Trends in acute rheumatic fever: the Barbados experience

A retrospective review of yearly admissions of acute rheumatic fever between 1971 and 1990 showed a declining trend with relative stability since 1986. The incidence rate of acute rheumatic fever (new attacks/year) was 2/100,000 total population or 7/100,000 childhood population (<19 years old) or 9/100,000 schoolchildren. The incidence rate per 10,000 hospital admission was a high of 20 in 1971 and remained a low of three since 1986. This low incidence of acute rheumatic fever should not give rise to complacency in its control, as there is an unexplained resurgence in the developed countries(Summary)

Acute purulent pericarditis in children caused by haemophilus influenzae

Acute purulent pericarditis caused by haemophilus influenzae is an unusual condition, especially in childhood. In most cases, respiratory symptoms are the presenting features, and children aged less than 4 years are most often affected. A high index of suspicion and aggresive microbiological and cardiological evaluation are often warranted to make an early diagnosis. We herein report two cases of pericarditis caused by H.influenzae in children aged less than two years. Pericardiocentesis was performed in each case. Early recognition, rapid diagnosis and aggressive medical and surgical therapy are paramount in the successful treatment of this condition (AU)

Acute purulent pericarditis in children caused by haemophilus influenzae

Acute purulent pericarditis caused by haemophilus influenzae is an unusual condition, especially in childhood. In most cases, respiratory symptoms are the presenting features, and children aged less than 4 years are most often affected. A high index of suspicion and aggresive micorbiological and cardiological evaluation are often warranted to make an early diagnosis. We herein reported two cases of pericarditis caused by H. influenzae in children aged less than two years. Pericardiocentesis was performed in each case. Early recognition, rapid diagnosis and aggressive medical and surgical therapy are paramount in the successful treatment of this condition.

Clinical manifestations of childhood lead poisoning

The medical records of 58 children admitted with a diagnosis of lead poisoning to the Bustamante Hospital for Children between January 1979 and June 1987 were reviewed. Clinical data consisting of age, sex, source of exposure to lead, presenting symptoms and signs were collected from the records. Laboratory investigations, namely, haemoglobin, peripheral blood smear, blood lead levels and X-rays, were also reviewed. Reports of Public Health Inspectors were used to identify the source of exposure and information was also obtained from parents or guardians

Adolescent admissions in Barbadian hospitals - abstract

A retrospective review of adolescent admissions (12 to 18 years) to the Queen Elizabeth Hospital (QEH) and the Psychiatric Hospital for the period of October, 1991 to September, 1992 was undertaken to determine the causes of hospitalization. There were 725 admissions consisting of 297 males and 428 females. The majority of the patients (535, i.e. 74 percent) spent between 1 and 5 days, while only 55 patients (7.6 percent) spent more than 14 days in hospital. The three most frequent causes of hospitalization were trauma (165), abortions (153), drug abuse/overdose (53). Psychiatric conditions accounted for 38 admissions. Based on our data, we estimated that a 15-bed adolescent unit set up at the QEH can serve the in-patient needs of the adolescent population in Barbados. This can be speedily achieved by restructuring the existing paediatric unit (AU)

Evaluation of oral erythromycin and local isoniazid instillation therapy in infants with Bacillus Calmette-Guerin lymphadenitis and abscesses

A randomized placebo-controlled prospective trial was conducted to evaluate the efficacy of erythromycin therapy in 69 patients affected with Bacillus Calmette-Guerin lymphadenitis. When patients who developed subsequent regional abscesses were excluded, erythromycin caused significantly earlier resolution of lymphadenitis (5.1 months vs. 5.7 months for placebo; p < 0.001) compared with placebo. There was no significant difference in the proportion of patients who developed subsequent regional abscesses between the 2 groups (47 percent for erythromycin, 60 percent for placebo, p = 0.14). When the entire group of 69 patients was evaluated for "duration to heal" (regardless of subsequent abscess formation), erythromycin therapy (4.1 +/- 1.5 sd months) did not differ significantly from the placebo group (3.5 +/- 1.3 months, p = not significant). Patients who develop subsequent abscess (n = 36) along with those with B. Calmette-Guerin regional abcesses at presentation (n = 27) were further studied to compare oral erythromycin therapy with that of single dose 50-mg intranodal isoniazid instillation. Local isoniazid therapy caused significantly earlier resolution of the abscesses (3.9 months) compared with erthromycin therapy (5.2 months; p < 0.001). (AU)

