The teaching facility at the Eric Williams Medical Sciences Complex: an additional rising star from the west

The teaching facility at the Eric Williams Medical Sciences Complex was designed to provide a comprehensive structural environment for a multidisciplinary faculty whose teaching methodology utilized an integrated problem-based learning approach. Though the faculty is over 11 years old, the full realization of the vision has not become a reality and the next 10 years will be devoted to fulfilling the dream. (AU)

Two-year mortality and its determinants following acute myocardial infarction in Trinidad and Tobago

The purpose of this study was to determine the occurrence of coronary artery disease risk factors in patients presenting with acute myocardial infarction(AMI) to a tertiary care institution in Trinidad and to determine the factors associated with increased mortality following AMI. All patients admitted to the Eric Williams Medical Sciences Complex (EWMSC) between January 1 and December 31, 1996, with a diagnosis of AMI were identified using the hospital admissions and discharge diagnosis databases. Demographic, clinical and laboratory variables were extracted from the hospital case records of patients with confirmed AMI. Sixty-one AMI patients (38 men) were admitted during the study period. Mean age of admittance was 60 ñ 11 years with an ethnic case mix of thirty-nine (62 percent) of East Indian descent, eight (13 percent) of African descent, twelve (20 percent) mixed ethnicity and three of Caucasian descent. Thirty patients (49 percent) were hypertensive. Thirty-two patients (53 percent) were diabetic and eighteen patients (30 percent) gave a history of cigarette smoking. The mean left venticular ejection fraction was 53 ñ 14 percent. The mean serum cholesterol from 29 patients was 228.2 ñ 49.0 mg/dl. Increasing age, female gender, an ejection fraction less than 40 percent, non treatment with streptokinase and in-hospital ventricular fibrillation were associated with poor survival. Multiple regression analyses identified three independent predictors of mortality. These were gender (p = 0.04), in-hospital ventricular fibrillation (p = 0.001) and an ejection fraction less than 40 percent (p = 0.02). Diabetes mellitus, hypertension, hyperlipidaemia and cigarette smoking were prevalent amongst patients presenting with AMI. Ventricular function was a major determinant of two-year mortality following AMI. Aggressive risk factor modification is recommended to prevent both first and recurrent coronary events.

Two-Year Mortality and its determinants following acute myocardial infarction in Trinidad and Tobago

The purpose of this study was to determine the occurrence of coronary artery disease risk factors in patients presenting with acute myocardial infarction(AMI) to a tertiary care institution in Trinidad and to determine the factors associated with increased mortality following AMI. All patients admitted to the Eric Williams Medical Sciences Complex (EWMSC) between January 1 and December 31, 1996, with a diagnosis of AMI were identified using the hospital admissions and discharge diagnosis databases. Demographic, clinical and laboratory variables were extracted from the hospital case records of patients with confirmed AMI. Sixty-one AMI patients (38 men) were admitted during the study period. Mean age of admittance was 60 ñ 11 years with an ethnic case mix of thirty-nine (62 percent) of East Indian descent, eight (13 percent) of African descent, twelve (20 percent) mixed ethnicity and three of Caucasian descent. Thirty patients (49 percent) were hypertensive. Thirty-two patients (53 percent) were diabetic and eighteen patients (30 percent) gave a history of cigarette smoking. The mean left venticular ejection fraction was 53 ñ 14 percent. The mean serum cholesterol from 29 patients was 228.2 ñ 49.0 mg/dl. Increasing age, female gender, an ejection fraction less than 40 percent, non treatment with streptokinase and in-hospital ventricular fibrillation were associated with poor survival. Multiple regression analyses identified three independent predictors of mortality. These were gender (p = 0.04), in-hospital ventricular fibrillation (p = 0.001) and an ejection fraction less than 40 percent (p = 0.02). Diabetes mellitus, hypertension, hyperlipidaemia and cigarette smoking were prevalent amongst patients presenting with AMI. Ventricular function was a major determinant of two-year mortality following AMI. Aggressive risk factor modification is recommended to prevent both first and recurrent coronary events.(AU)

Use of magnesium sulphate as adjunctive therapy for resection of phaeochromocytoma

The intraoperative control of cardiovascular disturbances associated with the resection of phaeochromocytoma is traditionally achieved by the use of deep anaesthesia in conjunction with A and B blockers, calcium antagonists, nitroglycerine or sodium nitroprusside. We report the successful use of magnesium sulphate as adjunctive therapy in the control of the cardiovascular consequences associated with surgical resection of a phaeochromocytoma in a patient.

