Acute pancreatitis: A 7 year retrospective cohort study of the epidemiology, aetiology and outcome from a tertiary hospital in Jamaica.

BACKGROUND: Acute pancreatitis (AP) is a significant cause of acute abdominal pain, morbidity and hospitalisation. There was previously a dearth of studies exploring the incidence, risk factors and outcome of AP in the Caribbean region. MATERIALS AND METHODS: All patients with a diagnosis of AP admitted to the University Hospital of the West Indies (UHWI) between 2006 and 2012 were reviewed. The epidemiological profile, risk factors, clinical presentation and outcomes of patients with AP were retrospectively studied. RESULTS: There were 70 females and 21 males with a median age of 44 years (range 2-86). The median age of males was significantly higher than that of females (p = 0.041). The incidence of AP was 74 per 100,000 admissions per year. Vomiting and abdominal tenderness were noted in the majority of patients. The most common aetiology was biliary disease (71.4%), idiopathic (12%), post-ERCP (6.6%) and alcohol (5.5%). Alcoholic pancreatitis was only seen in males whereas idiopathic and post-ERCP pancreatitis only occurred in females. The mean duration of hospitalisation was 9.51 ± 8.28 days. Disease severity was mild in 61.1%, moderately severe in 26.7%, and severe in 12.2% of patients. Factors associated with more severe disease included overweight/obesity, idiopathic aetiology and post-ERCP status. The case fatality rate was 2%. CONCLUSION: The incidence of AP was 74/100,000 hospital admissions annually. There was an unusual female preponderance, with biliary pancreatitis being the most common type occurring at an equal frequency among males and females. Only 12.2% of the total cases seen were severe. The case fatality rate was 2%. Local health policy should target timely interventions for biliary pancreatitis and should also address the local factors affecting disease severity.

Opportunities for Integrating Physical Health Within Assertive Community Treatment Teams: Results from Practitioner Focus Groups.

This qualitative study assessed the experiences of assertive community treatment (ACT) team members regarding the integration of physical and mental health self-management for persons with serious mental illness. Three focus groups elicited information from participants concerning barriers, strategies, and recommendations. Findings from inductive analyses revealed six overarching themes: (1) collaboration with primary care, (2) improvements in engagement, (3) team-focused roles, (4) education and training, (5) recommendations for system level barriers, and (6) systems collaboration. Participant recommendations suggest that ACT teams are well positioned to integrate mental and physical health treatment, but further research is needed to support integrated care.

Using mixed-method assessment to advance adolescent HIV prevention.

This two-phase, community-based pilot study examined the impact of an innovative calendar-based assessment on HIV risk perception and risk reduction planning with racially diverse youth aged 14 to 21 at a public health clinic. Participants (N = 232) completed a Sexual Health History Calendar (SHHC) assessing behaviors over the previous 12 months, risk self-appraisals, and future behavioral intentions. Youths' narratives included negative self-appraisals (36%), named a risk-related critical incident (13%) or regret (9%), or expressed increased risk awareness (9%) and need for behavior change (18%). A minority were positive (28%) or reflected improvement (7%). All Phase 2 participants (n = 122) identified at least one specific risky behavior they intended to change. These data and the SHHC's visual cues facilitated risk-reduction intervention tailored to the unique circumstances in which each youth's risk taking occurred. For nurses and other providers in clinical settings, the SHHC can offer a critical link between assessment and intervention.

Comparison of adolescents' reports of sexual behavior on a survey and sexual health history calendar.

Assessing sexual risk is critical for human immunodeficiency virus (HIV) and sexually transmitted infection (STI) prevention with adolescents. This article compares sexual risk reports from two self-administered instruments, a standard survey and a sexual health history calendar (SHHC), among racially diverse youth (n = 232) ages 14 to 21 seeking services at a public health clinic. Agreement between methods was assessed using Lin's concordance correlation coefficients (CCC) and Bland-Altman plots. Lin's CCC showed poor to moderate agreement between instruments on reports of sexual partners in the past 3 (0.47), 6 (0.55), and 12 (0.49) months. While individual sexual partner questions were refused a total of 179 times on the survey, youth reported having sexual partners during the same time period on the SHHC in most (77.1%) of these instances. Poor agreement was also found for condom use frequency (CCC = 0.17), with youth's frequency of condom use on the SHHC differing from that reported on the survey for more than half (55.6%) of the months they were sexually active. While lack of objective sexual behavior measures limits conclusions about the accuracy of reports, the ways in which youth's responses varied across instruments may offer insight into the complexity of adolescent sexual risk taking as well as have important implications for development of HIV/STI preventive interventions.

