24†Primary outcomes of management of convergence excess esotropia at moorfields eye hospital.

Convergence excess ET (CXE) is an esotropia with binocular single vision (BSV) at distance fixation but esotropia on accommodation for near fixation with near distance disparity (1). In this retrospective chart review our 1ry question:to evaluate the initial treatment to address CXE, whether this treatment successful or not, secondary question: to evaluate primary and final outcomes for control of near esotropia. Successful outcome defined as residual distance and near esotropia and near distance disparity of less than 10PD.We included patients with CXE managed at Moorfields Eye Hospital from 2003 until 2022, defined as 'esotropia with BSV at distance but esotropia on accommodation for near with near distance disparity over 8-10 PD while the eye is corrected with the full cycloplegic refraction'. All age groups were included, amblyopic eyes were excluded.668 patients were reviewed from 2005-2022, the mean age was 7.9years (+/- 6), first line treatment was bifocal glasses in 60%, which was successful in 83%, bi-medial recession was offered to 12.5%, only » of which were improved, Botulinum toxin administered to 3%, bimedial posterior fixation sutures done in 1.5% which did not improve condition. Other lines included single vision glasses and Bangerder foil to relieve double vision. The final outcome was well controlled esophoria in 65% of cases. Binocular single vision achieved in 28%.The management of convergence excess esotropia is still controversial, in our cohort most patients were managed with bifocals, the final motor and sensory outcomes were variable between patients. More than half of patients had satisfactory motor alignment. However, the sensory outcome was much less.

Prevalence and risk factors of Sexually Transmitted Infections (STI) among persons living with HIV attending the STI Clinic in Trinidad

Objective: To determine the prevalence and risk factors for sexually transmitted infections (STIs) among persons living with HIV (PLHIV) attending the STI Clinic in Trinidad. Design and Methodology: A cross-sectional study of STI prevalence among PLHIV attending the STI Clinic in Trinidad was conducted during the period April-September 2014. A questionnaire was administered to obtain socio-demographic data and risk factors for STI infections, a physical examination was carried out and patients were screened for STIs. Data were analysed using SPSS Version 22. Results: A total of 210 HIV infected patients (138 males [65.7%] and 72 females [34.3%]) were enrolled; age range 17-68 years, mean age 36.4 years. Of these, 68 (32.4%) were newly HIV diagnosed and 142 (67.6%) had a known history of HIV infection. Seventy-eight (37.1%) of the 210 patients were concurrently diagnosed with a STI. Homosexual/ bisexual study patients were more likely to be diagnosed with a STI (OR, 3.56; 95% CI, 1.94- 6.51) and more likely to be diagnosed with syphilis (OR, 4.84; 95% CI, 2.40-9.77). Multivariate analysis using binary multiple regression showed that risk factors for STIs included male sex (OR, 2.46; 95% CI, 1.06-5.73), homosexual/bisexual sexual orientation (OR, 2.26; 95% CI, 1.06-4.80) and multiple sex partners within the past 12 months (OR, 1.99; 95% CI, 1.03-3.86). Conclusion: There is a high prevalence of STIs among PLHIV in this study, especially among homosexual/ bisexual sexual males in whom the most commonly diagnosed STI was syphilis. Hence targeted HIV/STI prevention efforts are urgently needed in these patients.

Antibiotic Bactericidal Activity Is Countered by Maintaining pH Homeostasis in Mycobacterium smegmatis.

Antibiotics target specific biosynthetic processes essential for bacterial growth. It is intriguing that several commonalities connect the bactericidal activity of seemingly disparate antibiotics, such as the numerous conditions that confer broad-spectrum antibiotic tolerance. Whether antibiotics kill in a manner unique to their specific targets or by a universal mechanism is a critical and contested subject. Herein, we demonstrate that the bactericidal activity of diverse antibiotics against Mycobacterium smegmatis and four evolutionarily divergent bacterial pathogens was blocked by conditions that worked to maintain intracellular pH homeostasis. Single-cell pH analysis demonstrated that antibiotics increased the cytosolic pH of M. smegmatis, while conditions that promoted proton entry into the cytosol prevented intracellular alkalization and antibiotic killing. These findings led to a hypothesis that posits antibiotic lethality occurs when antibiotics obstruct ATP-consuming biosynthetic processes while metabolically driven proton efflux is sustained despite the loss of proton influx via ATP synthase. Consequently, without a concomitant reduction in respiratory proton efflux, cell death occurs due to intracellular alkalization. Our findings indicate the effects of antibiotics on pH homeostasis should be considered a potential mechanism contributing to antibiotic lethality. IMPORTANCE Since the discovery of antibiotics, mortality due to bacterial infection has decreased dramatically. However, infections from difficult to treat bacteria such as Mycobacterium tuberculosis and multidrug-resistant pathogens have been on the rise. An understanding of the cascade of events that leads to cell death downstream of specific drug-target interactions is not well understood. We have discovered that killing by several classes of antibiotics was stopped by maintaining pH balance within the bacterial cell, consistent with a shared mechanism of antibiotic killing. Our findings suggest a mechanism of antibiotic killing that stems from the antibiotic's ability to increase the pH within bacterial cells by disrupting proton entry without affecting proton pumping out of cells. Knowledge of the core mechanism necessary for antibiotic killing could have a significant impact on the development of new lethal antibiotics and for the treatment of recalcitrant and drug-resistant pathogens.