Use of magnesium sulphate as adjunctive therapy for resection of phaeochromocytoma

The intraoperative control of cardiovascular disturbances associated with the resection of phaeochromocytoma is traditionally achieved by the use of deep anaesthesia in conjunction with A and B blockers, calcium antagonists, nitroglycerine or sodium nitroprusside. We report the successful use of magnesium sulphate as adjunctive therapy in the control of the cardiovascular consequences associated with surgical resection of a phaeochromocytoma in a patient.(Au)

Severe aplastic anaemia - complete response to antilymphocyte globulin and cyclosporin

Severe aplastic anaemia is uniformly fatal unless treated with immunosuppressive therapy or bone marrow transplantation. The latter is curative in 65 percent of patients and is the treatment of choice in children and young adults. Antilymphocyte globulin (ALG) and cyclosporin may be used successfully in the absence of an HLA matched sibling donor. We report the case of a twelve year old boy with severe aplastic anaemia who received immunosuppressive with ALG and cyclosporin and is alive and well three years an six months post treatment.(AU)

Intrathoracic cystic hygroma in an infant with respiratory failure

A 6 month old infant presenting initially with clinical signs of bronchiolitis developed acute symptoms of large airway obstruction and respiratory failure despite treatment of bronchiolitis. Endotracheal intubation and oxygen therapy resulted in immediate and dramatic improvement of respiratory failure. Plain chest radiograph, computerized tomography and surgical biopsy with subsequent histological examination established that the respiratory failure was due to a mediastinal cystic hygroma.(AU)

Trial of three methods of introperative bupivacaine analgesia for pain after paediatric groin surgery

To evaluate the relative effectiveness of three techniques of regional anaesthesia in the provision of postoperative analgesia in children. Methods: Random assignment of 183 children scheduled for groin surgery to one of three groups. Bupivacaine 0.5 percent plain (2 mg.kgˉ) was injected by the surgeon after skin incision. Group A received wound infiltration. Group B had regional nerve blockade. Group C had a combination of both methods. Post-operatively, pain was assessed using the CHEOPS behavioral scale at half-hourly intervals until discharge home. Satisfactory pain control was arbitrarily defined as CHEOPS score of ≤ six. Potential differences among the groups were sought using graphical presentation of mean pain scores, the frequencies of pain scores, and the incidence of postoperative vomiting and oral analgesic consumption. Results: Fifteen patients had to be excluded from analysis. This left 61 patients in Group A, 55 in Group B and 52 in Group C. There were no demographic differences among the groups. No differences were demonstrated among the groups either in CHEOPS pain scores at any observation point (P = >0.8), or in the incidence of vomiting or need for postoperative analgesia. (P = 0.52 and P = 0.41 respectively). Overall, 80 percent of the observations made (1135/1425) met our definition of satisfactory pain control. A post hoc calculation of the power of the study confirmed sufficient power to detect a 5 percent difference among groups. Conclusion: All three methods achieved analgesia with 80 percent of the pain scores meeting our definition of satisfactory pain control. None of the techniques enjoyed any apparent advantage (AU)

Reversal of benzodiazepine sedation with flumazenil in a patient with tetanus

A 54-year-old female patient admitted with a diagnosis of tetanus had her sedation reversed with an infusion of flumazenil. Flumazenil appears to be of use in reversal of sedation in patients with accumulation of benzodiazepine after prolonged administration.

Reversal of benzodiazepine sedation with flumazenil in a patient with tetanus

A 54-year-old female patient admitted with a diagnosis of tetanus had her sedation reversed with an infusion of flumazenil. Flumazenil appears to be of use in reversal of sedation in patients with accumulation of benzodiazepine after prolonged administration. (AU)

Slient cholinesterase gene in an East Indian family in Trinidad - abstract

During a study to determine the frequency distribution of the enzyme pseudocholinesterase (Cholinesterase) in the population of Trinidad, an East Indian individual developed prolonged respiratory apnoea on administration of a routine dose of suxamethonium. This paper reports the results of analyses of the frequency distribution of pseudocholinesterase in the sera from the index case and 19 family members. Cholinesterase was detected qualitatively in the serum, using the Dibucaine Number (DN) and Fluoride Number (FN) tests (normal values: 78.8 per cent and 61.4 per cent, respectively), and quantitatively, using the modified Ellman method (normal plasma levels: 8:44 ñ 1.78 u/ml). Patients with low activity of the enzyme (inhibited < 20 per cent by dibucaine) are "suxamethonium-sensitive". DN and FN values in the serum of the index case could not be determined because of the negligible enzyme activity (0.17 u/ml). Of the 6 of 7 siblings available for testing, 1 was found with undeterminable DN and FN values and even lower enzyme activity (0.09 u/ml). The proband's marital partner, 2 children and father had normal enzyme patterns. This condition of `trace' enzyme activity is controlled by a `silent gene' (AU)

The rectus sheath block for post-operative pain: a medical intra-operative approach - abstract

