Annual Report 2021. Jamaica, Bermuda, and Cayman Islands: Responding to COVID-19 and Preparing for the Future

This Pan American Health Organization/World Health Organization Annual Report outlines contributions and achievements in Jamaica, Bermuda, and the Cayman Islands in the year 2021. The report also reinforces PAHO/WHO's core mission, through focus on the country level, recognizing that progress toward sustainable development hinges on improved health at the local and national levels. In 2021, PAHO/WHO supported Jamaica, Bermuda and the Cayman Islands on their path toward disaster risk reduction as well as the ongoing implementation of Phase II of the Smart Health Care Facilities in the Caribbean Project. This project, which aims to enhance the resilience of health facilities to ensure continuity of service delivery before, during and after hazards, such as hurricanes, has led to the upgrade of nine facilities so far. Working toward the upcoming restructuring of the Jamaican Ministry of Health and Wellness (MOHW) and Regional Health Authorities (RHAs) and health care reform in Jamaica, the country signed a technical cooperation agreement with PAHO to provide a national voluntary contribution, with projects developed to strengthen public financial management and results-based management, as well as a strategic plan for health information systems and a concept note for policy on health research. PAHO supported Jamaica’s efforts as the pandemic impact underscored the need to include mental health in emergency and disaster management, as well as activities that contributed to achieving milestones in tobacco control and road safety. Furthermore, PAHO assisted with initiatives to tackle the high prevalence of Noncommunicable Diseases (NCDs) in the population and promote better nutrition, such as the National Infant and Young Child Feeding Policy and Strategic Plan and front-of-package labelling.

Ministry of Health and Wellness Annual Report 2020-2021

This publication gives an overview of the Ministry of Health and Wellness for the year 2020-2021. It details vision, mission, strategic goals and objectives, results-based management framework, Executive direction and administration programme, health sector regulation programme. It also gives a special report on COVID-19 management response and financial report for the period

Vitals: A quarterly report of the Ministry of Health and Wellness, Jamaica April 2022

This document looks at dengue statistics for the period January 2018 to December 2021. It focuses on symptoms and signs, history, suspected and confirmed cases and mapping of cases in each parish for the period January 2018 to December 2019.

Key initiatives highlights 2020-2021

This document highlights the major achievement of the Ministry of Health for the period 2020-2021. Contains information about Health System Strengthening Programme (HSSP), mental health, National HIV/STI Programme, Integrated Vector Management Programme, non-communicable diseases, Jamaica Moves, Programme for the Reduction Of Matenal and Child Mortality and Enhancing Healthcare Services Delivery Project.

Annual Report 2020. Universal Health and the Pandemic. Resilient Health Systems. Jamaica, Bermuda, and the Cayman Islands

Founded in 1902 as the independent specialized health agency of the inter-American system, the Pan American Health Organization (PAHO) has developed recognized competence and expertise, providing technical cooperation to its Member States to fight communicable and noncommunicable diseases and their causes, to strengthen health systems, and to respond to emergencies and disasters throughout the Region of the Americas. In addition, acting in its capacity as the World Health Organization’s Regional Office, PAHO participates actively in the United Nations Country Team, collaborating with other agencies, the funds and programs of the United Nations system to contribute to the achievement of the Sustainable Development Goals (SDGs) at country level. This 2020 annual report reflects PAHO’s technical cooperation in the country for the period, implementing the Country Cooperation Strategy, responding to the needs and priorities of the country, and operating within the framework of the Organization’s regional and global mandates and the SDGs. Under the overarching theme of Universal Health and the Pandemic – Resilient Health Systems, it highlights PAHO’s response to the COVID-19 pandemic as well as its continuing efforts in priority areas such as communicable diseases, noncommunicable diseases, mental health, health throughout the life course, and health emergencies. It also provides a financial summary for the year under review.