DJ-1 mutation decreases astroglial release of inflammatory mediators.

Mutations in DJ-1, reactive gliosis and concomitant inflammatory processes are implicated in the pathogenesis and progression of Parkinson's disease (PD). To study the physiological consequences of DJ-1 mutation in the context of neuroinflammatory insult, primary cortical astrocytes were isolated from DJ-1 knockout mice. Astrocytes were exposed to 1µg/mL lipopolysaccharide (LPS) for 24h following 2h pre-exposure to inhibitors of MEK (U0126), JNK (JNK inhibitor II) or p38 (SB203580). Real-time PCR was used to assess the LPS-induced expression of pro-inflammatory mediators cyclooxygenase 2 (COX2), inducible nitric oxide synthetase (NOS2), and tumor necrosis factor α (TNFα). LPS-induced expression of COX2 decreased similarly in DJ-1(+/+) and DJ-1(-/-) astrocytes in response to inhibition of p38, but was unaffected by inhibition of MEK or JNK. No significant alterations in NOS2 expression were observed in any inhibitor-treated cells. The inhibitors did not affect expression of TNFα; however, DJ-1(-/-) astrocytes had consistently lower expression compared to DJ-1(+/+) counterparts. Secretion of TNFα and prostaglandin E2 (PGE2) into the culture medium was significantly decreased in DJ-1(-/-) astrocytes, and inhibition of p38 decreased this secretion in both genotypes. In conclusion, DJ-1(-/-) astrocytes may provide decreased neuroprotection to surrounding neurons due to alterations in pro-inflammatory mediator expression.

Injuries and violence in the Caribbean: how big is the problem?

OBJECTIVE: To quantify and characterize deaths from injuries and violence in the English- and Dutch-speaking Caribbean. DESIGN AND METHODS: The most recent year of available national cause-of-death data for each country for the period 2007-2013 was selected from the CARPHA regional mortality database. An analysis of regional causes of deaths by age and gender was completed. The crude injury death rate for each country, by gender, was also calculated followed by a descriptive analysis of the type of injuries contributing to death in each country. RESULTS: In the English- and Dutch-speaking Caribbean, annual deaths from injuries accounted for 11.5% of all deaths and four times as many men as women died from an injury. Among persons aged 15-44 years, 116,931 person-years of life was lost due to injuries. More males aged 1-44 years died from violence (one in four) than from any other cause. The injury death rate and the related causes varied substantially across countries within the region. CONCLUSIONS: Understanding the current mortality profile of injury and violence in the region is critical to the development of effective and efficient interventions to address this problem. Variability of these profiles across the region suggests that more research is needed to inform development of age, gender and country-specific programmes.

Malaria and its vectors in the Caribbean: the continuing challenge of the disease forty-five years after eradication from the islands / La malaria y sus vectores en el Caribe: el continuo desafío de la enfermedad, cuarenta y cinco años después de su erradicación de las islas

