Existence of a silent gene for pseudocholinesterase in a Trinidad population

Although the values reported were higher than those reported for Caucasians, differences in dibucaine number for pseudocholinesterase values among the three ethnic groups in Trinidad and Tobago, were not significant. Eight individuals had intermediate dibucaine numbers values between 40 and 70; one of them was African, 3 were East Indians, and 4 Mixed. Two of the mixed group were of Portuguese lineage and had significantly lower dibucaine numbers and enzyme concentration. Two sisters of East Indian origin had an inestimable dibucaine number and their pseudocholinesterase values were just detectable, suggesting the presence of a 'silent gene' for pseudocholinesterase. These studies, which are being extended, suggest that the dibucaine number should be estimated prior to succinylcholine administration in patients in Trinidad and Tobago who are at risk of apnoea

The relationship of a prenatal one-hour plasma glucose screening and risk factors in a mixed population - abstract

A 50 gm prenatal one-hour plasma glucose challenge test was done on 158 mothers between 24 and 28 weeks' gestation to evaluate the relationship of this test with recognized risk factors and ethnicity. A value of 140 mg/dl or more was considered abnormal. Twenty-one (13.9 percent) had an abnormal result. When compared to those with normal values we found that a positive result was noted in 36.8 percent of mothers over 30 years old compared to 6.6 percent of mothers less than 30 years old (p<0.001). There was no significant difference between both groups with respect to parity and a family history of diabetes mellitus or hypertension. More women of East Indian descent (20.9 percent) had an abnormal result compared to those of African and Mixed descent (11.3 percent); but the difference was not significant (p<0.1). Fifty percent of the women who were over 30 years of age and of East Indian descent had a positive screen. The sensitivity and specificity of the risk factors - age over 30 years and being of East Indian descent - were 63.6 percent and 40.9 percent for sensitivity with the specificity being 82.4 percent and 75.0 percent, respectively. The 13.9 percent positive screening value is high in comparison to international figures. This screening test has a role in primary care obstetrics, but because of the potential cost limitations to testing all antenatal patients, we recommend that there is merit in initially confining screening to the above two risk groups in our population (AU)

Existence of a silent gene for pseudocholinesterase in a Trinidad population

Although the values reported were higher than those reported for Caucasians, differences in dibucaine number for pseudocholinesterase values among the three ethnic groups in Trinidad and Tobago, were not significant. Eight individuals had intermediate dibucaine numbers values between 40 and 70; one of them was African, 3 were East Indians, and 4 Mixed. Two of the mixed group were of Portuguese lineage and had significantly lower dibucaine numbers and enzyme concentration. Two sisters of East Indian origin had an inestimable dibucaine number and their pseudocholinesterase values were just detectable, suggesting the presence of a 'silent gene' for pseudocholinesterase. These studies, which are being extended, suggest that the dibucaine number should be estimated prior to succinylcholine administration in patients in Trinidad and Tobago who are at risk of apnoea (AU)

Sick sinus syndrome and primary systemic amyloidosis

A sixty-eight-year-old woman with documented sick sinus syndrome was found to have, five years later, florid clinical features of systemic amyloidosis which only then led to recognition of an underlying IgA, Kappa paraproteinaemia. The literature on this association is outlined. Underlying plasma cell dyscrasias should be excluded in cases of unexplained sick sinus syndrome.(AU)

Accurate pre-operative diagnosis of ovarian cancer by a combination of clinical criteria, ultrasonography and CA 125 - abstract

Early pre-operative treatment of ovarian cancer is hindered by a lack of reliable criteria for its early diagnosis. This study was undertaken to assess the value of clinical criteria, ultrasonography and serum CA 125 values in the differential diagnosis of benign and malignant pelvic masses. Thirty-six consecutive patients who had elective surgery for investigation and management of an adnexal mass were enrolled in the study from May to October, 1988. All patients had a clinical examination, serum CA 125 measurement and ultrasound pre-operatively, and their menopausal status determined. Based on these findings, a scoring system was devised (Table). Twenty patients had serum CA 125 values < 35 U/ml and histology confirmed a benign ovarian lesion. The remaining 16 patients had serum CA 125 levels > 35 U/ml, and their tumours were confirmed to be malignant histologically. There were significant differences in age (p<0.01), menopausal status (p=0.01), clinical impression score (p<0.01), ultrasound score (p<0.001) and serum CA 125 level (p<0.001) in patients with benign as compared to malignant lesions. The most useful single diagnostic criterion was serum CA 125 levels, and diagnostic accuracy was increased by adding menopausal status and ultrasound findings (sensitivity > 90 per cent; specificty 95.2 per cent) (AU)