A Case of Graves' Disease Resistant to Carbimazole

ABSTRACT We describe a case of a patient with Graves' disease who failed to respond to carbimazole. Our patient remained thyrotoxic despite maximal carbimazole dosage. Our patient was switched to propylthiouracil which subsequently made the patient euthyroid. The patient was then definitively treated with radioiodine treatment. This case highlights the need to increase awareness of carbimazole resistance to prevent patients from being given escalating doses of carbimazole which increases the probability of adverse effects and extend their time in the hyperthyroid state.

Sonoelastographic Assessment of the Gender-related Changes of Achilles the Tendon

ABSTRACT Objective: To assess the gender-related differences in the elasticity and thickness of the Achilles tendon among healthy young participants. Methods: A total of 48 volunteers, who were healthy adults between the ages of 20 and 25 years, were included in this study. The metabolic equivalent (MET) scores, tendon thickness and shear wave velocities (SWVs) were compared between the males and females. Results: The median age of the males was 24 years and that of the females was 23 years. The mean body mass index (BMI) score was 22.22 ± 1.92 kg/m2 among the males and 21.84 ± 2.29 kg/m2 among the females. The median MET score of both the males and the females was 4. The median SWV was found to be 4.76 m/s in the males and 4.77 m/s in the females. There was no statistically significant difference in age, BMI, MET scores and SWV values between the males and the females (p = 0.349, p = 0.537, p = 0.923 and p = 0.578, respectively). The mean thickness of the Achilles tendon was found to be statistically significantly higher in the males than in the females (4.47 ± 0.41 mm and 4.03 ± 0.44 mm, respectively) (p = 0.001). Conclusion: The effect of gender on the Achilles tendon's elastic property is not a significant covariate in the young, healthy sample. Muscle strength may play a more important role in the Achilles tendon's injury rather than in tendon's elasticity.

Evaluation of Neutrophil-to-Lymphocyte Ratio and Monocyte-to-Lymphocyte Ratio in Gouty Arthritis Attacks

ABSTRACT Objective: To evaluate neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR) in patients with gouty arthritis. Methods: Forty-five patients with gout and 45 healthy age and gender matched individuals were included in this study. Clinical and laboratory data of patients during acute gouty arthritis (AGA) attack period, as well as in remission and control group data, were reviewed and recorded from medical files. Patients were divided into two groups as having the arthritis attack and in remission. Results: Neutrophil-to-lymphocyte ratio values were 4.19 ± 3.37 in AGA patients, 2.64 ± 1.74 in patients in remission and 2.07 ± 1.01 in controls. Neutrophil-to-lymphocyte ratio values in AGA were higher than patients in remission and controls, whereas there was no difference between patients in remission and controls (p < 0.0001, p <0.0001, p = 0.453, respectively). Monocyte-to-lymphocyte ratio values were 0.36 ± 0.21 in AGA patients, 0.25 ± 0.15 in patients in remission and 0.22 ± 0.06 in controls. Monocyte-to-lymphocyte ratio was higher in AGA patients than in patients in remission and controls, but there was no difference between patients in remission and healthy individuals (p < 0.0001, p < 0.0001, p = 0.604, respectively). The NLR and MLR values in AGA patients had positive correlations with C-reactive protein, erythrocyte sedimentation rate and leucocyte count. The cut-off value of NLR was 2.18 in receiver operating characteristic (ROC) analysis (73% sensitivity, 63% specificity, AUC = 0.676; p = 0.004). The cut-off value of MLR was 0.22 in ROC analysis (62% sensitivity, 54% specificity, AUC 0.655; p = 0.011). Conclusion: We concluded that MLR and NLR could be used as cheap and useful inflammatory markers predicting arthritis attacks in patients with gout.