OBJECTIVES: Given the occurrence of autochthonous malaria in non-endemic island countries in the last 10 years, this study evaluates the risk factors for malaria transmission in the malaria "endemic and "non-endemic" countries of the Caribbean region. DESIGN: Data on imported and autochthonous malaria for the 27-year period (1980-2006) were gathered from surveillance units in the 21 Caribbean Epidemiology Centre (CAREC) Member Countries (CMCs) via the CAREC epidemiology unit. Anopheles mosquito data were also gathered from various sources. The vector and malaria data were correlated to determine the current risk of malaria transmission. RESULTS: Imported cases. For the 26-year period (1980-2005), there were 897 reported cases in the CMC islands. Jamaica (38.4%) > Trinidad and Tobago (19.5%) > Bahamas (15.8%) > Cayman Islands (12.5%) were mostly affected. Only the smallest CMCs eg Anguilla and British Virgin Islands reported no imported malaria. Indigenous malaria. Over the same time period, malaria was seen mainly in the three mainland countries of Guyana (514 386 cases) > Suriname (275 361) > Belize (85 313). However, for the period 1995-2005, Belize and Guyana reported reduction in case numbers of 84% and 54% respectively. At the same time, Suriname reported a cyclical pattern of reported cases resulting in 77% increase in cases between 1995 and 2005. "Non-endemic" CMCs such as Trinidad and Tobago, and Bahamas, did report autochthonous malaria. In 2006/7, Jamaica reported 340 P falciparum cases, coming just 1-2 years after a massive 505% increase in imported malaria in the region - 88% in Jamaica. Anopheles spp: There was a rich diversity of Anopheles mosquitoes - 29 spp. in CMCs. Mainland CMCs and nearby island countries had most spp. recorded. Smaller countries with limited ecological niches such as St Kitts, Anguilla, Turks and Caicos Islands (TCI) and Bermuda had little or no Anopheles spp. Two main Anopheles axes were identified - An albimanus in the northern CMCs and An aquasalis in the southern Caribbean. CONCLUSION: All the essential malaria transmission conditions - vector, imported malaria organism and susceptible human host - now exist in most CMCs. A call is now made for enhanced surveillance, vector control and anti-malaria skills to be established in CMCs, in particular in: C Recognizing the possible impact of climate change on the spread of anopheles and malaria transmission. C Improving vector control skills for anopheles in CMCs. C Strengthening malaria surveillance skills. C Upgrading malaria therapy and prophylaxis. C Emphasizing malaria prevention and education for all community and professional sectors.

OBJETIVOS: Dada la incidencia de la malaria autóctona en los países insulares no endémicos en los últimos 10 años, este estudio evalúa los factores de riesgo de la transmisión de la malaria en los países "endémicos" y "no endémicos" con respecto a esta enfermedad en la región del Caribe. DISEÑO: Se recogieron datos sobre la malaria autóctona e importada correspondiente a un período de 27 años (1980-2006). Los datos provinieron de las unidades de vigilancia epidemiológica de los 21 CMCs, es decir, los países miembros del Centro de Epidemiología del Caribe (CAREC), a través de la unidad de epidemiología de este último. También se recogieron datos sobre el mosquito anófeles, a partir de varias fuentes. Se estableció una correlación entre los datos del vector y la malaria respectivamente, a fin de determinar el riesgo actual de transmisión de la malaria. RESULTADOS: Casos importados. En un periodo de 28 años (1980-2005), se reportaron 897 casos en las islas del CMC. Jamaica (38.4%) > Trinidad y Tobago (19.5%) > Bahamas (15.8%) > Islas Caimán (12.5%) fueron los más afectados. Sólo los países miembros más pequeños del CMCs, a saber, Anguila e Islas Vírgenes Británicas (IVB) no reportaron casos de malaria importada. Malaria indígena. En el mismo periodo de tiempo, se vieron casos de malaria principalmente en los 3 países del continente: Guyana (514 386 casos) > Surinam (275 361) > Belice (85 313). Sin embargo, para el periodo de 1995-2005, Belice y Guyana reportaron reducciones en el número de casos, de 84% y 54% respectivamente. Al mismo tiempo, Surinam reportó un patrón cíclico de casos reportados con el consiguiente aumento de un 77% de casos entre 1995 y 2005. De hecho, países "no endémicos" del CMCs, como Trinidad y Tobago, y Bahamas, reportaron malaria autóctona. En 2006/7, Jamaica reportó 340 casos de P falciparum, lo que se producía justamente 1-2 años luego de un masivo aumento de 505% de casos de malaria importada en la región, y un 88% en Jamaica. Anófeles spp: Había una gran diversidad de mosquitos anófeles: 29 spp. en los países del CMCs. Los países CMCs del continente y los países insulares tuvieron los registros más altos de spp. Los países más pequeños, tales como Saint Kitts, Anguila, Islas Turcas y Caicos, con nichos ecológicos limitados, tuvieron poco o ningún anófeles spp. Se identificaron dos ejes principales de anófeles - an. albimanus en los CMCs norteños y an. aquasalis en el Caribe sureño. CONCLUSION: Todas las condiciones esenciales para la transmisión de la malaria - vector, organismos de malaria importada y huésped humano susceptible - se hallan actualmente presentes en la mayoría de los países del CMCs. Se esta haciendo un llamado a reforzar la vigilancia, aumentar el control de vectores, y desarrollar habilidades anti-malaria, en los países del CMCs, especialmente en cuanto a: C Reconocer el posible impacto del cambio climático en la propagación del anófeles y la transmisión de la malaria. C Mejorar las habilidades del CV para el anófeles en los países del CMCs. C Fortalecer las habilidades de vigilancia de la malaria. C Actualizar la terapia y la profilaxis en relación con la malaria. C Poner énfasis en la prevención de la malaria y la educación de toda la comunidad y el sector profesional.

