Prescribing practices in the management of hypertension in the Caribbean's.
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Biomedical subjects
Publications and source records attributed to A Atallah.
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OBJECTIVES: To determine the efficacy of oral theophylline compared with placebo in people with stable chronic obstructive pulmonary disease (COPD). METHODS: Systematic review of randomized-controlled trials comparing oral theophylline with placebo for a minimum of 7 days in people with stable COPD. RESULTS: Twenty randomized-controlled trials were included in this review. The following outcomes showed significant improvement with theophylline compared with placebo: FEV1 and FVC both improved with theophylline (weighted mean difference [WMD] 0.10 L; 95% confidence interval [95% CI] 0.04-0.16 and WMD 0.21 L; 95% CI 0.10-0.32, respectively). VO2 max also improved with theophylline (WMD 195.27mL/ min; 95% CI 112.71-277.83), as did PaO2 and PaCO2 (WMD 3.18 mmHg; 95% CI 1.23-5.13 and WMD -2.36mmHg; 95% CI -3.52 to -1.21, respectively). Patients preferred theophylline over placebo (relative risk 2.27; 95% CI 1.26-4.11). Theophylline increased the risk of nausea compared with placebo (RR 7.67; 95% CI 1.47-39.94). CONCLUSION: This review has shown that theophylline still has a role in the management of stable COPD, and is preferred by patients over placebo. However, the benefits of theophylline in stable COPD have to be weighed against the risk of adverse effects.
BACKGROUND: Nutritional disorders observed in children with eczema may be aggravated by inappropriate diet, sometimes with dramatic effects. CASE REPORT: A child aged 3 years 7 months presented a state of severe malnutrition with edema (kwashiorkor). The child had chronic eczema and had been given a highly restrictive diet based on a principle of exclusion without medical advise. Cure was achieved without sequelae with a normal diet. DISCUSSION: This case illustrates the fragility of nutritional status in children with chronic widespread skin disease due to the risk of cutaneous loss of protein. Kwashiorkor is an exceptional observation in developed countries and, in this context, might be on the rise due to the popularity of exclusion diets for presumed allergic disease.
BACKGROUND: Schistosomiasis is a parasite that is carried by freshwater snails. The intestinal form infects the intestine, liver and spleen and can be fatal. OBJECTIVES: The objective of this review was to assess the effects of oxamniquine or praziquantel for treating Schistosomiasis mansoni SEARCH STRATEGY: We searched the Cochrane Infectious Diseases Group trials register, the Cochrane Controlled Trials Register, Medline, Lilacs and reference lists of articles. The Revista da Sociedade Brasileira de Medicina Tropical and Brazilian Tropical Medicine Congress abstracts were handsearched SELECTION CRITERIA: Randomised and quasi-randomised trials comparing oxamniquine and/or praziquantel to placebo for the treatment of Schistosomiasis mansoni. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. MAIN RESULTS: Thirteen trials met the inclusion criteria. Praziquantel and oxamniquine were effective in curing Schistosoma mansoni infection when compared to placebo. In Africa, praziquantel 40 mg/Kg is more effective than oxamniquine 15 mg/Kg in individuals older than 14 years (OR 3.54, 95%CI 1.70, 7.38), but no difference was found when compared with oxamniquine 30 mg/Kg (OR 0.29, 95%CI 0.08, 1.01). In Brazil, praziquantel was equally effective when compared with oxamniquine in individuals older than 14 years (OR 1.70, 95%CI 0.83, 3.49). Both drugs appear safe. There was no difference in reinfection rate between zinc supplementation and placebo (OR 0.82, 95%CI 0.47, 1.41). REVIEWER'S CONCLUSIONS: IPraziquantel and oxamniquine both appear to be effective for the treatment of Schistosomiasis mansoni, although lower doses of oxamniquine (less than 30 milligrams per kilogram) may not be as effective.