Hypertrophic Cardiomyopathy in Infancy

ABSTRACT Objective: To report comprehensively the clinical features and the management strategies of hypertrophic cardiomyopathy in infancy. Methods: Comprehensively retrieved studies published from 2000 to present constituted the study materials for this article. Results: Signs of myocardial ischaemia and cardiomegaly are the predominate manifestations of this lesion. The spectrum of the aetiology and management of hypertrophic cardiomyopathy in infancy have been updated in the past several decades. Long-term small-dose digoxin combined with prednisone, supplemented by the angiotensin-converting enzyme inhibitor capto-pril, is an accepted therapy for endocardial fibroelastosis in infancy. The treatment with recombinant human α-glucosidase enzyme replacement therapy can reverse the electrocardiographic changes of infantile Pompe 's disease. Conclusion: Hypertrophic cardiomyopathy in infants of diabetic mothers is usually benign and transient, and the treatment is not needed unless heart failure occurs. Differential diagnosis of hypertrophic cardiomyopathy from congenital heart defects is important for subsequent management.

Is Serum Antioxidant Status Impaired in Pregnant Women at High Risk for Carrying a Down Syndrome-affected Fetus?

ABSTRACT Objective: To establish the oxidant/antioxidant status in serum samples from pregnant women above the threshold for Down syndrome (DS) risk, according to the quadruple test. Methods: Thirty maternal serum samples that were above the threshold for DS risk (study group) were chosen from pregnant women whose quadruple tests were studied at Ankara University Ibni Sina Hospital Central Laboratory. They were matched with the control group consisting of 30 pregnant women whose DS risk were below threshold. Malondialdehyde level, glutathione peroxidase and non-enzymatic superoxide radical scavenger activities (NSSAs) were analyzed in the study and control groups. Results: It was found that NSSA was significantly decreased in the study group as compared to the control group (p = 0.006). Malondialdehyde levels had a tendency to increase with gestational week in both groups (p = 0.042 in the study group and p < 0.001 in the control group). Conclusion: There is a significant decrease in non-enzymatic antioxidant capacity in pregnant women that were above the threshold for DS risk, as compared to the control group. In the context of these results, dietary antioxidant supplementation might be a useful approach during early gestation, especially around the time of conception, possibly to prevent bearing a DS fetus.

The Relationship between Serum IL-17 and IL-23 Levels, and Other Disease Activity Parameters in Patients with Behçet's Disease

ABSTRACT Objective: To investigate the relationship between disease activity and the involvement of Behçet's disease (BD) and serum levels of interleukin (IL)-17 and IL-23. Methods: Sixty patients with BD and 20 healthy control group subjects were included in this study. The patients were divided into four groups according to clinical findings as follows: entero-Behçet, mucocutaneous-Behçet, neuro-Behçet and vascular-Behçet. The serum levels of the IL-17 and IL-23 levels were evaluated using enzyme-linked immunosorbent assay. Results: Of the BD patients, 15 (25%) had active disease and 45 (75%) had inactive disease. The serum levels of IL-23 and IL-17 were statistically significantly higher in the patients with BD than in the control groups (p < 0.05). A significant relationship was also observed between the disease activity, and both the erythrocyte sedimentation rate and the C-reactive protein levels (p < 0.05). The mean serum levels of IL-17 and IL-23 in patients with active disease were 0.07 ± 0.25 pg/ml and 36.0 ± 30.5 pg/ml, respectively. There was no statistically significant relationship between the disease activity and the serum levels of IL-17 and IL-23 (p > 0.05). There were also statistically significant relationships between the disease activity and uveitis, retinal vasculitis or superficial thrombophlebitis. Conclusion: No relationship was found between BD and serum levels of the IL-17 and the IL-23.