Mortality trends and potential years of life lost in the English and Dutch-speaking Caribbean, 1985-2000 / Tendencias de la mortalidad y años potenciales de vida perdidos en el Caribe de habla Inglesa y Holandesa, 1985-2000

OBJECTIVE: To describe mortality trends and potential years of life lost (PYLL) due to leading causes of death in 21 Caribbean countries during 1985, 1990, 1995 and 2000. METHODS: Mortality data for 1985, 1990, 1995 and 2000 were analyzed to identify regional mortality trends using crude, age-specific and age-adjusted death rates and potential years of life lost. The variables used were age, gender and underlying cause of death. RESULTS: During 1985-2000, there was an overall 5% decrease in age-adjusted mortality rates and male mortality exceeded female mortality. Heart disease was the leading cause of death, with cancers, cerebrovascular diseases, diabetes mellitus and hypertensive disease also among the top five causes in most years. Prostate cancer and cancer of the uterus and breast were the leading causes of death due to cancers. HIV disease (AIDS) featured in the ten leading causes of death for the first time in 1995 and was the 5th leading cause in 2000. CONCLUSION: During the period 1985-2000, countries experienced an increase in mortality due to non-communicable diseases, AIDS and assaults (homicides); the latter two causes were most common among the 15-44 year age group. In 2000, AIDS, heart disease and assault (homicide) were the largest contributors to PYLL.

OBJETIVO: Describir las tendencias de la mortalidad y los años potenciales de vida perdidos (APVP) debido a las causas principales de muerte en 21 países caribeños durante 1985, 1990, 1995 y 2000. MÉTODOS: Se analizaron los datos de la mortalidad de los años 1985, 1990, 1995 y 2000, a fin de identificar tendencias de mortalidad regionales, usando tasas crudas de mortalidad ajustadas por edad y específicas por edad, así como años potenciales de vida perdidos. Las variables usadas fueron la edad, el género y la causa subyacente de muerte. RESULTADOS: Durante 1985-2000, hubo una disminución general de un 5% en las tasas de mortalidad ajustadas por edad y la mortalidad masculina excedió la mortalidad femenina. Las enfermedades cardíacas fueron la causa principal de muerte, hallándose junto a distintas formas de cáncer, las enfermedades cerebrovasculares, la diabetes mellitus, y la hipertensión, entre las cinco causas principales de muerte en la mayor parte de los años. El cáncer de próstata y el cáncer de útero y mamas, se encontraban entre las principales causas de muerte. El VIH (SIDA) se sumaba a la lista de las diez causas principales de muerte, por primera vez, en 1990, y fue la 5ta causa principal en el año 2000. CONLCUSIÓN: En el 2000, el SIDA, las enfermedades cardíacas y los asaltos (homicidios) fueron los principales contribuyentes de APVP.

Mortality trends and potential years of life lost in the English and Dutch-speaking Caribbean, 1985-2000.

OBJECTIVE: To describe mortality trends and potential years of life lost (PYLL) due to leading causes of death in 21 Caribbean countries during 1985, 1990, 1995 and 2000. METHODS: Mortality data for 1985, 1990, 1995 and 2000 were analyzed to identify regional mortality trends using crude, age-specific and age-adjusted death rates and potential years of life lost. The variables used were age, gender and underlying cause of death. RESULTS: During 1985-2000, there was an overall 5% decrease in age-adjusted mortality rates and male mortality exceeded female mortality. Heart disease was the leading cause of death, with cancers, cerebrovascular diseases, diabetes mellitus and hypertensive disease also among the top five causes in most years. Prostate cancer and cancer of the uterus and breast were the leading causes of death due to cancers. HIV disease (AIDS) featured in the ten leading causes of death for the first time in 1995 and was the 5th leading cause in 2000. CONCLUSION: During the period 1985-2000, countries experienced an increase in mortality due to non-communicable diseases, AIDS and assaults (homicides); the latter two causes were most common among the 15-44 year age group. In 2000, AIDS, heart disease and assault (homicide) were the largest contributors to PYLL.