Malignant carcinoid syndrome: failure of anti-oestrogenic therapy

A pre-menopausal patient with a six-year history of symptoms of the metastic carcinoid syndrome leading to progressively worsening carcinoid heart disease is described. The failure of anti-oestrogenic therapy (sequential bilateral oophorectomy and Tamoxifen therapy) to halt progression of disease was documented. Death resulted from right ventricular failure associated with pulmonary and tricuspid valvular disease (AU)

ACTH - inosine pranobex in the treatment of AIDS: encouraging results

Twenty patients with acquired immune deficiency syndrome (AIDS) received treatment with inosine pranobex and specific antibacterial andanti-parasitic therapy. Five died shortly after hospitalization, but a further fifteen who also received ACTH, survived, gained weight and improved clinically, biochemically and haematologically (AU)

An analysis of skin involvement in lupus erythematosus - abstract

Of 105 patients diagnosed as lupus erythematosus at the Port-of-Spain General Hospital between 1981 and 1986, 86 satisfied the ARA criteria for the classification of SLE, whilst 19 were clinically and histologically DLE. Fifty-eight SLE patients were of African origin, 24 of Asian origin and 4 were mixed. The ages of onset varied from 14 to 64 years, the majority presented in the 15 to 24-year age group. Of the SLE group, 55 percent had malar rash and 21 percent discoid lesions; this is higher than in the Jamaican study (32 percent and 14 percent respectively). Photosensitivity in the Trinidadian patients (20 percent) and the Jamaican patients (12 percent) was lower than that reported in temperate zones. These differences may be due to genetic and environmental factors. Direct immunofluorrescence (DIF) on 32 biopsies of non-sun esxposed (NSE) skin was characteristic of SLE in 80 percent cases compared to 30 percent by histology. Deposits of IgG, IgA and complement in the NSE skin are associated with a poor prognosis. IgM deposits were found in the NSE skin of 4 DLE patients; this probably represents a transitional phase to SLE, a benign state or a distinct subset of lupus erythematosus. This study confirms that DIF is a far more reliable and sensitive diagnostic tool than histology in the differential diagnosis of SLE and DLE, and in the early detection of SLE (AU)

HLA-DR Antigens in the Trinidadian population: a preliminary study - abstract

The HLA-DR locus antigens were investigated in 150 healthy, unrelated Trinidadians. Seventy of these were of Negro origin, 60 of East Indian and 20 mixed (mainly of East Indian and Negro). There were substantial differences between the DR antigen frequencies of the Trinidadian Negro and East Indian. The antigens DR1 and DRw6 showed significantly lower frequencies among East Indian population (1.6 percent and 4.3 percent) than in the Negro (15 percent & 20.2 percent) or the mixed (28.6 & 10 percent) group. Surprisingly, there was a marked similarity between the frequencies of the antigens HLA-DR1, DR2, DR3 and Drw6 in the Trinidadian Negro and North American Caucasian, a result perhaps of racial admixtures in the Trinidadian Negro. The relatively high incidence of DR3 in both the East Indian (21.6 percent) and Negro (25.2 percent) populations was notable in the light of the positive association between DR3 and DR4 with insulin-dependent diabetes mellitus and of DR3 with systemic lupus erythematous. The comparatively low incidence of HLA-DR5 in both our Negroes (3.0 percent) and East Indians (8.5 percent), relative to the frequencies in North American Caucasian and Negro populations, is of interest as this antigen has been associated with Kaposi's Sarcoma in AIDS patients in the United States of America. This cancer is rare in our patients (AU)

Immunological surface marker and histocompatibility antigens in childhood acute Lymphoblastic leukaemia in Trinidad - abstract

