Constitutional precocious puberty in a girl aged four years and three months

The advent of puberty in girls with its manifestation by adrenarch and memarche occurs on an average from 11 to 13 years of age. The outside limits of normality are accepted as 9 years and 17 years. The further these limits are advanced or delayed, the greater the parental worry and the greater the clinical interest their arouse. (AU)

Intestinal parasitic infestation among parturients in Trinidad and Tobago

In this limited survey, 42.5 percent of parturients were found to be infested with intestinal parasites. Hookworm, Trichuris and Entamoeba infestations were the most common. Race, social class and locality influenced the incidence of different types of infestations. Those infested with hookworm had longer labor, smaller babies and higher incidence of prematurity. (Summary)

Dietary deficiency and pre-eclamptic toxaemia: a preliminary communication

Pre-eclamptic toxaemia is a major obstetric and neonatal problem in the Caribbean. It is associated with a high incidence of mortality and morbidity. The cause of pre-eclamptic toxaemia is not known. It is postulated that dietary deficiency in lysine and tryptophon may be the factors. A preliminary clinical trial is being conducted and a more complete survey is contemplated, depending on funds (AU)

Management of vaginal infections in Trinidad and Tobago - abstract

Vaginal infections are being treated inadequately, inapppropriately or unnecessarily not to speak of failure to treat them when present. Therefore the survey was carried out to find out what practical problems were encountered and what suggestions could be given to overcome them. 227 unselected patients attending the obstetric and gynaecological clinics in the hospital were investigated. Every other woman (57 percent) had one or more forms of infection with candidiasis being responsible for over 35 percent with trichomonas in 27 percent and pyogenic 10 percent. Candidal infection was twice as common among obstetric patients than gynaecological patients. Contrary to popular belief, there was slightly higher incidence among the higher socio-economic group than the lower. Problems in diagnosis were encountered both in symptomatology or in laboratory procedure. More than 25 percent of the infected group had no symptoms at all while nearly 48 percent of the uninfected group had symptoms referable to vaginal infections. The type of discharge also was not helpful. Hence proper diagnosis will rest only on accurate laboratory investigations. Therefore routine high vaginal swab in all clinic patients, just as routine haemotological investigation is done in antenatal cases, is advocated. Problems faced with laboratory work were overcome by a simple, quick method if collecting swabs with minimal equipment; preparing a medium locally for transport without haste and finding a method which is reliable, cheap and convenient. This modified CPLM medium, prepared locally, gave 96 percent positive for Trichomonas and 90 percent for candidiasis. No other test gave equally reliable results and for both the major infecting organisms. Where the incidenc was high and laboratory facilities very limited, and clinical picture confusing, a drug that can combat the two major, if not all 3 types, infections is the ideal. Therefore a clinical trail with 'Nifuratel' (Magmilor) was carried out and the results presented for overall and for each individual group of cases. What became evident in the survey, was the place for the simple surgical procedures which helped in the eventual success. The overall success rate was 80 percent cure with candida being cured in 82 percent and trichomonas in 78 percent. Side effects were minimal. No teratogenic effects were noted (AU)

The problems of grand multiparity: an analysis of 2,582 cases delivered in General Hospital, Port-of-Spain Trinidad, from 1965-67

The incidence of grand multiparity is 11.2 per cent in the General Hospital, Port-of-Spain, Trinidad. The criterion of grand multiparity used was seventh viable pregnancy and over. 49.7 per cent of the patients had complications in pregnancy. The percentage of patients booked for hospital delivery was 10.9. The incidence of complications varied greatly with the standard of antenatal care. Anaemia and hypertensive diseases were the commonest complications of pregnancy and contributed directly or indirectly to the high maternal and foetal losses in the series. Prevention of grand multiparity should be the future primary aim. Good and impeccable antenatal care and hospital delivery will be the sheet anchors in lowering the maternal and foetal death rate (AU)

The rhesus negative factor in Trinidad and Tobago - abstract

This study was to determine the incidence of Rhesus negative persons in the population and any differences in race, sex or A.B.O. groups. Also the incidence, outcome of Rhesus isoimmunization and the factors influencing these were studied. Data were obtained from 5,892 consecutive persons attending the blood bank in the General Hospital for a period of about 10 months and from 1,885 patients attending the Antenatal Clinic over a similar period. The incidence of the Rhesus negative group was 5.5 percent in the general population. Of the Rh negative mothers, 6.8 percent have affected babies. There are very few guides as to which babies of Rh negative mothers would be affected (AU)

Factors influencing the high incidence of grand multiparity in Trinidad and Tobago

One of every five pregnancies in Trinidad and Tobago occurs in a grand multipara, a woman who has previously had at least six gestations terminating beyond week 28. Several factors contributing to this high incidence of excessive parity are observed to include a lengthy reproductive career, illegitimacy, lack of religious beliefs, ethnic differences, and many ephemeral psychosocial influences (AU)

Face-down position for repair of vesicovaginal fistula

A simple method of achieving face-down position for the vaginal repair of certain types of vesicovaginal fistula is described and its advantages mentioned. It is particularly useful for bladder-neck, juxta-urethal and large midvaginal fistulas, since it readily affords adequate exposure. It does require the use of endotracheal intubation by an experienced anesthesiologist (AU)