Comparing supports for LGBT aging in rural versus urban areas.

Studies of rural populations typically underrepresent lesbian, gay, bisexual, and transgender (LGBT) older adults. This secondary analysis examined data from a nationwide sample of LGBT baby boomers (n = 1201). Geographic differences with respect to self-reported outness, acceptance of sexual identity, social and familial support, and household income were assessed with one-way analyses of variance. Guardedness about one's sexual identity and household asset levels were assessed with chi-square analyses. Rural individuals reported lower levels of outness, guardedness with people including siblings and close friends, and lower levels of household income. Providers should consider strategies for connecting older rural LGBT adults for potential care and support.

Inflammatory bowel disease in Jamaica.

BACKGROUND: Although inflammatory bowel disease (IBD) has been reported worldwide, it is primarily a disease of the developed world and most studies have reported on Caucasian populations. METHODS: All IBD patients seen at the University Hospital of the West Indies, Jamaica, between January 2000 and January 2010 were reviewed. RESULTS: There were 103 patients, 64 had ulcerative colitis (UC) and 39 Crohn's disease (CD), ratio of 1.6:1. In patients with UC there were 21 males and 42 females (M:F=0.5:1), whilst in those with CD 21 were males and 17 females (M:F=1.2:1). The mean age was 32.3 (range 2-84) years. Only 3.9% of patients were current smokers, 6.8% were past smokers. A family history of IBD was present in 7%. In CD patients, 56% had colitis only and 21% had small bowel disease. In UC patients, 31% had pancolitis, and 44% left-sided disease. The duration of disease was 5 years in 32%, 5-20 years in 54%, and more than 20 years in 14%. The main presenting features were diarrhea (93%), rectal bleeding (56%), abdominal pain (48%), weight loss (25%) and nausea and vomiting (19%). For patients with CD, presentation also included fistulas and small bowel obstruction. Extraintestinal manifestations were present in 38% of patients, and joint pain was present in 67.5% of them. Other extraintestinal manifestations were primary sclerosing cholangitis in 20% and pyoderma gangrenosum in 15%. CONCLUSION: IBD is relatively uncommon in Jamaica. UC is more common than CD. Most cases of CD had colitis only. The clinical features and outcome are similar to other reports.

Prevalence of gastrointestinal symptoms among ambulatory HIV patients and a control population.

BACKGROUND: The gastrointestinal tract is a common site of involvement in HIV-infected patients. Gastrointestinal symptoms are common in the general population and are associated with decreased quality of life. METHODS: Ambulatory consecutive HIV-infected patients and consecutive healthy blood donors seen in Jamaica were studied. A 19-item questionnaire of GI symptoms was administered. RESULTS: There were 196 respondents. Among 99 HIV patients, the mean number of symptoms was 2.9 and in 97 controls 3.3 (p=0.091). Dysphagia and odynophagia were present in 8.1% of HIV patients and 3.1% of the controls (p=0.129). Belching was present in 59.6% of HIV patients and in 96.8% of controls (p≤0.001). In the control group, 44.3% had heartburn compared to 29.3% of HIV patients. Within the preceding year, 26.3% of HIV participants and 12.4% of controls sought medical attention for their GI symptoms (p=0.001). GI symptomatology was directly related to immune status in the HIV group as patients with a CD4 count of less than 200 cells/µL reported up to 6 GI symptoms, those with CD4 of 201-350 cells/µL had 3 symptoms, and patients with CD4 greater than 351 cells/µL had 1 symptom. Pain on swallowing, and vomiting were significantly more common in patients with CD4 <350 cells/µL than in controls. CONCLUSIONS: GI symptoms were common in HIV patients and controls. In HIV patients symptoms were directly related to CD4 count. Pain on swallowing and vomiting were significantly more common in patients with CD4 <350 cells/µL than in controls.