Between October, 1983 and May, 1986, seventeen cases of childhood acute lymphoblastic leukaemia (ALL) were diagnosed on clinical grounds, supported by the findings of blast cells in the blood film or the bone marrow aspirate. All the patients had more than 25 percent blast cells in the bone marrow. Patients were described as belonging to a particular ethnic group when all four grandparents belonged to that group. Typing for lymphocyte surface markers was done at the time of the initial diagnosis. Fifteen of seventeen cases were under 10 years of age. Boys outnumbered girls by almost 5:1 Ten of the seventeen patients were of East Indian origin; five were of mixed ethnicity, with three of these having at least one grandparent of East Indian origin. Seven of the patients under ten years of age presented with bone and/or joint pains. Nine of the seventeen ALL patients were successfully phenotyped for immunological surface markers. Six of these carried T-cell markers. Four of the six T-cell clones were thymocytes (three stage III and one stage I). Three patients were common ALL antigen-positive (CALLA+) but these also had markers suggestive of a pre-B phenotype (OK-, OKB2+, CALLA+ and OKT-10+). HLA tissue typing of ten of the patients showed an enhanced frequency of th HLA B-40 antigen when compared with controls (p<.0001). This antigen was present in 60 percent of the patients typed, 40 percent of whom carried the HLA A2/B40 halotype. None of the cases carried the HLA B-5 antigen although this antigen had a frequency of 19 percent in the control group (p<0.05). The antigen A-11 showed a decreased frequency (10 percent percent in patients compared with controls (13.3 percent), while B-15 showed an increased frequency (15.0 percent) compared with the control group (4.0 percent), but these differences were not statistically significant. Childhood leukaemia in Trinidad is primarily a disease of East Indian children. Bone or joint pain seems to be a common presenting feature and the common ALL antigen type of leukaemia is less common than T-cell leukaemia, Current evidence would suggest a linkage diequilibrium between HLA B-40 and childhood ALL in Trinidad (AU)

Immunopathological studies in a mixture of pemphigus and pemphigoid - abstract

This is the first report from the Commonwealth Caribbean of a mixture of two rare forms of vesiculobullous diseases. A mixture of both bullous pemphigoid and pemphigus vulgaris was present in a 61 year-old East Indian man. He presented at the Dermatology Clinic of the Port-of-Spain Hospital with vesiculobullous lesions of both the tense and flaccid types extending throughout his trunk, limbs and face. Skin biopsies showed both immunoglobulin and complement at the intercellular spaces of the epidermis of the flaccid bulla and at the basement membrane zone (BMZ) from the tense bulla supporting the existence of both pemphigus and pemphigoid but the fourth confirmed the above findings. This patient gave a favourable clinical response to corticosteroid therapy with the disappearance of pemphigus antibodies but the anti-BMZ antibodies (typical of pemphigoid) persisted, as expected. It is clear from these findings that immunopathological investigations are not only essential in the early diagnosis of these rare bullous forms but also in prognosis (AU)

Response of mildly to moderately malnourished children to measles vaccination

Nutritional aspects of measles vaccination were examined in 51 Trinidadian children from one to three years of age with no prior history of measles. The subjects were divided into two weight-for-length groups derived from the Havard Standards and included 22 children with a weight-for-length of 90 percent or greater and 29 children with a weight-for-length of less than 90 percent. There were no significant differences in the two groups in general immune function, as assessed by white blood cell counts, immunoglobulin and C3 levels, nor in immune response, as assessed by measles antibody titres and direct migration inhibition of leukocytes to measles antigen following vaccination. All of the subjects seroconverted following vaccination, with titres of 1:40 or above. There were no significant changes in nutritional status in either group following vaccination, other than a small but significant rise in total serum protein levels in the normal group. (AU)

Blood alcohol concentrations of motor vehicle accident victims at the Port-of-Spain General Hospital Casualty Department, December 1984: a preliminary report - abstract