Rapamycin Improves Vascular Remodelling in a Controlled Rat Model of Monocrotaline-Induced Pulmonary Hypertension

ABSTRACT Background: Pulmonary arterial hypertension (PAH) is a serious disease characterized by the progressive elevation of the pulmonary arterial resistance, leading to the right ventricular failure and death. Objective: To evaluate the effect of rapamycin (RAPA), a potent cell-cycle inhibitor, on exercise capacity, right ventricular hypertrophy and pulmonary vascular remodelling on rats. Methods: A total of 39 nine-week-old male Wistar rats (160-240 g) were divided into three groups: the control (n = 10), PAH control (n = 15) and PAH-RAPA (n = 14) groups. On the 1st day, 60 mg/kg monocrotaline was injected intraperitoneally to induce PAH in the PAH control group and PAH-RAPA groups. On the 21st day, 3 mg/kg/day RAPA was started orally, and the animals were followed for 35 days. On the 35th day, the exercise capacity of the rats was analysed through a modified forced swimming test. After measuring their right ventricular systolic pressure using an open-chest method, their hearts and lungs were excised and analysed histopathologically for right ventricular hypertrophy and pulmonary vascular remodelling. Results: Rapamycin treatment provided limited and insignificant improvements in exercise capacity, right ventricular systolic pressure and right ventricular hypertrophy of the rats. However, there was significant recovery in the rats' pulmonary artery muscular layer thickness with the RAPA treatment (p < 0.049). On the 35th day, the mortality rate was 0% in the control group, 53.1% in the PAH control group and 42.9% in the PAH-RAPA group. No statistically significant decrease was observed in their mortality rates with the RAPA treatment (p > 0.16); however, a significant recovery was noted in terms of the rats' median life span (p < 0.006). Conclusion: Pulmonary artificial hypertension is a progressive disease that is not curable with current therapies. Rapamycin may have the potential to reverse vascular remodelling and prolong life expectancy in cases of pulmonary hypertension.

Malignant Melanoma and Atypical Fibroxanthoma: An Unusual Collision Tumour

ABSTRACT Two different neoplasms in the same biopsy material, called collision tumour, were studied. These tumours are rarely seen in the skin. We report the case of a 79-year-old female with a collision tumour composed of amelanotic malignant melanoma and atypical fibroxanthoma of the face. The histological and immunopathological features observed are discussed.

Anti-RA 33: A Marker of Good Prognosis in Seronegative Rheumatoid Arthritis

ABSTRACT Objective: Autoantibodies are evident in the early stages of rheumatoid arthritis (RA) and play important roles in diagnosis. The aim of this study was to investigate the diagnostic capability and extent of anti-RA 33 positivity and clinical characteristics in patients with RA. Methods: We included 67 RA patients and 20 healthy subjects in our study. Duration of symptoms, duration of disease, the extent of delay in diagnosis, episodes of clinical remission, and type and number of disease-modifying antirheumatic drugs (DMARDs) taken were noted. To evaluate quality of life, the Health Assessment Questionnaire (HAQ) Disability Index (consisting of 20 questions) was applied. Disease activity was evaluated with Disease Activity Score (DAS) 28. The laboratory assessments included erythrocyte sedimentation rate, C-reactive protein level and serologic assessments for rheumatoid factor, anti-cyclic citrullinated protein and anti-RA 33. Results: The mean disease duration was 14.56 months. A total of 38 (56.7%) patients were positive for anti-RA 33 antibodies. Twenty-four (63%) of patients positive for anti-RA 33 were clinically in remission. A negative correlation was evident between anti-RA 33 positivity and number of DMARDs taken and HAQ score (r = −0,766, p < 0.001; r = −0.737, p < 0.001). A positive correlation was evident between anti-RA 33 positivity and DAS 28 score (r = 0.287, p = 0.019). Conclusion: Anti-RA 33 antibodies have poor diagnostic capability in patients with RA. Anti-RA 33 antibodies may exert helpful effects determining prognosis in established RA patients.