Intestinal ischemia in systemic lupus erythematosus.

Bowel ischemia, an uncommon but devastating complication of systemic lupus erythematosus (SLE), poses a significant clinical challenge. A 52-year-old female with SLE presented with recurrent abdominal pain for two months which culminated in acute, severe pain with vomiting. Abdominal CT scan revealed ischemia of multiple segments of bowel. She responded slowly to methylprednisolone alone and eventually responded to methylprednisolone combined with cyclophosphamide. A high index of suspicion for bowel ischemia is required in patients with SLE presenting with acute abdominal pain.

Helicobacter pylori infection in the Caribbean: update in management

Helicobacter pylori infection of the stomach is one of the commonest chronic infections world wide and in the Caribbean, over 50 of the population are affected. H pylori is probably transmitted from person to person by oro-fecal and oro-oral means. H pylori is directly associated wirh peptic ulcer disease, chronic antral gastritis, gastric carcinoma and B-cell lymphoma of the stomach. In patients with peptic ulcer and H pylori infection, eradication of infection with antibiotics significantly decreases recurrence of ulcers. All patients with H pylori related disease should be tested and treated if positive. The treatment of H pylori infection has evolved over the years but at present triple therapy which includes two antibiotics is recomended.(AU)

Domestic and School Violence Among High School Students in Jamaica

This study determined the prevalence of domestic and school violence among high school students in Jamaica. A self-report questionnaire was administered to 3,124 students (1,468 boys and 1,657 girls) from 34 randomly selected high schools in 13 of the 14 parishes in Jamaica. There were 1,590 tenth graders (mean age 16 years) and 1,534 eleventh graders (mean age 17 years). One thousand six hundred and seventeen students were from rural and 1,507 from urban communities and 1,642 and 1,482 were children of professionals and nonprofessionals, respectively. The results revealed that 78.5 percent of the students had witnessed violence in their communities, 60.8 percent in their schools, and 44.7 percent in their homes. Twenty-nine percent of the students had caused injury to persons. Several weapons and techniques were used by the students during violent acts and these included the use of hands or feet 59.8 percent, nasty words 59.1 percent, kicks and punches 54.5 percent, blunt objects 26.5 percent, knives 18.4 percent, ice picks 9.3 percent, machetes 8.9 percent, scissors 8.5 percent, forks 7.5 percent, guns 6.9 percent, other weapons (e.g. bottles, dividers) 6.7 percent, acids 5.5 percent, and alkalis 4.9 percent. Significantly higher numbers of boys, 10th graders, and urban students indicated that they used more of the 14 weapons than girls, 11th graders and rural students, respectively. Effective programmes are urgently need to address the high rate of violence recorded in this study among high school youths in Jamaica.

Domestic and School Violence Among High School Students in Jamaica

This study determined the prevalence of domestic and school violence among high school students in Jamaica. A self-report questionnaire was administered to 3,124 students (1,468 boys and 1,657 girls) from 34 randomly selected high schools in 13 of the 14 parishes in Jamaica. There were 1,590 tenth graders (mean age 16 years) and 1,534 eleventh graders (mean age 17 years). One thousand six hundred and seventeen students were from rural and 1,507 from urban communities and 1,642 and 1,482 were children of professionals and nonprofessionals, respectively. The results revealed that 78.5 percent of the students had witnessed violence in their communities, 60.8 percent in their schools, and 44.7 percent in their homes. Twenty-nine percent of the students had caused injury to persons. Several weapons and techniques were used by the students during violent acts and these included the use of hands or feet 59.8 percent, nasty words 59.1 percent, kicks and punches 54.5 percent, blunt objects 26.5 percent, knives 18.4 percent, ice picks 9.3 percent, machetes 8.9 percent, scissors 8.5 percent, forks 7.5 percent, guns 6.9 percent, other weapons (e.g. bottles, dividers) 6.7 percent, acids 5.5 percent, and alkalis 4.9 percent. Significantly higher numbers of boys, 10th graders, and urban students indicated that they used more of the 14 weapons than girls, 11th graders and rural students, respectively. Effective programmes are urgently need to address the high rate of violence recorded in this study among high school youths in Jamaica.(Au)