Hospital admission figures, cirrhosis death rates, per capita alcohol consumption rates and other indices have for many years indicated a high prevalence of alcoholism in Trinidad and Tobago. A six-month survey of the Medical wards, Port-of-SPain General Hospital by Prasad in 1979 showed that 47 percent of male admissions and 5 percent of female admissions were alcohol-related. Beaubrun (1978)) demonstrated a close inverse relationship (r = -0.978) between total motor vehicle and the real price of rum, i.e. the price relative to average personal income. Trinidad and Tobago has one of the highest per capita motor vehicle accident rates anywhere, even higher than the United States and very much higher than Europe. It is well established that alcohol is the single most important factor yet identified in traffic accidents wherever this has been studied. Nevertheless, there has been some reluctance to enact B.A.C. laws and to introduce the Breathalyser and other controls until more specific local research has been done to establish clearly the relationship between alcohol and such accidents. For these reasons a survey was carried out in December 1984 to determine the blood alcohol concentrations of all persons seen at the Casualty Department of the Port-of-Spain General Hospital as a result of traffic accidents. PROCEDURE: A pilot study was carried out first to refine the schedule for use in the study and to test its feasibility. A one-month survey was then carried out. Blood specimens were taken of all victims and a schedule filled out. Venous blood specimens were taken in Fluoride Oxalate and analyzed by a staff member of the Department of Pathology. Thirty-eight (38) accident victims were seen. More than 68 percent had blood alcohol concentrations higher than 0.05 percent (50mg. per 100 ml) and 55 percent had concentrations higher than 0.08 percent (80 mg per 100 ml) which is the legal limit in the United Kingdom. Blood specimens from three (3) controls, i.e. not involved in accidents, showed levels of between .002 percent (2mg percent) and .011 percent (11 mg percent). Many of the accident victims had B.A.Cs well over 0.1 percent (100 mg/100ml), and some were over 0.2 percent (200mg/100ml), levels of 0.2 percent could only be tolerated by habitual excessive drinkers who have developed considerable tolerance. The findings of this preliminary study point to an urgent need for B.A.C. legislation and the introduction of the breathalyser and other preventive strategies aimed at reducing the drinking/driving hazard (AU)

Some characteristics of Trinidad and Tobago kidney stone formers - abstract

During the period June 1983 to June 1985, 79 kidney stone formers of Trinidad and Tobago were evaluated by the ambulatory protocol of Pak, and their acid loading and urine citrate levels measured. Patient receiving medications that could affect the metabolism of calcium, uric acid or oxalate were asked to discontinue their use before and throughout the period of evalution. Forty-five males and 34 females were examined. Mean age of males was 43 years and of females 43 years. Males passed 3.4 ñ 4.4 stones in the previous 3 years and retained 1.0 ñ 2.2 stones. Females passed 1.9 ñ 2.7 stones in the previous 3 years and retained 1.7 ñ 2.9. Mean 24 hr urine volumes were as follows: females: 1,464 ñ 786 ml; Males: 1,369 ñ 585 ml. Renal hypercalciuria was found in three, absorptiive hyperuricosuria in one and hyperparathyroidism in one person. One person had renal tubular acidosis; seven had hyperuricosuria. Ten persons had high urine calcium levels because of a high dietary calcium intake. Hypocitraturia was found in 38 out of 50 respondents examined. A metabolic abnormality was found in 77 percent of the patients (AU)

Characterisation of mixed connective tissue disease - abstract

Of sixteen patients with MCTD, 10 62 percent) presented with the clinical features of systemic lupus erythematosus (SLE) and 6 (37 percent) with SLE-scleroderma. Ninety-four per cent had a speckled antinuclear factor pattern and 100 percent had IgG deposits in a speckled pattern within the epidermal cell nuclei of the skin. Seventy per cent of these patients had nRNP antibodies. These characteristics are more typical of the mixed connective tissue syndrome than of SLE or scleroderma. The low incidence of Raynaud's phenomenon in our group of patients (18 percent) with MCTD is probably due to the tropical climate. The IgM deposits in the skin of a significant number (67 percent) of the patients with the clinical picture of SLE-scleroderma probably represent an early stage in the development of the disease. The significance of high serum IgA in the clinically diagnosed SLE group is not understood and is now being further investigated. This study strongly suggests that laboratory investigations are of primary importance in distinguishing MCTD from SLE and other forms of collagen vascular diseases (AU)

HLA antigens in diabetics of African descent in Trinidad - abstract

The pattern of HLA distribution was studied in one hundred and fifteen Trinidadian diabetics of African ancestry. Insulin-dependent diabetes (IDDM) patients showed a positive association with HLA - A11 and B5 antigens (p<0.05) with relative risks of 5.9 and 3.2 respectively. In addition, HLA -B8 showed a positive but not statistically significant deviation, while HLA - B12 showed a negative association (relative risk 0.27). There was no association found between HLA -B15 and IDDM. Maturity-onset diabetics (MODM) showed positive association with HLA - B5 (p <0.025 and relative risk 2.93), and a significant negative association with HLA - A2, A3 and A9. In most populations, strong associations may be found between certain HLA antigens and IDDM, the associations" varying depending on the ethnicity of the population. Interestingly, no association has been observed between HLA antigens and MODM in Caucasian populations. However, several workers have observed significant deviations of HLA antigens in indigenous African MODM patients. In addition, the inconsistency of HLA antigen associations with IDDM in persons of African ancestry compared to that in Caucasians has led to the suggestion that diabetes mellitus in native Africans is genetically different from that in Caucasians. Our findings would tend to support this view (AU)