Malaria and its vectors in the Caribbean: the continuing challenge of the disease forty-five years after eradication from the Islands.

OBJECTIVES: Given the occurrence of autochthonous malaria in non-endemic island countries in the last 10 years, this study evaluates the risk factors for malaria transmission in the malaria "endemic and "non-endemic" countries of the Caribbean region. DESIGN: Data on imported and autochthonous malaria for the 27-year period (1980-2006) were gathered from surveillance units in the 21 Caribbean Epidemiology Centre (CAREC) Member Countries (CMCs) via the CAREC epidemiology unit. Anopheles mosquito data were also gathered from various sources. The vector and malaria data were correlated to determine the current risk of malaria transmission. RESULTS: Imported cases. For the 26-year period (1980-2005), there were 897 reported cases in the CMC islands. Jamaica (38.4%) > Trinidad and Tobago (19.5%) > Bahamas (15.8%) > Cayman Islands (12.5%) were mostly affected. Only the smallest CMCs eg Anguilla and British Virgin Islands reported no imported malaria. Indigenous malaria. Over the same time period, malaria was seen mainly in the three mainland countries of Guyana (514 386 cases) > Suriname (275 361) > Belize (85 313). However, for the period 1995-2005, Belize and Guyana reported reduction in case numbers of 84% and 54% respectively. At the same time, Suriname reported a cyclical pattern of reported cases resulting in 77% increase in cases between 1995 and 2005. "Non-endemic" CMCs such as Trinidad and Tobago, and Bahamas, did report autochthonous malaria. In 2006/7, Jamaica reported 340 P falciparum cases, coming just 1-2 years after a massive 505% increase in imported malaria in the region--88% in Jamaica. Anopheles spp: There was a rich diversity of Anopheles mosquitoes--29 spp. in CMCs. Mainland CMCs and nearby island countries had most spp. recorded. Smaller countries with limited ecological niches such as St Kitts, Anguilla, Turks and Caicos Islands (TCI) and Bermuda had little or no Anopheles spp. Two main Anopheles axes were identified--An albimanus in the northern CMCs and An aquasalis in the southern Caribbean. CONCLUSION: All the essential malaria transmission conditions--vector, imported malaria organism and susceptible human host--now exist in most CMCs. A call is now made for enhanced surveillance, vector control and anti-malaria skills to be established in CMCs, in particular in: Recognizing the possible impact of climate change on the spread of anopheles and malaria transmission. Improving vector control skills for anopheles in CMCs. Strengthening malaria surveillance skills. Upgrading malaria therapy and prophylaxis. Emphasizing malaria prevention and educationfor all community and professional sectors.

A cross-sectional survey to estimate the prevalence of family history of colorectal, breast and ovarian cancer in a Scottish general practice population.

A cross-sectional survey of all patients aged 30-65 in four general practices within one Local Health Care Co-operative in Fife, Scotland was undertaken to measure the prevalence of family history of colorectal, breast and ovarian cancer. A total of 7619 patients aged 30-65 responded to a postal questionnaire (response rate 59%). In all, 17% of respondents (1324, 95% Cl 16-18%) reported a relative affected by colorectal, breast or ovarian cancer. Of those, 6% (78, 95% CI 5-7%) met the Scottish guidelines for referral for genetics counselling. In all, 2% (24, 95% CI 1-3%) of all individuals with an affected relative had received genetic counselling and risk assessment. Of these, 25% (6, 95% CI 8-42%) met the moderate- or high-risk criteria for developing a cancer. In conclusion, the number of patients who are at a significantly increased risk of cancer on the basis of a family history is small (approximately 10 per General Practitioner (GP) list). It is therefore unrealistic to expect GPs to develop expertise in genetic risk estimation. A simple family history chart or pedigree is one way that a GP can, within the constraints of a GP consultation, determine which patients should be reassured and which referred to the local cancer genetic clinic.

Ten years of glaucoma blindness in Fife 1990-99 and the implications for ophthalmology, optometry and rehabilitation services.