The Impact of Visual Impairment on the Quality of Life of Diabetic Patients Attending the University Hospital of the West Indies

ABSTRACT Objective: To assess the impact of visual impairment on the quality of life (QOL) of patients with diabetic retinopathy attending the Retina Eye Clinic at the University Hospital of the West Indies (UHWI). Method: A questionnaire modelled from the National Eye Institute Visual Function Questionnaire (NEIVFQ-25) was administered to 150 patients with diabetic retinopathy. The questions ranged from concern with their vision, health and social problems to functional ability. The associations between an overall QOL score and level of visual impairment among other variables were assessed using chi-square test and the t test in the SPSS software. Results: The mean age was 56 ± 10 years. Sixty-six percent were females. Type 2 diabetes was more common in 63% and 79% of the females and males, respectively. There were significant negative associations between QOL and increased duration of diabetes mellitus (DM) (p = 0.016), reduced vision (left eye; p < 0.049), reduced monthly income (p = 0.008), lack of compliance with exercise (p = 0.021), and a special diet (p = 0.01). There were no significant relationships between QOL and age (p = 0.495), marital status (p = 0.318) and DM type (p = 0.651). Conclusion: Poorer QOL was associated with decreased left eye visual acuity, lower income and lack of compliance with exercise and special diet among patients with diabetic retinopathy at UHWI.

An Autopsy Series: Lightning-related Deaths in Van and Hakkâri Provinces, Turkey

ABSTRACT Objective: To report the largest series of lightning-related deaths in Turkey, to review the literature on this subject, and to identify similarities and differences between the autopsy findings in this study and the information available in literature. Methods: In this study, autopsy reports and crime scene investigation data on 11 lightning-related fatalities that occurred in the Van and Hakkâri Provinces, Turkey, from January 1, 2011 to December 31, 2015 were retrospectively reviewed. Results: Of the 1699 fatalities, 11 (2.53%) evaluated by medico-legal autopsy in the Van and Hakkâri Province in a 5-year period died from lightning strikes. Of these cases, 10 (90.1%) were males and 1 (9.9%) was female (p < 0.05). All cases were in the 11 to 33 years age group. All cases were injured outdoors. Conclusion: We concluded that deaths due to lightning strikes are relatively rare in Turkey, and may be reduced with precautions such as avoiding staying under trees or in the vicinity of high towers, refraining from touching metal objects, avoiding lying on the ground, leaning on walls, and crouching outdoors.

Do the Different Types of Pulmonary Hypertension Cause the Same Effect on Right Heart and Serum Asymmetrical Dimethylarginine Levels in Female Patients?

ABSTRACT Objective: Right-heart function is a major determinant of clinical outcome in patients with elevated pulmonary artery pressure due to pulmonary venous hypertension (PVH) and pulmonary arterial hypertension (PAH). Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide synthase. This study aimed to evaluate if different types of pulmonary hypertension (PH) would cause the same effect on right-heart functions and serum ADMA levels in female patients. Methods: This study included patients with PAH as group I, patients with PVH due to mitral stenosis (mitral valve area ≤ 1.5 cm2, without any additional valve or left-heart disease and systolic pulmonary artery pressure ≥ 50 mmHg in transthoracic echocardiography) as group II, and healthy control subjects as group III. Transthorasic echocardiographic evaluations for right-heart functions were performed according to the guidelines of the American Society of Echocardiography. Venous blood samples were collected, and the serum ADMA concentrations were obtained with the ELISA kit (DRG® International Inc., Springfield, NJ, USA). Results: Patients in groups I and II had higher ADMA levels than healthy control subjects. Right-atrium area and dimensions, right-ventricular (RV) volumes, grade of tricuspid regurgitation, systolic pulmonary arterial pressure, RV wall thickness, and RV outflow tract diameters were significantly higher in group I patients than in group II patients. Right-ventricular myocardial performance index was lower, and RV fractional area change and tricuspid valve systolic tissue Doppler velocity were higher in group II patients than in group I patients. Conclusion: This study demonstrated that both PAH and PVH caused increase in right-heart dimensions and impairment in right-heart functions.