Seroepidemiology of Helicobacter pylori infection in a Jamaican community

We researched epidemiologic associations between environmental and demographic factors and prevalence of Heliobacter pylori infection in a suburban Jamaican community. Using a clustered sampling technique, 22 domestic yards enclosing 60 separate households were randomly selected from a local community. All household members (n=346) were invited to participate following informed consent; the overall compliance rate ws 58.9 percent. A detect IgG antibodies raised against H. pylori. Environmental and demographic information was obtained by questionnaire. The seroprevalence of H. pylori was 69.9 percent (n=202). Analysis of the independent variables revealed three major components: Component 1 described, collectively, good personal hygiene and sanitation, indoor water supply and absence of straying animals in the peridomestic area; Component 2 included older age, good personal hygiene and large yard size; Component 3 the presence of domestic animals (cats and dogs) and again, large yard size. These three complexes explained 42.2 percent of the variability in the data set. Logistic regression showed that Components 2 and 3 were independently associated with H. pylori seropositivity, indicating that a combination of demographic, environmental and zoonotic factors is involved in the spread of H. pylori infections at the tropical community level. (AU)

Use of illicit drugs among high-school students in Jamaica

Reported are the results of a survey to assess the prevalence of illicit drug use among high school students in Jamaica. A total of 2417 high-school students in 26 schools were covered: 1063 boys and 1354 girls of whom 1317 were grade-10 students (mean age 15.7 years) and 1100 were grade-11 students (mean age 16.8 years). Of the students, 1072 and 1354 were from rural and urban schools, respectively, while 1126 and 1291 were children of parents who were professionals and nonprofessionals, respectively. The following drugs were used by the students: marijuana (10.2 percent), cocaine (2.2 percent), heroin (1.5 percent) and opium (1.2 percent). Illicit drug use among males, urban students and children of professionals was higher than that among females, rural students and children of nonprofessionals, respectively.(Au)

Helicobacter pylori and peptic ulcer diseases

The recent recognition of the association between Helicobacter pylori and peptic ulcer disease (PUD) has revolutionised the approach to the management of ulcers. Up to 95 percent of patients with duodenal ulcers and 70-80 percent with gastric ulcers have H. pylori infection. Peptic ulcer disease is a chronic recurrent disorder. The eradication of H. pylori in patients with PUD results in a significant decrease in the relapse rate of ulceration and alters the natural history of PUD. Several regimes are available for H. pylori eradication and most include two antibiotics given for a least seven days. Patients with either a first or recurrent attacks of peptic ulcer should be considered for eradication therapy. These patients should also receive an adequate course of an antisecretory medication for promotion of ulcer healing.(AU)

Use of alcohol, tobacco and non prescription drugs among Jamaican high school students

The prevalence of alcohol, tobacco and non-prescription drugs was investigated among 2417 Jamaican high school students (1063 boys, 1354 girls). 1317 were grade 10 (form four or 16 years old) and 1100 were grade 11 (form five or 17 years old): 1072 and 1345 were from rural and urban schools, respectively; and 1126 and 1291 were children of professionals and non-professionals, respectively. The prevalence of alcohol and tobacoo use was 50.2 percent and 16.6 percent, respectively; and there was a high level of non-prescription drug use: paracetamol (85.7 percent), aspirin (76.7 percent), multivitmains (41.9 percent) and bismuth (29.9 percent). Drugs use among males, urban students, and children of professionals was higher than among females, rural students and children of non-professionals.(AU)

