marks defined in normal versus tumour tissue as well as between tissue and cell lines. The majority of SNP heritability lies in regions marked by H3k27 acetylation in prostate adenoc7arcinoma cell line (LNCaP) or by DNaseI hypersensitive sites in cancer cell lines. We find a high degree of similarity between European and African American ancestries suggesting a similar genetic architecture from common variation underlying PrCa risk. Our findings showcase the power of integrating functional annotation with genetic data to understand the genetic basis of PrCa.

Prostate Cancer Susceptibility in Men of African Ancestry at 8q24.

The 8q24 region harbors multiple risk variants for distinct cancers, including >8 for prostate cancer. In this study, we conducted fine mapping of the 8q24 risk region (127.8-128.8Mb) in search of novel associations with common and rare variation in 4853 prostate cancer case patients and 4678 control subjects of African ancestry. All statistical tests were two-sided. We identified three independent associations at P values of less than 5.00×10(-8), all of which were replicated in studies from Ghana and Uganda (combined sample = 5869 case patients, 5615 control subjects; rs114798100: risk allele frequency [RAF] = 0.04, per-allele odds ratio [OR] = 2.31, 95% confidence interval [CI] = 2.04 to 2.61, P = 2.38×10(-40); rs72725879: RAF = 0.33, OR = 1.37, 95% CI = 1.30 to 1.45, P = 3.04×10(-27); and rs111906932: RAF = 0.03, OR = 1.79, 95% CI = 1.53 to 2.08, P = 1.39×10(-13)). Risk variants rs114798100 and rs111906923 are only found in men of African ancestry, with rs111906923 representing a novel association signal. The three variants are located within or near a number of prostate cancer-associated long noncoding RNAs (lncRNAs), including PRNCR1, PCAT1, and PCAT2. These findings highlight ancestry-specific risk variation and implicate prostate-specific lncRNAs at the 8q24 prostate cancer susceptibility region.

Longitudinal changes in IOP and incident glaucoma in the Barbados Eye Studies

PURPOSE: There are a few longitudinal population studies describing the progression of intraocular pressure (IOP) or the risk of developing incident open-angle glaucoma (OAG). This report examines changes in IOP and measures the incidence of IOG over a 4-year period in the population of the Barbados Eye Studies. METHODS: The Barbados Incidence Study of Eye Disease (BISED) re-examined members of the Barbados Eye Study (BES) cohort, the original sample being based on a simple random sample of the country's population aged 40 - 84 years. At both visits patients had applanation tonometry, automated Humphrey perimetry, a comprehensive opthalmological examination, colour stereo fundus photography, blood pressure and anthropometric measurements and a detailed interview. RESULTS: A total of 3427 participants or 85 percent of the eligible cohort were re-examined in BISED. The IOP analyses were based on the subset of 2640 Black participants without glaucoma (OAG, or other type) or history of IOP lowering treatment at either visit. The mean age at follow-up was 55 years and 60 percent were women. Mean IOP was 17.3 mmHg (SDñ3.0, median 17.0) at baseline and increased by 2.6 mmHg (SDñ3.6 mmHg, median 2.3)(p<0.001by paired 1 test) in 4 years. Factors positively associated with longitudinal increases in IOP include age (p=0.001) and baseline hypertension (p=0.014) or high systolic blood pressure(p=0.005), while there was an inverse association with baseline IOP. Among the 2989 Black participants without OAG at baseline,the 4-year incidence of OAG was 2.2 percent (95 percent CI: 1.7 percent, 2.8 percent). Incidence was highest among persons classified as suspect OAG at baseline (26.1 percent) followed by ocular hypertensives with IOP >21 mmHg (4.9 percent) and lowest in persons with normal / other diagnoses and with IOP ó21 mmHg (0.8 percent). However, 32 of the 67 new cases of OAG (48 percent) had IOP ó21 at baseline. CONCLUSION: Significant increases in IOP were seen at 4-year follow-up in persons without glaucoma or IOP-lowering treatment history. While high IOP increases the risk of OAG, almost half of the incident cases had IOPó21mmHg at baseline. These results highlight the importance of prognostic factors, other than IOP, in determining the development of OAG.(AU)