The aim of this study was to determine the characteristics of the patients in Fife who were registered as blind with a main diagnosis of glaucoma between 1990 and 1999. The case notes of 87 people were studied. The average age at registration was 78 years (S.D. = 14). By the time of first referral to hospital, more than half were already aware of visual loss. Forty-five per cent of referrals had no optometry input. Compliance with treatment was poor in at least 26% of patients. Only 44% had glaucoma surgery. There were significant findings with regard to mental health, particularly dementia, which was eventually present in 24%. At least one-third of patients had a hearing impairment. One-third of those registered as blind could have been registered earlier. However, staff from the local provider of rehabilitation and social work services for the blind were shown to have provided prompt and helpful support to 95% of those registered. Consideration should be given to the way in which elderly patients with advanced glaucoma are managed, with awareness of mental health and hearing problems and emphasis on early referral to rehabilitation services.

Acceptability of universal hepatitis B vaccination among school pupils and parents.

The World Health Organisation (WHO) recommends universal hepatitis B (hepB) vaccination for all countries, but this policy has not been adopted in the UK and its acceptability there is unknown. We investigated the attitudes of secondary one (S1) school pupils aged 12-13 years (n = 50) and parents (n = 39) using semi-structured focus group discussions. There was a lack of awareness of hepB among most participants prior to the study. Parents sought further information, including the risks of infection and vaccine side effects. No participants identified cultural or socioeconomic barriers to being vaccinated against hepB. The majority of pupils and nearly all parents were in favour of universal hepB vaccination. Offering hepB vaccination to all S1 pupils, in school, should therefore be highly acceptable, providing that sufficient information on the risk of hepB infection and vaccine safety is provided. A facility for answering questions and a forum for pupil education should also be offered.

Impact of an interdisciplinary low vision service on the quality of life of low vision patients.

AIM: To investigate the impact of an interdisciplinary low vision service on the vision related quality of life of service users. METHODS: 71 patients were interviewed 2 weeks before their appointment with the service and again 6 months later to assess any changes in their vision related quality of life. The majority of these patients had age related macular degeneration. RESULTS: After contact with the service the majority of patients indicated a reduction in concern about most quality of life issues. They were significantly less anxious about deterioration of their vision, safety within the home, and coping with everyday life. CONCLUSION: Improvements in many areas of their vision related quality of life indicate that this interdisciplinary low vision service has a positive impact on the lives of service users. However many patients were still unable to carry out their preferred everyday activities, and feelings of loneliness and isolation were unchanged. The identification of issues unrelieved by input from the service will be important in planning future service delivery.

Stenting of partial and total coronary occlusions in Trinidad and Tobago.

In order to evaluate the efficacy and safety of coronary stenting, we reviewed the first 32 consecutive patients (34 vessels) who underwent elective coronary stenting during the period August 1999 to August 2000 inclusive at the Digital Lab installed at the Eric Williams Medical Sciences Complex, Trinidad and Tobago. Aspirin, heparin and ticlopidine were used routinely. Abciximab was used in selected cases (38%). The mean age of patients was 55 +/- 10 years. Eighty-one per cent were male, 52% were hypertensive and 21% were diabetic. Sixty-five per cent had severe angina. Prior Coronary Artery Bypass Grafting (CABG) was performed in 3% and previous Percutaneous Transluminal Coronary Angioplasty (PTCA) in 3%. Multivessel disease was present in 43%. The mean left ventricular ejection fraction was 53 +/- 12%. The culprit lesion was located in either the native left anterior descending (LAD) coronary artery (53%), right coronary artery (RCA) (31%), circumflex artery 13% and saphenous vein graft (3%). The mean baseline diameter stenosis was 91 +/- 9% and this was reduced to 13 +/- 33% after stenting. Procedural success was 100% for 26 partially occluded vs 50% for 8 totally occluded vessels. For the total occlusions, procedural success was inversely related to the duration of the occlusion. There were no cases of death, acute vessel closure, Q-wave myocardial infarction, repeat PTCA or emergent Coronary Artery Bypass Graft (CABG) during and following the procedure. Distal embolization occurred in one patient. The mean duration of hospital stay was one day (for 30 outpatient cases). One patient had recurrence of symptoms with a negative stress test. No patient underwent repeat angiography during the first year of follow-up. Coronary stents were successfully implanted at a tertiary care facility in the Caribbean with low in-hospital morbidity and mortality. Stents markedly reduced the diameter stenosis of the coronary lesion during PTCA. The incidence of clinical restenosis was low. Coronary revascularisation can be successfully achieved by coronary stenting in the Caribbean.