Adolescent pregnancy in Grenada

A retrospective review of adolescent deliveries (maternal age range: 12-19 years) at the maternity unit of the main General Hospital, Grenada, was undertaken for the years 1987 and 1988 using the delivery room register and hospital medical records. These mothers were compared with women who delivered during the same period but were aged between 20 and 30 years. Of the 3203 deliveries which occurred during the study period, 613 (20 percent) involved adolescents, giving a prevalence rate of one in five pregnancies. chi 2 and Fisher's exact test analyses revealed that pregnancies occurred in younger adolescents ( age less than 16 years, n = 58) carried an increased risk of preterm labour, operative delivery, prematurity, small-for gestational age infants, asphyxia and perinatal mortality when compared with the 'optimum reproductive age group'. Older adolescents (16-19 years, n = 555) had a higher risk pregnancy induced hypertension but otherwise compared well with the optimal reproductive age group. Adolescent pregnancy is very prevalent in Grenada and the reproductive outcome for young adolescents < 12 years of age is relatively poor.

Rheumatic fever in the eighties: the Barbadian experience - abstract

A retrospective review of yearly admissions of acute rheumatic fever between 1971 and 1990, showed a declining trend with relative stability since 1986. The incidence rate of acute rheumatic fever (new attacks/year) was 2/100,000 total population of 7/100,000 childhood population < 19 years of age or 9/100,000 school children. The incidence rate per 10,000 hospital admissions was a high of 20 in 1971 and has remained a low of three since 1986. There were no significant differences in presentation in the period 1981-1985 when compared with the period 1986-1990, using chi square analyses. The only exception was carditis (without concomitant arthritis), which was significantly more frequent in the latter half of the decade. This low incidence of acute rheumatic fever should not give rise to complacency in its control, as there is an unexplained resurgence in developed countries (AU)

Outbreak of Bacillus Calmette-Guerlin-associated lymphadenitis and abscesses in Jamaican children

An outbreak of axillary lymphadenitis and abscesses after Bacillus Calmette-Guerlin (BCG) vaccination (Pasteur Paris, Batch N5122) occurred in 139 Jamaican children between January and July, 1988. The overall rate of this complication was 0.95 percent. The attack rate was 1.92 percent among the 0- to 6 week age group and 0.6 percent in the 7- to 52-week age group. Of 139 patients there were 77 males and 62 females and the mean age at presentation was 4 months. The mean size of the BCG scar, duration of healing and Mantoux reaction size differed significantly in patients compared with those of control infants (P less than 0.01). Mycobacterium bovis was isolated from 11 patients. Immunologically index patients and controls differed significantly only with respect to T lymphocyte subpopulation percentages and concanavalin A stimulation indices. Evaluation of the BCG vaccine did not reveal either increased potency or microbial contamination. We conclude that increased susceptibility to the Pasteur strain of BCG might have contributed to the increased incidence of complications in these Jamaican children and hence caution should be exercised in switching one vaccine for another as is often done in the developing countries. (AU)

Evaluation of oral erythromycin and local instillation of INH therapy, in infants with BCG lymphadenitis - abstract

The most common adverse effect of BCG vaccination is regional lymphadenitis, but the treatment of this complication is controversial. A group of 69 patients, with BCG adenitis following vaccination were randomly assigned to receive either "no therapy" or oral erythromycin for one month. Systemic erythromycin therapy caused earlier resolution of the lymph node but failed to prevent progression to abscess formation. Patients who developed subsequent abscesses (36) and another group who had abscess at the time of presentation (27) showed more rapid resolution when treated with single instillation of isoniazid (50mg) into the abscess cavity, compared to oral erythromycin therapy (AU)