Cataract and mortality in an Afro-Caribbean population: the Barbados eye studies

OBJECTIVE: Age related cataract is the major cause of visual impairment globally, and is more prevalent in black than white populations. Several studies have shown associations between cataract and mortality, and this report aimed to examine whether lens opacities were associated with mortality in an Afro-Caribbean population. DESIGN AND METHODS: The Barbados Incidence Study of Eye Disease (BISED) re-examined the Barbados Eye Study (BES) cohort, which was based on a simple random sample of Barbadian-born citizens, age 40 to 84 years. Eighty-five percent of those eligible (3,427 participants) has a 4-year follow-up visit. Both visits included an interview, anthropometric measurements, and a detailed ophthalmologic examination, including lens grading with the LOCS II method. Mortality was verified from records held at the Ministry of Health. RESULTS: Cardiovascular disease was the principal cause of death (3.7 percent), followed by malignant neoplasms (1.4 percent). Cumulative 4-year mortality increased from 3.1 percent among those without cataract to 6.0 percent, 8.9 percent and 19.6 percent for cortical-only, nuclear-only and mixed cataract, respectively. An independent association was demonstrated between mixed opacities and 4-year mortality (death rate ratio: 1.6). Co-existing diabetes acted as an effect modifier, increasing mortality in those with mixed lens opacities. The presence of any nuclear cataract (death rate ratio 1.5) was also associated with an increase risk of death. CONCLUSION: This study is the first to confirm an association between cataract and mortality in a population of African descent.(AU)

Diabetic retinopathy in a black population: the Barbados Eye Study

OBJECTIVE: The distribution of diabetic retinopathy in black populations is largely unknown. The authors present retinopathy data from the predominantly black participants of the Barbados Eye Study (BES). DESIGN AND PARTICIPANTS: Prevalence study of 4631 participants based on a random sample of the Barbados population 40 to 84 years of age (84 percent participation). MAIN OUTCOME MEASURES: Diabetes was defined as self-reported history of physician-diagnosed diabetes or glycosylated hemoglobin greater than 10 percent (>2 standard deviations above the population mean of persons without a diabetes history). Retinopathy was assessed by independent grading of 30 degrees color stereo fundus photographs of the disc and macula. RESULTS: Diabetes was present in 19.4 percent of black (n = 4314), 15.2 percent of mixed (black and white, n = 184), and 7.5 percent of white/other (n = 133) self-reported racial groups. In the black/mixed population, regardless of diabetes status, the prevalence of retinopathy was 5.9 percent. In the 636 black and mixed participants with diabetes, the prevalence of retinopathy was 28.5 percent: 19.8 percent had minimum changes, 7.7 percent had moderate changes, and 0.9 percent had severe retinopathy. Clinically significant macular edema (CSME) was found in 8.6 percent of those with diabetes. CONCLUSIONS: In the population of African origin, approximately 1 in 17 persons had retinopathy. Among those with diabetes, 28.5 percent had retinopathy and 8.6 percent had CSME. These results highlight the clinical and public health relevance of diabetic retinopathy in the black populaion.(AU)