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We examined the variation in stated practice in the management of acute myocardial infarction (AMI) among doctors in Australia, Brazil, Chile, India and Thailand. Hospitals were identified as primary, secondary or tertiary by investigators from around their own region. All doctors within each hospital who would be expected to treat patients with AMI were asked to indicate which investigations and treatments they would offer to a patient with an AMI who develops angina on Day 3 after admission. The numbers of hospitals ranged from 5 to 26 per country, and doctor response rates varied from 70 to 100%. Within-country variation was large, and statistically significant variations were seen between countries in the use of most interventions. The large variation both between and within a range of countries across the economic spectrum suggests a widespread need for agreement about what constitutes appropriate management after AMI.
We present a case of malignant schwannoma (MS) of the parapharyngeal space which completely encircled the internal carotid artery in close proximity to the skull base and required resection of the internal carotid artery along with the excision of the tumour. There have been three previous case reports in the literature of malignant schwannoma of the parapharyngeal space of which one case was associated with neurofibromatosis. Our patient did not exhibit any feature of neurofibromatosis.
The authors report an isolated pediculated thrombus in the left ventricle of a young 14 year old girl with systemic lupus erythematosus with antiphospholipid antibodies without any other cardiovascular abnormality, especially ventricular wall motion abnormalities. After surgical ablation of the thrombus, the patient was followed up to avoid recurrence. This type of cardiac lesion (ventricular thrombosis without underlying myocardial disease) is exceptionally rare. Echocardiographic follow-up after surgical ablation showed no recurrence of thrombosis after four years.
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A case of osteochondroma arising from the C2 transverse process, responsible for vertebral artery compression with complete occlusion and C2 nerve root irritation with C2 neuralgia, is reported. Complete surgical removal was achieved via the lateral anterior approach.
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BACKGROUND: Arterial hypertension is a frequent disease, responsible for a significant morbidity, in the French Caribbean regions. Today, epidemiological studies on this topic remain few. OBJECTIVES: To analyse the prevalence, awareness, treatment and control of arterial hypertension in the French Caribbean regions. METHODS: Analysis of the INHAPAG cohort (Incidence of Arterial Hypertension in the Working population Antillo-Guyanaise) carried out in 2001, and including 6113 active subjects recruited in Guadeloupe, Martinique and Guyana. The procedure of diagnosis of arterial hypertension comprises two visits, with a series of three measurements of the blood pressure at each visit. RESULTS: Prevalence of hypertension is estimated to be 18.9% among women and 19.5% among men. The rates of treatment are higher among women (74.8 vs 34.4%) than among men, resulting in a much better control rate (61.3% vs 38.6% among men). An analysis of factors associated with the presence of arterial hypertension shows a noxious role of low education level among women. CONCLUSION: Our study finds marked differences between women and men in the treatment and control of arterial hypertension and underline the need for improving blood pressure management of the latter.
Higher prevalence and poorer control of hypertension have been observed in populations with low socioeconomic status. The causal link between socioeconomic factors and hypertension is complex. What is the impact of medical services compared with other health status determinants? We aimed to assess blood pressure prevalence and control in an unemployed disadvantaged population receiving state financial support and with easy access to health care. This was a cross-sectional study of 2420 consecutive subjects in Guadeloupe, a French Caribbean island, who were referred for check-up in a health centre. As unemployed persons, they all benefited from state financial support and special coverage. Blood pressure was averaged from three consecutive measurements. Subjects not taking antihypertensive medications and with average BP > 140/90 mmHg underwent an additional visit. A total of 1088 men aged 42 +/- 10.6 years and 1332 women aged 40 +/- 11 years were included from November 2001 to November 2003. Hypertension prevalence was 25.2% in men and 22.1% in women, while awareness was 40.2% in men and 73% in women. Blood pressure was controlled (<140/90 mmHg) in 19% of men and 37,2 % of women receiving antihypertensive medication. Among women, 58% were overweight and 29% obese. Hypertension prevalence was slightly higher than that recently observed in cohorts of workers in Caribbean regions and metropolitan France. Control was poorer despite similar awareness and treatment rates. These findings suggest that a universal healthcare system can reduce, but not fully eliminate, disparities in hypertension care and prevalence across income categories.