Stenting of partial and total cornary occlusions in Trinidad and Tobago

In order to evaluate the efficacy and safety of coronary stenting, we reviewed the first 32 consecutive patients (34 vessels) who underwent elective coronary stenting during the period August 1999 to August 2000 inclusive at the Digital Lab installed at the Eric Williams Medical Complex, Trinidad and Tobago. Aspirin, heparin and ticlopidine were used routinely. Abciximab was used in selected cases (38 percent). The mean age of patients was 55 ñ 10 years. Eighty-one percent were male, 52 percent were hypertensive and 21 percent diabetic. Sixty-five percent had severe angina. Prior Coronary Artery Bypass Grafting (CABG) was performed in 3 percent and previous Percutaneous Transluminal Coronary Angioplasty (PTCA) in 3 percent. Multivessel disease was present in 43 percent. The mean left ventricular ejection fraction was 53 ñ 12 percent. The culprit lesion was located in either the native left anterior descending (LAD) coronary artery (53 percent), right coronary artery (RCA) (31 percent), circumflex artery 13 percent and saphenous vein graft (3 percent). The mean baseline diameter stenosis was occluded vs 50 percent for 8 totally occluded vessels. For the total occlusions, procedural sucess was inversely related to the duration of the occlusion. There were no cases of death, acute vessel closure, Q-wave myocardial infarction, repeat PTCA or emergency Coronary Artery Bypass Graft (CABG) during and following the procedure. Distal embolization occurred in one patient. The mean duration of hospital stay was one day (for 30 outpatient cases). One patient had recurrence of symptoms with a negative stress test. No patient underwent repeat angiography during the first year of follow-up. Coronary stents were successfully implanted at a tertiary care facility in the Caribbean with low in-hospital morbidity and mortality. Stents markedly reduced the diameter stenosis of the coronary lesion during PTCA. The incidence of clinical restenosis was low. Coronary revascularisation can be successfully achieved by coronary stenting in the Caribbean (AU)

Stenting of partial and total coronary occlusions in Trinidad and Tobago

In order to evaluate the efficacy and safety of coronary stenting, we reviewed the first 32 consecutive patients (34 vessels) who underwent elective coronary stenting during the period August 1999 to August 2000 inclusive at the Digital Lab installed at the Eric Williams Medical Sciences Complex, Trinidad and Tobago. Aspirin, heparin and ticlopidine were used routinely. Abciximab was used in selected cases (38). The mean age of patients was 55 +/- 10 years. Eighty-one per cent were male, 52 were hypertensive and 21 were diabetic. Sixty-five per cent had severe angina. Prior Coronary Artery Bypass Grafting (CABG) was performed in 3 and previous Percutaneous Transluminal Coronary Angioplasty (PTCA) in 3. Multivessel disease was present in 43. The mean left ventricular ejection fraction was 53 +/- 12. The culprit lesion was located in either the native left anterior descending (LAD) coronary artery (53), right coronary artery (RCA) (31), circumflex artery 13 and saphenous vein graft (3). The mean baseline diameter stenosis was 91 +/- 9 and this was reduced to 13 +/- 33 after stenting. Procedural success was 100 for 26 partially occluded vs 50 for 8 totally occluded vessels. For the total occlusions, procedural success was inversely related to the duration of the occlusion. There were no cases of death, acute vessel closure, Q-wave myocardial infarction, repeat PTCA or emergent Coronary Artery Bypass Graft (CABG) during and following the procedure. Distal embolization occurred in one patient. The mean duration of hospital stay was one day (for 30 outpatient cases). One patient had recurrence of symptoms with a negative stress test. No patient underwent repeat angiography during the first year of follow-up. Coronary stents were successfully implanted at a tertiary care facility in the Caribbean with low in-hospital morbidity and mortality. Stents markedly reduced the diameter stenosis of the coronary lesion during PTCA. The incidence of clinical restenosis was low. Coronary revascularisation can be successfully achieved by coronary stenting in the Caribbean.

Child sexual abuse: what the urologist needs to know.