Diabetic retinopathy in Barbados: the Barbados eye study

OBJECTIVE: Diabetic retinopathy is an important cause of visual loss in Barbados and the Caribbean region. The Barbados Eye Study (BES) provides the largest source of population based data on diabetic retinopathy in black adults. METHODS: This is a prevalence study of 4,631 participants based on a random sample of the Barbados population aged 40-84 years (84 percent participation). Diabetes was defined as self-reported history of physician diagnosed diabetes and/or glycosylated haemoglobin > 10 percent (2 standard deviations above the population mean of persons without a diabetes history). Retinopathy was assessed by independent gradings of 30 degrees colour stereo fundus photographs of the disk and macula. RESULTS: Diabetes was present in 19.4 percent of blacks (n=4,313), 15.2 percent of mixed black and white; n=184), and 7.5 percent of white/other (n=133) self reported racial groups. Type 1 diabetes was infrequent. In the overall black/mixed study population regardless of diabetes status, the prevalence of retinopathy was 5.9 percent. In the 636 black and mixed participants with diabetes and gradable fundus photographs, the prevalence of retinopathy was 28.5 percent; 19.8 percent had minimum background changes, 7.7 percent had moderate changes and 0.9 percent had severe retinopathy. Clinically significant macular oedema (CSME) was found in 8.6 percent of those with diabetes. CONCLUSION: In the Afro-Caribbean population over 40 years of age, about 1 in 17 persons had retinopathy. Among those with diabetes, 28.5 percent had retinopathy and 8.6 percent had CSME. These results highlight the clinical and public health relevance of diabetic retinopathy in the region (AU)

Diabetes, hypertension, and central obesity as cataract risk factors in a black population. The Barbados Eye Study

OBJECTIVE: The increased cataract prevalence of black populations, especially of cortical cataract, remains unexplained. The authors evaluate the relationships of diabetes, hypertension, and obesity patterns to lens opacities, by age, among 4314 black participants in the Barbados Eye Study. DESIGN AND PARTICIPANTS: Prevalence study of a random sample of the Barbados population, ages 40 to 84 years (84 percent participation). MAIN OUTCOME MEASURES: Associations with age-related lens changes (grade > or = 2 in the Lens Opacities Classification System II at the slit lamp) were evaluated in logistic regression analyses by age (persons < 60 years and > or = 60 years). Results are presented as odds ratios (OR) with 95 percent confidence intervals. RESULTS: Of the 1800 participants with lens changes, most had cortical opacities. Diabetes history (18 percent prevalence) was related to all lens changes, especially at younger ages (age < 60 years: OR = 2.23 [1.63, 3.04]; age > or = 60 years: OR = 1.63 [1.22, 2.17]). Diabetes also increased the risk of cortical opacities (age < 60 years: OR = 2.30 [1.63, 3.24]; age > or = 60 years: OR = 1.42 [1.03, 1.96]); additional risk factors were high diastolic blood pressure (age < 60 years: OR = 1.49 [1.00, 2.23] and higher waist/hip ratio (all ages: OR = 1.49 [1.00, 1.84]). Diabetes was also related to posterior subcapsular opacities. Glycated hemoglobin levels were positively associated with cortical and posterior subcapsular opacities. Overall, 14 percent of the prevalence of lens changes could be attributed to diabetes. CONCLUSIONS: The high prevalence of cortical opacities was related to diabetes, hypertension, and abdominal obesity, which also are common in this and other black populations. Interventions to modify these risk factors, especially in populations which they are highly prevalent, may have implications to control visual loss from cataract, which is the first cause of blindness worldwide.(Au)

Implications of hypertension in Barbadians: findings from the Barbados Eye Study Group

Hypertension is the most significant chronic disorder in the Caribbean, affecting approximately 45 percent of adults aged 45 years and older. This condition has significant clinical and public health implications, as elevated blood pressure is associated with considerable morbidity and mortality in populations of black African descent. Here we report some of the cardiovascular implications of blood pressure in Barbadians. The Barbados Eye Study commenced in 1988 and included 4 709 participants or 84 percent of a simple random sample of the island's population aged 40 to 84 years. Measurements included blood pressure (two random zero sphygmomanometer measurements), anthropometry including weight, height and body circumferences, visual acuity, perimetry and applanation tonometry measured by trained observers, and assay of glycated haemoglobin. The median age of the study population was 58 years, 57 percent were female and 93 percent reported their race as black. Among black participants the overall prevalence of hypertension (mean systolic blood pressure > 140 mmHg and/or mean diastolic blood pressure > 90 mmHg and/or a history of antihypertensive treatment) was 55.4 percent with 49.8 percent of men and 59.6 percent of women being affected. The prevalence of self-reported angina in men (based on the Rose questionnaire) was 1 percent in normotensives, 1.3 percent in untreated hypertensives, and 1.5 percent in treated hypertensives. Corresponding prevalences of angina were higher in women, being 2.0 percent, 2.4 percent and 4.5 percent, respectively. The prevalence of self reported myocardial infarction in men was 1.3 percent in normotensives, 2.3 percent in untreated hypertensives and 5.7 percent in treated hypertensives; and, in women, 2.2 percent in normotensives, 2.1 percent in untreated hypertensives and 5.0 percent in hypertensives. The prevalences of cerebrovascular accidents was higher in men than in women: 1.4 percent in normotensive men vs 0.9 percent in normotensive women; 2.3 percent in untreated hypertensive men vs 1.6 percent in untreated hypertensive women; and 6.5 percent in treated hypertensive men vs 4.4 percent in treated hypertensive women.(AU)