Hepatic cirrhosis in Jamaica

The aetiology, biochemistry, clinical features and complications of histologically confirmed hepatic cirrhosis in 45 patients (26 females, 19 males) seen at the University Hospital of the West Indies, Jamaica, between 1984 and 1994 was presented. The age range was 1 to 72 years (mean 48 years). Abdominal swelling and weight loss were the commonest symptoms, occurring in 51 percent and 47 percent of patients, respectively. Jaundice was a presenting feature in 44 percent. Hepatomegaly was present in 71 percent of patients and splenomegaly in 33 percent. The aetiological factors were: alchol (36 percent), bush tea (18 percent), chronic active hepatitis (11 percent), drugs (7 percent), and haemochromatosis (2 percent). Hepatitis B surface antigen was detected in 2 of 20 patients tested. 24 percent of the patients also had diabetes mellitus, 29 percent were anaemic, 29 percent were thrombocytopenic, 4 percent were leukopenic, and the prothrombin time was prolonged in 22 percent. The albumin/globulin ratio was reversed in 71 percent of the patients. The alkaline phosphatase was elevated in 56 percent, the aspartate aminotransferase was increased in 58 percent and the gamma glutamyl transpeptidase in 56 percent. 56 percent of the patients had macronodular cirrhosis; the liver showed a micronodular pattern in 18 percent; 7 percent had biliary cirrhosis; 7 percent chronic active hepatitis with cirrhosis; and 13 percent showed a mixed macro-micronodular pattern. Ascites and fluid overloaded developed in 44 percent of the patients. Hepatic encephalopathy occurred in 18 percent and upper gastrointestinal bleeding in 18 percent.

Hepatic cirrhosis in Jamaica

The aetiology, biochemistry, clinical features and complications of histologically confirmed hepatic cirrhosis in 45 patients (26 females, 19 males) seen at the University Hospital of the West Indies, Jamaica, between 1984 and 1994 was presented. The age range was 1 to 72 years (mean 48 years). Abdominal swelling and weight loss were the commonest symptoms, occurring in 51 percent and 47 percent of patients, respectively. Jaundice was a presenting feature in 44 percent. Hepatomegaly was present in 71 percent of patients and splenomegaly in 33 percent. The aetiological factors were: alchol (36 percent), bush tea (18 percent), chronic active hepatitis (11 percent), drugs (7 percent), and haemochromatosis (2 percent). Hepatitis B surface antigen was detected in 2 of 20 patients tested. 24 percent of the patients also had diabetes mellitus, 29 percent were anaemic, 29 percent were thrombocytopenic, 4 percent were leukopenic, and the prothrombin time was prolonged in 22 percent. The albumin/globulin ratio was reversed in 71 percent of the patients. The alkaline phosphatase was elevated in 56 percent, the aspartate aminotransferase was increased in 58 percent and the gamma glutamyl transpeptidase in 56 percent. 56 percent of the patients had macronodular cirrhosis; the liver showed a micronodular pattern in 18 percent; 7 percent had biliary cirrhosis; 7 percent chronic active hepatitis with cirrhosis; and 13 percent showed a mixed macro-micronodular pattern. Ascites and fluid overloaded developed in 44 percent of the patients. Hepatic encephalopathy occurred in 18 percent and upper gastrointestinal bleeding in 18 percent.(AU)

Short report: long-term serum antibody isotype responses to Strongyloides stercoralis filariform antigens in eight patients treated with ivermectin

The enzyme-linked immunosorbant assay was used to investigate long term changes in serum immunoglobulin G1 (IgG1), IgG4, IgE, and IgA against Strongyloides stercoralis phosphate-buffered saline-soluble filariform larval antigens in eight Jamaican patients treated with ivermectin. Patients were followed for periods of between 170 and 542 days. Based on repeated formalin-ether concentration and agar plate culture, all patients were found to be uninfected up to 18 months following chemotherapy. Generally, all antibody isotype levels decreased following treatment, although there was considerable heterogeneity among patients. In a single patient with hyperinfection, the decrease in IgG4 was marginal and may represent a treatment failure. Reduction in serum antibody isotype responses to S. stercoralis following treatment may be used to assess the effectiveness of ivermectin in treating endemic strongyloides (AU)