Preliminary report on hyperprolactinaemia in Trinidadian women: prevalence, clinical and endocrine features - abstract

Since the development of a reliable method of assay for prolactin, it has become widely accepted that disorders of prolactin secretion constitute the most common disorder of hypothalamic/pituitary function. Ninety female patients with serm prolactin concentrations above 40ng/ml (normal 0 - 14 ng/ml) over a one-year period were reviewed. The mean age of presentation was 31 years (range 16 -54). Of the 90 patients, 60 percent were Negro, 36 percent East Indian and 4 percent mixed. The commonest presenting complaints were (86 percent), galactorrhoea (68 percent) and hirsutism (57 percent). Fourteen patients had radiological evidence of tumour; all these had prolactin levels greater than 100ng/ml (range 121 - 895ng/ml) and 60 percent had LH/FSH ratios of less than 1.00. Over the last three years, requests for prolactin assays have increased markedly. During the period June 1984 to July 1985, 1,030 assays were done of which 20 percent were above 40ng/ml. This trend reflects an increased awareness of the importance of this condition (AU)

The significance of serum IgE levels in Trinidad and Tobago - abstract

In Trinidad, normal non-atopic children, mean age 2.5 years, had serum IgE's of 133 Ku/l whereas in the northern hemisphere the corresponding value for 9-month to 3-year-old children is 33 Ku/1 and the adult mean is 100 Ku/1. However, childhood asthmatics with helminthic infestation had a mean serum IgE of 1,432 Ku/l. On the other hand, childhood asthmatics whose stools were negative for helminths had significantly (840 Ku/l) less serum IgE, confirming the additive effect of helminths upon the type I hypersensitivity response in children. Those children who were diagnosed as having atopic dermatitis had the highest mean serum IgE concentrations (1,892 Ku/l). Blood Donors had a mean serum IgE of 231 Ku/l. It is concluded that serum IgE is of significant importance in identifying the atopic state, even in countries with endemic helminthic infestation. However, local normal and abnormal ranges need to be established before the results can be correctly interpreted (AU)

Allergies in Trinidad and Tobago - abstract

Observations for over eighteen months with the establishment of an Allergy Clinic at the Port-of-Spain General Hospital are being presented. Skin testing for immediate Type I hypersensitivity by the Gell and Coombs classification was done on all patients with a history of allergy. The skin testing results showed that 63 percent of the patients were positive to Dermatophagoides pteronys-sinus; 55 percent positive to D. fariniae; 48 percent to house dust; 31 percent to a mixture of 4 moulds and 32 percent to a mixture of feathers. Therefore house dust mites and house dust were the major offending allergens. This confirms the observation in the temperate region that asthma is related to allergy and to house dust mites. During the course of this clinic, it was observed that in the majority of the patients with allergies, illnesses seemed to occur at the time of the year coinciding with that of the highest humidity. Consequently, a retrospective study of asthma with hospital data on admission was reviewed over a five-year period, 1975-1979. The mean monthly admission rate was 66 (range 46 to 98) with a rate of 57 (range 46 to 69) from January to September and 90 (range 86 to 98) from October to December. This seems to correlate with humidity which is low January to May (mean 79.4 percent) and high in July to December (mean 85.3 percent). The lag between the rise in humidity and the rise in admissions in October could suggest that the relationship is not a direct cause-effect one. The radioimmunoassay method was used for quatitating the serum IgE in a selected group of patients. Mean for the first 26 patients was 485 iu/ml and in only 7 of the first 26 patients done for IgE was less than 300 iu/ml the suggested upper limit. These are high values compared with non-allergic Swedish children whose mean is 66 iu/ml. and healthy Ethiopian children free of parasites whose mean was 325 iu/ml using a similar technique (AU)