Work site heart health promotion and practice: a pilot project of the Heart Foundation of Barbados

The workplace has long been recognised as an important setting in which to promote the practice of healthy living since most individuals spend more than one-third of their day in such situations which might be considered a "captive environment". The Heart Foundation of Barbados, aware of the significantly high prevalence of lifestyles related illnesses and the opportunities and potential for effecting positive change in the workplace, embarked on a worksite heart pilot project aimed at determining the feasibility of establishing such a programme in Barbados and determining its impact and effect on health practices of workers in the workplace and elsewhere. The study was conducted among the staff of a local professional services firm. It consisted of risk factor screening of staff members, teaching of and certification in Cardiopulmonary Resuscitation (CPR), and facilitating regular related activities. Two years after the initiation of the project an anonymous knowledge, attitudes and practice questionnaire was administered to participants. 116 (88 percent) members of staff was taught and certified in CPR, and a further 3 persons were trained and certified as CPR instructors. Anthropometric and blood pressure measurements were performed on the 116 participants. Over the two years of the project the company developed a significantly enhanced health consciousness and profile, as evidenced by the formation of a health club, active participation in national healthy lifestyles activities and the conducting of a regular related seminars, lectures and associated and related activities. Finally, among those responding to the knowledge attitudes and practices survey 60 percent of 60 participants returning completed questionnaires reported a positive change in their lifestyle as a direct result of the programme. Among 63 percent there was an enhanced personal attitude to the company. 36 participants (60 percent), reported that they would provide assistance in an emergency situation, of which 64 percent expressed confidence in doing so, and 58 percent attributed their confidence to their involvement in the programme. Preliminary results suggest that the introduction and implementation of a work site heart health promotion and practice programme is acceptable to workers in Barbados, is feasible, and results in improvement of worker health attitudes and practices.(AU)

The hypertensive Caribbean

Caribbean populations demonstrate a dramatic epidemiological transition, with cardiovascular disease the most common cause of death and hypertension the leading risk factor. Epidemiological surveys in the 1980s in Barbados and Trinidad found prevalence rates of 42 percent and 25 percent in population over 40 years and 35 years old, respectively, using the WHO criterion of blood pressure (BP) > 160/95. In a strictly standardised seven country survey carried out in 1992 and 1993 (ICSHIB) prevalence rates (BP>160/95) in the over 25 year old population of Barbados, Jamaica and St. Lucia were 21.5 percent, 17.5 percent and 18.3 percent, respectively, but 50 percent higher for BP>140/90. The gradient correlated closely with body mass index and with economic development and gross national product. In this study, rates of awareness, treatment and control were also highest in Barbados (90 percent, 85 percent, and 72 percent) and lowest in St. Lucia (74 percent, 59 percent and 35 percent). At the 140/90 level these figures were much lower, e.g. 75 percent, 66 percent and 38 percent in Barbados control was lower still, with only 18 percent having a most recent recorded blood pressure of <140/90. Part of the discrepancy may reflect the recognised higher value of "office" versus "home" BP recordings, and a "white coat effect". Nevertheless all studies indicate that the great majority of hypertensives in the Caribbean are not having their blood pressure controlled, with ominous implications for morbidity and mortality in the coming decades. Drugs used in primary care in Barbados conform to current (JNC VI, 1997) recommendations, i.e., frequency of use: thiazide, beta blocker, angiotensin converting enzyme inhibitor and calcium channel blocker, but dietary approaches were documented in only one-third of patients. Greater effort needs to be placed on non-drug therapeutic approaches, and innovative mechanisms need to be developed urgently to achieve this, along with appropriate Caribbean strategies for low cost drug regimens. The Commonwealth Caribbean Medical Research Council has prepared, with wide consultation, regional guidelines for hypertension management.(AU)