Adolescent pregnancy in Grenada - abstract

A retrospective review of adolescent deliveries (maternal ages 12 - 19 years) at the Maternity Unit of the main General Hospital, Grenada, was done by inspecting medical records. These patients were compared with women who delivered during the same period but were aged 20-30 years. Of 3,203 deliveries which occurred during the study period, 613 (20 per cent) involved adolescents, formimg a prevalence rate of 1 in 5 pregnancies. Chi Square analyses revealed that pregnancies occurring in younger adolescents (age less than 16 years, N=58) carried an increased risk of preterm labour, operative delivery, prematurity, small-for-gestational-age-infants, asphyxia and perinatal mortality when compared to the `Optimum reproductive age-group'. Older adolescents (16-19 years, N=555) had higher risk for pregnancy induced hypertension but otherwise compared well with the `Optimum reproductive age-group'. Adolescent pregnancy is highly prevalent in Grenada, and the reproductive outcome for young adolescents (<16 years) is relatively poor (AU)

Clinical manifestations of childhood lead poisoning - abstract

Clinical characteristics of 58 patients admitted to the Bustamante Hospital for Children with lead poisoning are described. The most common source of lead exposure was backyard battery smelters. The majority (58 percent) of the patients were less than three years of age. Lead toxicity was more severe in younger children; they had higher lead levels and a greater incidence of encephalopathy. Patients with lower haemoglobin values had relatively higher lead levels (r= -0.54;p<0.001), and a higher incidence of encephalopathy (p<0.011). Radiology evidence of lead poisoning was present in 96 percent of our patients. This demonstrates the usefulness of X-rays in diagnosis, particularly in areas where blood lead levels are not easily availabel (AU)

Arthritis in childhood: a report on 65 consecutive cases observed at the University Hospital of the West Indies

In a two-year period (October 1985 - September 1987), 65 children presented to the Child Health Department and/or rheumatology clinic at the University Hospital with arthritis. Eighteen children (28 percent) had juvenile chronic arthritis, ten (15 percent) rheumatic fever, eight (12 percent) systemic lupus erythematosus and thirteen (20 percent) had self-limiting arthritis. Systemic onset of juvenile chronic arthritis occurred only in one child; nine children has polyarticular and eight pauci-articular onset of disease. The self-limiting arthritis was difficult to differentiate from juvenile chronic arthritis; therefore serological testing for bacterial and viral infections should be performed before anti-rheumatic therapy is undertaken. Arthritis in childhood is not uncommon in Jamaica. However, the outcome appears to be generally favourable except in a few cases of juvenile chronic arthritis (AU)

Omental cyst masquerading as ascites

This report describes a three-year-old girl with an omental cyst masquerading as ascites. A review of the literature has shown that large omental cysts are frequently misdiagnosed as ascites. Ultrasonography is a valuable aid in the diagnosis (AU)

Further seizures following febrile seizure: assessment of risk factors

Retospective evaluation of records pertaining to 316 children admitted to the Queen Elizabeth Hospital for febrile seizures showed a recurrence rate of 24 per cent. Age at onset of first febrile seizure, a positive family history and atypical initial seizure were identified as risk factors for subsequent seizures. Other factors, namely abnormal pregnancy, gestational age, birthweight, neonatal problems and neurological abnormality, did not affect the chances of recurrence (AU)

Fever in children: ideas and illusions - abstract

Fever is a common symptom in children. Yet concepts vary between physicians and parents. We interviewed 120 mothers at three participating locations (University Hospital of the West Indies, Bustamante Hospital for Children and Shortwood Medical Centre) to ascertain their concepts and practices concerning fever in their children. None of the mothers used thermometers to detect fever; the majority (85 percent) were unable to define fever in terms of temperature. Tepid sponging with alcohol and administration of antipyretics were the measures most frequently undertaken to reduce fever. There is a need to educate parents and health-care personnel about fever and its management in children, particularly to discourage the use of topical alcohol (AU)

Arthritis in childhood: report of 61 consecutive cases seen at the University Hospital of the West Indies - abstract