PURPOSE: We define what the urologist needs to know regarding child sexual abuse. MATERIALS AND METHODS: Based on our experience in treating numerous child victims of sexual assault and a review of the contemporary literature, the data concerning child sexual abuse incidence, risk factors, clinical presentation, child interview, physical examination and management were analyzed. RESULTS: It is estimated that at least 1 in 4 girls and 1 in 10 boys will suffer victimization by age 18 years. There are no predicting socioeconomic factors. In legally proved cases of child sexual abuse the majority of victims have no diagnostic physical findings. Examination findings change depending on the position of the child, degree of relaxation, amount of labial traction and time to perform the evaluation. Findings that are consistent but not independently diagnostic of abuse include chafing, abrasions or bruising of inner thighs or genitalia, scarring, tears or distortion of the hymen, a decreased amount of or absent hymenal tissue, scarring of the fossa navicularis, injury to or scarring of the posterior fourchette/posterior commissure and scarring or tears of the labia minora. In all 50 states physicians are mandated by law to report to child protection services whenever they suspect that a child has been sexually abused. CONCLUSIONS: The urologist must routinely examine the anogenital area of children during routine urethral evaluation and include child sexual abuse as part of the routine urological history.

Influence of the metabolic sequelae of liver cirrhosis on nutritional intake.

BACKGROUND: The liver plays a central role in ingestive behavior; alterations in metabolic signaling to the brain stem as a result of chronic liver disease could influence intake. OBJECTIVE: We examined the influence of metabolic sequelae of liver disease on nutrient intake and nutritional status. DESIGN: Nutritional status and spontaneous dietary intake were examined in 65 cirrhotic patients and 14 control subjects. The response to feeding was investigated in 14 control subjects and a subgroup of 31 cirrhotic patients. Comparisons were made between patients with primary biliary cirrhosis (PBC) and hepatocellular cirrhosis (HC). RESULTS: Patients were nutritionally depleted. The fasting rate of lipid oxidation in the HC group was greater than in the control group (P < 0.01). In the fasting state, only HC patients were hyperinsulinemic [121.2+/-78.5 compared with 41.3+/-18.6 pmol/L in control subjects (P < 0.001) and 64.7+/-15.8 pmol/L in PBC patients (P < 0.05)] and this persisted during the response to feeding. In the fed state, the magnitude of change in carbohydrate oxidation was greatest in the HC group (HC: 34.6%; control: 23.1%; PBC: 25.2%). Carbohydrate and energy intakes of the HC group were lower than in control subjects (carbohydrate: 193+/-38.3 compared with 262+/-48.1 g/d, P < 0.05; energy: 6.29+/-1.40 compared with 9.0+/-2.12 MJ/d, P < 0.05). CONCLUSIONS: Reductions in carbohydrate intake could be mediated by hyperinsulinemia and compounded by preferential uptake of carbohydrate. This may enhance gastrointestinal satiety signaling and contribute to hypophagia.

Dermatomyositis: a dermatology-based case series.

BACKGROUND: Dermatomyositis is associated with significant morbidity and occasional mortality. Currently there is no consensus on treatment for patients with dermatomyositis. OBJECTIVE: Our purpose was to review the clinical features and response to therapy of patients with dermatomyositis and compare these data with previous series of patients with dermatomyositis/polymyositis. METHODS: Clinical characteristics of 65 patients seen during a 10-year period were reviewed retrospectively. Twenty-one of these patients were enrolled in a prospective, uncontrolled study of treatment with high-dose prednisone followed by slow tapering. RESULTS: Clinical features were similar to those previously described; however, muscle strength at diagnosis was on average greater in patients in this series than in patients previously reported. Malignancy was present in 5 of 43 adult patients (12%), but was not found in patients with juvenile dermatomyositis. Another connective tissue disease was present in 19% of patients. Twelve patients had dermatomyositis sine myositis. Eighteen of 21 patients (85%) in the prednisone study group had resolution of myositis. CONCLUSION: Patients with dermatomyositis in this series had less active myositis at presentation, but were otherwise similar to patients with dermatomyositis/polymyositis previously reported. Treatment with high-dose daily prednisone followed by slow tapering was effective.

Free-living energy expenditure and behaviour in late infancy.

OBJECTIVES: The energy requirements of infants are determined by body size, growth rate, and physical activity. Little is known of the determinants of energy expended on activity. The relation between free-living energy expenditure and behaviour was investigated in infants aged 9 and 12 months. METHODS: Total energy expenditure (TEE) was estimated by the doubly labelled water method and fat free mass was estimated from the 18O dilution space. Behaviour was assessed by two 24 hour activity diaries. SUBJECTS: Thirty four normal healthy infants. RESULTS: TEE was negatively related to the time spent feeding and negatively related to the time spent upset. Body size, represented by fat free mass, accounted for only 19% of the variation in TEE, whereas the combination of fat free mass and two behavioural variables explained 46% of the variation in TEE. CONCLUSIONS: Behaviour contributed significantly to TEE. The energy requirements of individual subjects in this age group cannot be predicted with accuracy from body size alone.