Factors associated with hypertension in Barbadians: findings from the Barbados Eye Study cohort

Although hypertension has emerged as the most common chronic non-commuciable disease in the Caribbean, affecting approximately 45 percent of those aged 40 years and older, few studies have attempted to elucidate the contribution of risk factors to the burden of hypertensive disease. The Barbados Eye Study commenced in 1988, and included 4709 participants or 84 percent of a simple random sample of the island's population, aged 40 to 84 years. Measurements included applanation tonometry, visual acuity and perimetry, blood pressure with a random zero sphygmomanometer, anthropometry including weight, height, and body circumferences performed by trained observers, as well as the assay of glycated haemoglobin. The median age of the cohort was 58 years, 57 percent being female, with 93 percent reporting their race as Black. In patients not receiving treatment for hypertension, mean systolic and diastolic pressures were significantly higher in Blacks compared to Whites or others, mean systolic pressure: 132.1 ñ 21.1 mm Hg vs 129.6 ñ 19.8 mm Hg, respectively (p=0.021); mean diastolic pressure: 79.4 ñ 11.3 mm Hg vs 76.1 ñ 10.8 mm Hg, respectively (p=0.001).(AU)

A twenty-five year review of maternal mortality in Barbados: 1970-1994

Maternal mortality is a sensitive indicator of the health status of a country, reflecting not only the quality of obstetric care, but of all services which contribute to the well-being of women of reproductive age. All maternal deaths taking place in Barbados in the twenty-five year period 1970-1994 were ascertained and the causes of death documented. The overall maternal mortality rate was 86 deaths per 100,000 live births, and unexpectedly high level of mortality. The major causes of deaths were sepsis, complications due to ectopic gestation and abortion, haemorrhagic complications and hypertensive disorders of pregnancy. Improvements in the provision of services resulted in no deaths due to sepsis being documented after 1985, nor were there any deaths attributed to complications of abortion or ectopic gestation after 1989. We note a reduction in the annual mortality rate over the last decade of the period reviewed, albeit significantly less than expected given the level of improvement in health care services. In particular, the maternal mortality rate due to hypertensive disease of pregnancy had remained unchanged. Further research is therefore necessary to elucidate factors which affect the access of patients to health care services, as well as their utilisation of such services. Furthermore, research aimed at evaluating the actual services available to pregnant women might also be appropriate, in order to allow the formulation of strategies aimed at reducing the maternal mortality rate further.(AU)

Weight and body composition changes during pregnancy in Barbadian women - abstract

Weight gains occur during normal pregnancy in women with free access to food. Maternal nutrition status prior to conception and during pregnancy is a critical determinant of foetal growth and pregnancy outcomes. These gains reflect changes in the composition of the maternal body as well as changes in the products of conception. There are limited data from the West Indies about maternal nutritional status during pregnancy as well as the factors determining changes in body composition and pregnancy weight gain. We report the results of a prospective study of 342 pregnant Barbadian women conducted between August 1994 and February 1996 which assessed nutritional changes during pregnancy and their impact on glucose metabolism. This report is, however, limited to the changes observed in nutritional indices. At registration, age and parity were strongly analysed demonstrated that change in weight between registration (at a median time of 15 weeks gestation) and 36 weeks gestation and postpartum, were independently and inversely associated with BMI and age. Parity was not found to be independently associated with weight change. Changes in body composition were examined by deriving estimates of fat and lean mass. Estimated fat mass gains were consistent with those reported from well-nourished Western societies, and were mainly determined by initial BMI. We also observed gains in lean mass as a consequence of pregnancy. (AU)