A two-year survey (October'85 - September'87) was undertaken to determine the pattern of arthritides in children presenting to the Child Health Department, and/or Rheumatology Clinic, at the University Hospital. There were 61 children (24 males, 37 females) aged from one to sixteen years, with a median age of ten years. The duration of follow-up ranged from one month to nine years. Seventeen (28 percent) children were diagnosed as juvenile chronic arthritis. A polyarticular onset was seen in 9/17 children, pauci-articular onset in 7/17 children and one child had a systemic onset. The most commonly affected joint was the knee (25 percent), followed by small joints of the hand (19 percent). Residual joint dysfunction was mild in 8 children and severe in 2. The remaining 7 children had no functional abnormalities at the time of last review. Nine (15 percent) children had arthritis associated with rheumatic fever, without evidence of carditis. Seven (11 percent) children were diagnosed as systematic lupus erythematosus (SLE). The main features of SLE in addition to arthritis were skin rashes, fever and generalised lymphadenopathy. Renal involvement was seen in 2 children. Two children with SLE also had homozygous sickle-cell disease. A self-limiting type of arthritis was seen in 13 (21 percent) children. Three (5 percent) had septic arthritis and another three had Kawasaki disease. Nine had other types of arthritides. Arthritis in childhood is not uncommon in Jamaica. However, the outcome appears to be generally favourable except in a few cases of juvenile chronic arthritis (AU)

Routine investigations in first febrile seizures

Retrospective evaluation of records pertaining to 338 children presenting with a first episode of febrile seizure revealed a high performance rate of routine haemoglobin levels, total white cell and differential count, blood glucose, serum electrolyte and urea levels, lumbar puncture for cerebrospinal fluid examination and blood cultures. Lumbar puncture emerged as the most useful investigation in detecting eight children with meningitis, three of whom were over the age of two years. Transient elevation in blood glucose levels, hyponatraemia and low serum bicarbonate levels were noted in some children but their significance is not known. Routine haemoglobin estimation detected sixteen children with unsuspected anaemia, but the remaining investigations were largely unhelpful (AU)

Bed utilization study in paediatric medical patients at the Queen Elizabeth Hospital, Barbados

Details of a bed utilization study of 1,654 paediatric medical ward admissions to the Queen Elizabeth Hospital, Barbados, during 1983 are analysed. Forty-one per cent of admissions had a respiratory problem, 14 percent had infectious diseases, 9 percent central nervous system conditions, and 36 percent had diseases of other systems. Analysis of hospital stay revealed that 20 percent of patients spent less than 24 hours and these mostly for bronchial asthma (31 percent, respiratory tract infections (15 percent, and gastroenteritis (10 percent). Most long-stay patients had either congenital heart disease (12 percent), social problems (11 percent) or diabetes mellitus (10 percent). We recommend that the establishment of a short-stay unit could eliminate 20 percent of admissions, who spent less than 24 hours. A further 21 percent (poisoning and gastroenteritis) could be significantly reduced with good health education (AU)

Bed utilisation in paediatric medical patients at the Queen Elizabeth Hospital - abstract

Details of paediatric bed utilisation during 1983 were collected. Of 1,654 admissions, there were 959 (58 percent) males and 695 (42 percent females (ratio 1.3: 1). The peak admission month was November (10 percent) and the lowest was March (6 percent). Forty-six per cent were from the central parish of St. Michael . Eighteen per cent were age 0-3 months; 19 percent, 3-12 months; 38 percent, 1-5 years; and 25 percent, 5-12 years. Forty-one per cent had a respiratory problem, 17 percent gastro-intestinal, 9 percent CNS, 33 percent involved other systems. Twenty per cent of patients spent less than 24 hours in hospital; these were mostly for bronchial asthma (31 percent), respiratory tract infections (15 percent) and gastroenteritis (10 percent). Most long-stay patients had congenital heart disease (12 percent), social problems (11 percent) or diabetes mellitus (10 percent). Antibiotic therapy was prescribed for 46 percent patients. There were 21 deaths, 50 percent from gastroenteritis and sepsis and 20 percent from cardiac abnormalities. Forty per cent were less than 1 year of age. The mean age was 25 months; and 76 percent of deaths occurred between 20:00 and 06: hours. The establishment of a short stay unit could eliminate 20 percent of admissionsi.e. those who spent less than 24 hours and those with a diagnosis of febrile convulsions (5 percent). Twenty-one per cent (poisoning and gastroenteritis could possibly be reduced with good health education (AU)