This study was designed to test the hypothesis that if early post-operative pain is adequately controlled then subsequent analgesia would be more effectively maintained. An intraoperative rectus sheath block was designed in which about 20 cc of 0.5 per cent bupivacaine were infiltrated into the plane containing the segmental spinal nerves within the rectal sheath just prior to wound closure. Twenty-six adult patients undergoing abdominal surgery via a mid-line incision were randomly allocated to 2 groups which were matched for age, sex, type of procedure and size of patient. The control group of 10 patients received pethidine 100 mg/i.m. every 4 hours for the first 24 post-operative hours. The rectus sheath group of 16 patients, in addition to the rectus sheath block, also received pethidine 100 mg/i.m. every 4 hours for 24 hours post-operatively. Pain scoring was done at six hours and twenty-four hours post-operatively, using a verbal rating scale. Statistical analysis, using The Mann-Whitney U test at the 5 per cent level, showed that post-operative analgesia, using the rectus sheath block and intra muscular pethidine, was superior to that obtained by pethidine alone at both 6 and 24 hours post-operatively (AU)

Deaths within 24 hours of surgical procedures at the Port-of-Spain General Hospital (January, 1976 to December, 1987)

Mortality, possibly related to anaesthesia, was reviewed prospectively over a 12-year period. There were 186 deaths in 129,107 anaesthetics. Mortality was predominantly confined to the 15 - 44, and 45 - 64 -year age groups. The overall mortality rate was 1:694. Sixteen deaths were directly related to regional and local anaesthesia and three were directly related to general anaesthetic management. In 66 deaths, general anaesthesia was considered to be contributory, and 101 deaths were considered to be unassociated with anaesthesia (AU)

Pilot study of propofol as an induction agent

A clinical trial of propofol as an induction agent was performed on 100 patients of A.S.A. physical status I and II. Nine (9) percent developed pain on injection, 24 percent apnoea and 20 percent various haemodynamec changes. 99 percent wished to receive the drug again as an induction agent. Propofol is a 2,6, diisopropyl phenol formulated as an aqueous emulsion in soya bean oil. Clinical trials with this formulation began in 1983 and it had been shown to induce anaesthesia rapidly and smoothly and recovery was associated with no hangover effects. It was thus decided to test its usefulness as an induction agent in a West Indian population for surgical procedures lasting less than 60 minutes. These were mainly gynaecological, urological and orthopaedic surgical procedures. (AU)

Pilot study on midazolam as an induction agent for minor surgical procedures

Midazolam, a water-soluble benzodiazepine, was used to induce anaesthesia in 32 patients for minor surgical procedures. Patients showed cardiovascular stability, smooth induction and good recovery at a dose of 0.15 mg/kg. This dose was unaffected by premedication, and as such this drug is recommended as a satisfactory induction agent for short surgical procedures (AU)

Trial to observe the adverse reactions to alphathesin

A six-month survey was performed to determine the incidence of adverse reactions to Alphathesin (Althesin) in a West Indian community. Of the 69 patients surveyed, 30 showed adverse reactions to the drug, but these could have been due to overdosage. A 2 percent incidence of bronchospasm was a sigfnificant finding as this reaction would be due to hypersensitivity and is a high figure. The paper suggests that care should be exercised in the use of this drug since there appears to be significant incidence of adverse reactions in our community (AU)

A retrospective study of tetanus cases at Port of Spain General Hospital 1978-1981

This study presents 42 cases of tetanus which were admitted to the I.C.A. over a four year period. Though the country has reached its mortality goal of 1/1000,000 for tetanus, the cases seen are still preventable and are a drain on the economy. The most vulnerable group are those in the age group 45 to 64 and females show a higher mortality than males. Patients with other medical problems are particularly at risk and diabetics and hypertensives should receive active immunization. The survey showed that our urban population are more at risk than our rural population. The reason for this is not known but may mean that agriculture is practiced in the urban communities and these groups need to be reminded about immunization. Over the years the mortality from tetanus has dropped from 60 percent to 44 percent but this does not compare well with other reports. This will only happen if high quality nursing and medical care can be provided for these patients with a high nurse and doctor per patient ratio in a well equipped Intensive Therapy Unit where great attention to sepsis ventilation using Curare or Pancuronium tracheostomy and physiotherapy can be provided to the Grade II and III patients. It would be nice to see renewed campaigns to immunize the whole population against tetanus since success will only be achieved when 100 percent of the population is actively immunized. Paster in his paper suggests that immunization can be achieved by 1 dose of 250Lf of tetanus toxoid providing satisfactory antibody levels for 5 years and may be a good way to achieve adult vaccination in the at risk group. (AU)

Oxytocics and their effect on systemic blood pressure during general anaesthesia for caesarean section

168 patients who had general anaesthesia for Caesarean sections had their blood pressure changes analysed according to their response to syntometrine or syntocinon. Patients who received 5 units of syntocinon showed the greatest cardiovascular stability and it is suggested that this is the oxytoxic of choice for patients receiving general anaesthesia for Caesarean section. (AU)