Fat distribution and glucose metabolism in pregnancy: an anthropometric study of Barbadian women

Two hundred and fifty women were studied to evaluate the effects of maternal growth on glucose and insulin metabolism during the pregnancy. Participants were recruited from the antenatal clinic at the Queen Elizabeth Hospital, Barbados, if they booked by 16 weeks' gestation. Anthropometric indices, including skinfold thickness, weight, height and hip circumference, were measured at recruitment, and participants subjected to a 75-gm oral glucose tolerance test (WHO criteria) at 18 weeks' gestation. Fasting blood samples were collected for plasma lipids, venous plasma glucose (VPG), serum insulin, c-peptide and glycosylated haemoglobin. Samples were taken at 1 and 2 hours post glucose load for VGP (fasting: p=0.003; 1 hour: p=0.008; 2 hour: p=0.026) and fasting insulin levels (p=0.02). High mean hip circumference at booking was associated with raised VPG (fasting:p=0.07; 1 hour: p=0.04; 2hour: p=0.16) and fasting serum insulin (p<0.001). Fat distribution, rather than global obesity per se, may be an important factor influencing glucose and insulin metabolism during pregnancy (AU)

Outcome of live-born infants in Barbados requiring neonatal care, before and after the introduction of a neonatal intensive care unit - abstract

A review of the outcome of neonatal care over a 72-month period (November, 1987 - October, 1993) was retrospectively analysed. The study looked at the changing trends of survival, as influenced by the development of a neonatal intensive care unit (NICU) at the Queen Elizabeth Hospital in November, 1990. During the study period, 4,838 neonatal admissions were analysed; 57 percent were pre-NICU and 42.5 percent post-NICU. Significantly more babies were ventilated in the post-NICU era (p < 0.00001) and survival proportionately increased (p = 0.0027). Although there was no statistical difference in the overall survival in the two eras (p = 0.435), the data indicated that the very low birth weight babies and those ultimately ventilated survived longer in the NICU era (p = 0.0018). With increased survival of premature babies, and the impact of more sophisticated neonatal care, it is likely that one will see more significant trends in the unit-specific mortality. In addition, the surviving children must be carefully looked at to determine their neurodevelopmental outcome in a society with limited health resources (AU)

Long-term follow-up of infant malnutrition in Barbados studies of glucose tolerance in well-adapted young adults - abstract

Childhood origins of adult disease may be important in the Caribbean, for instance in the later sequelae, if any, of under and malnutrition. Several such hypotheses can be tested for diabetes, including severity of the initial episode(s) leading to pancreatic fibrosis, and weight gain after puberty, causing further B-cell stress. The 1985 WHO criteria defined a malnutrition-related diabetes (MRDM) category, but causal evidence is slim. We examined a series from a chort (N=311) of survivors of infant marasmus (M), Kwashiorkor (K) and age-matched controls (C), all followed since presentation, for over 20 years. Cases were defined on infant weight for age < 2 SDs below expected. Of the first 90 subjects invited, 84 (93 percent) attended for a standardized portocol by trained observers, of a full 2-hour glucose tolerance test and anthropometric measures. (The results are shown in a table). These preliminary results show that average catch-up growth was complete in these previously severely malnourished young adults. While fasting blood glucose (FG) results were similar, following challenge the 2 hr values (2hr G) were significantly higher in female M than respective C(t=3.25, p<0.001) not accounted for by their greater weight, and higher in all M than C (p=0.02). Waist/Hip ratios were no different. Thus, despite these young people being well-adapted in a generally favourable socioeconomic setting, there is some evidence of glucose intolerance following challenge. This could be a prodrome for later development of diabetes. As they are also the first to have responded to the follow-up invitation, those who may not respond may be less well-adapted and hence at even greater risk of glucose intolerance and perhaps other problems (AU)

