Left ventricular hypertrophy: a common finding in an adult African population in Tobago, West Indies - abstract

A total adult African population of age 16 years and over is being assessed for cardiovascular risk factors. Mean body mass index of the 303 men was 26.5 and that of the 465 females, 31.0. Hypertension was present in 19.0 per cent of women (89/465). Diabetes was present in 7.9 per cent men (24/303), 11.0 per cent women (51/465). Preliminary data reveal that ECG left ventricular hypertrophy, MACPC display using a modified Sokolow and Lyon Index (ECGLVH) is common: it is present in 27.4 per cent of men (83/303) -9.7 per cent of women (45/465). Results of echocardiograms are available on 198 men and 321 women. Males with ECGLVH had a higher mean of left ventricular wall thickness in diastole (p 0.025) and a higher mean of intraventricular septal thickness in diastole (IVSD) (p 0.05). Females with ECGLVH did not have a higher mean of LVWD or IVSD. LV mass was calculated by the criteria of Devereux and Reichek (1976). Mean left ventricular mass (LVMASS) was higher in respondents with ECGLVH both for males (p 0.05) and for females (p 0.05). Mean LV mass increased across the ten year age groups from 25 - 64 years both sexes (p 0.05). Mean blood pressures of respondents without LVH for males were 111.4/69.5, for females were 118.8/69.5. Further research into the factors affecting LV mass in this population are underway (AU)

Acute myocardial infraction following blunt chest trauma due to the kick of a cow

A previously healthy 29-year-old man developed electrocardiographic evidence of an anterolateral myocardial infarction following the kick of a cow to the left precordial area. This was complicated by three episodes of ventricular fibrillation and cardiogenic shock. After five months, electrocardiographic and echocardiographic evidence of ventricular aneurysm persists (AU)

Cutaneous histoplasmosis in the acquired immune deficiency syndrome: a report of three cases from Trinidad

Three cases are reported of patients with the acquired immune deficiency syndrome (AIDS) and cutaneous histoplasmosis. Their initial presentation was that of a generalised malculopapular rash. Two patients were bisexual males and the third was an unmarried female. The range of opportunistic infections seen in AIDS patients in Trinidad is mentioned and clinicians are alerted to the fact that in areas endemic for histoplasma capsulatum maculopapular rash in patients with AIDS may suggest disseminated histoplasmosis. The value of skin biopsy is mentioned. (AU)

Skin biopsy and cutaneous histoplasmosis in the acquired immune deficiency syndrome in Trinidad - abstract

Eighteen patients with the acquired-immunodeficiency syndrome (AIDS) presented with primary skin manifestations at the Port-of-Spain General Hospital in 1986. The lesions included local (3) and generalised (4) dermatitis, pustules, plaques (2), crateriform ulcers (2), erythematous lesions (4) and maculo-papular rashes (7). Some patients had a mixture of lesions. The maculo-papular rashes were commonest. Full-thickness skin biopsies were stained with periodic acid-Schiff and methamanine silver; yeast forms of Histoplasma capsulatum were found in 11 cases. Three of these cases had a post-mortem examination; this revealed the presence of the fungus in all the tissues sampled which included brain, liver, spleen and lymph nodes. The skin lesions were the only presenting clinical manifestations of disseminated histoplasmosis in these patients. Histoplasmosis capsulatum is endemic in Trinidad and Tobago but clinical infection was extremely rare before the advent of the AIDS epidemic. In areas endemic for H. capsulatum, clinicians should be alerted to the fact that cutaneous lesions in patients with AIDS may suggest histoplasmosis. Given the facts that cultures may be negative and unnecessarily delay treatment, that the histoplasmin skin test is of doubtful value and that serological titres are unreliable in the immunocompromised, we advocate full-thickness skin biopsy to diagnose histoplasmosis in AIDS patients (AU)

Racial and other characteristics of human T cell leukemia/lymphome (HTLV-1) and AIDS (HTLV-111) in Trinidad

Adult T cell leukaemia/lymphoma was first recognised as a clinical entity in southwest Japan. Subsequently the Caribbean has been found to be another area where the disease is endemic, and sporadic cases have been identified in different parts of the world. The human T cell leukaemia/lymphoma virus (HTLV-1) is causally related to adult T cell leukaemia/lymphoma. A sub-group of HTLV, designated HTLV-111, has recently been isolated from many patients with the acquired immunodeficiency syndrome (AIDS) and preAIDS, and there is now evidence that this variant is the primary cause of AIDS. This is the first report from Trinidad to describe twelve cases of adult T cell leukaemia/lymphoma and 14 of AIDS. All were in patients of African descent. No cases were seen in subjects of East Indian descent, who, like those of African descent, comprise as much as 40 percent of the population

Wenckebach phenomenon occurring in secondary syphilis

A case is described in which A-V nodal dysfunction in the form of the Wenckebach phenomenon occurred in a patient suffering from secondary syphilis. It was associated with a slight degree of cardiac enlargement. The patient presented with palpitations which resolved with antisyphilitic therapy, but the cardiac enlargement persisted. Electrocardiograms carried out on a further 49 consecutive patients with secondary syphilis showed no evidence of A-V nodal conduction defect. Abnormal eletrocardiograms were found in eight (16 per cent.) of the series, and in three (6 per cent.) the abnormality consisted of ST segment and T wave changes (AU)

First isolation of Eastern equine virus from a case of encephalitis - abstract

A strain of Eastern Equine virus was isolated from a fatal human case of encephalitis for the first time in Trinidad in 1970. The virus was recovered from the blood and the brain of the patient. This new strain was found closely related to the TRVL prototype strain of Eastern Equine, isolated from Curlex nigripalpus in 1969. It was further identified at the National Communicable Diseases Centre as a South American strain of Eastern Equine. Validity of the isolate was confirmed by reisolation of the virus from the original materials. The etiological relationship of the virus to the patient's illness was established by the demonstration of a seroconversion to the isolated and to the TRVL prototype strain of Eastern Equine. A second case of human encephalitis occurred a week later in the same area. No virus was isolated from the acute phase blood. Diagnosis was made on the basis of an immuno-conversion to Eastern Equine. These two patients probably came into contact with the virus in the Santa Cruz Valley, which is situated in the Northern Range of Trinidad and fairly close to Port-of-Spain. In the Santa Cruz Valley, only three other humans have been found so far to have antibodies to Eastern Equine. They were living at the same spot where the first case supposedly became infected. Human survey as well as a field programme are stil in progress (AU)

First isolation of a South American strain of eastern equine virus from a case of encephalitis in Trinidad

A South American strain of Eastern Equine virus was isolated from a fatal human case of encephalitis for the first time in Trinidad in 1970. This virus was recovered from the blood and brain of the patient. Validity of the isolate was confirmed by reisolation of the virus from the original materials. The etiological relationship of the virus to patient's illness was established by the demonstration of a secroconversion to the isolate and to the TRVL prototype strain of Eastern Equine virus. A second case of human encephalitis occurred a week later in the same geogrphical area. No virus was isolated but the diagnosis was made on the basis of an immunoconversion. (Summary)