Acute myocardial infarction in Barbados - abstract

This project set out to establish the accurate documentation of patients presenting with acute myocardial infarction (AMI) to the medical wards of the Q.E.H., with investigation of putative factors, as well as to establish the feasibility of a prospective AMI register. Prospective analysis was carried out with daily review, and entry of data on prepared forms, of patients admitted with suspected AMI. Assessment of risk factors was made by questionnaire, anthropometric measurements and biomedical indices, with documentation of AMI by standard criteria. Initial results for the 3-month period commencing November 1, 1990, showed 26 patients with AMI. Three patients were visitors and 23 were Barbadian. Four of the Barbadian patients died within 24 hours of admission and a further 3 died before discharge from hospital. Of the 19 Barbadians surviving > 24 hours (11 males, 8 females), 18 were black and 1 white, 5 having previously had AMIs. Eight were known to be hypertensive, 7 were diabetic and of these, 3 suffered from both disorders. Over the study period a further 11 patients were admitted with anginal episodes, 9 of whom were known to have ischaemic heart disease. A further 18 patients admitted with suspected AMIs were not subsequently shown to have ischaemic myocardial disease. Extrapolation of preliminary data suggests an incidence of 100 cases of AMI annually. The accuracy of this estimate will be clarified by continuation of this study. Inherent problems and their relevance to the accurate documentation of AMI will be discussed. A prospective register is an important method of accurately documenting AMI (AU)

Focal seizures related to non-ketonic hyperglycemia - abstract

The aim of this paper is to highlight the association of non-ketonic hyperglycemia and focal seizures. Six patients, including 3 previously undiagnosed diabetics, were seen at the Queen Elizabeth Hospital, Barbados. All patients (except Case 5) were seen by at least one of the authors, while Case 4 was an outpatient whose case notes were reviewed. Three patients showed movement-induced or kinesignetic seizures, 2 had significant post-ictal weakness of the involved limb which was the arm in 5 patients and both limbs in 3. The face was involved either alone (1 patient) or with the arm (2 patients). There was one example of Epilepsia partialis Continua and 3 patients had recurrent episodes of focal seizures when glucose control was lost. Glucose values varied from 17.8 to 55.1 mmol/l, while calculated osmolarity values were elevated in all cases to a mild or moderate extent (299.1 to 346.5 mosmoles/l). The occurrence of focal seizures in the middle-aged or elderly patient should signal the possibility of diabetes mellitus. These seizures are refractory to anticonvulsant therapy and respond best to insulin and rehydration(AU)

Prevalence of HIV infection in STD clinic attenders in Barbados - abstract

In October 1987, an HIV counselling and testing study was initiated at Barbados' principal STD Clinic. The aim of the study was to determine the asymptomatic HIV carriage rate in a potentially high-risk population. Sequentially selected patients were counselled, and those agreeing to the HIV test were screened for antibodies, using Karpas AIDS test and the Abbott Recombinant ELISA test. Seropositive results were confirmed by Western Blot at CAREC. One hundred and eighteen males and eighty females were counselled. One hundred and eight males agreed to be tested and six (5.5 percent) were positve. Seventy-six females accepted the test and one (1.3 percent) was positive. The Karpas AIDS test as a screening test correlates satisfactorily with the Abbot ELISA. Of the seropositive patients for whom information is available, five of five males admitted to sex with prostitutes, three of five patients claimed sexual contact with tourists and five of five males admitted to sex with prostitutes, three of five patients claimed sexual contact with tourists and five of six had had a positive VDRL test for syphilis in the previous five years. The females was a prostitute and one of the positive males was bisexual. This male and one other positive male had received a blood transfusion in the previous five years. In this study population, HIV infection appears to be predominantly heterosexually acquired and particularly associated with sexual contact with prostitutes. A possible association between HIV infection sex with tourist needs further study (AU)