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PubMed2004

Observations on the seasonal prevalence and vertical distribution patterns of oviposition by Aedes aegypti (L.) (Diptera: Culicidae) in urban high-rise apartments in Trinidad, West Indies.

The seasonal prevalence and vertical distribution of oviposition of Aedes aegypti were studied for 53 wk in 1999--2000 using modified ovitraps located at several elevations. The ovitraps were positioned both indoors and outdoors in high-rise apartments in the urban township of John John, Port of Spain, Trinidad, West Indies. Of 988 ovitraps, 490 were collected during the months of the wet season, with 404 (84.4%) positive with 18,536 Ae. aegypti eggs. Of 498 ovitraps collected during the dry season, 335 (67.3%) were positive with 12,255 Ae. aegypti eggs. Data from different elevations showed that significantly more eggs were collected at 13-24 m elevations than any other elevation. The results suggest that the invasion of high rise ecosystems by Ae. aegypti can enhance transmission of dengue. This ecological shift in the Ae. aegypti population exploited new habitats associated with human activity, suggesting that strategies should be developed to educate householders as well as creating appropriate vector control measures to prevent future threats of dengue transmission.

Aedes↗

PubMed2000

Brain abscess at the University Hospital of the West Indies.

Surgical infections of the central nervous system are still attended by high rates of morbidity and mortality, although substantial progress has been made since the advent of computed tomography (CT) scanning technology. In this retrospective review of 25 surgically treated patients with either brain abscess or subdural empyema at the University Hospital of the West Indies, the majority of patients were male and between the ages of 10 and 30 years with a mean age of 16.9 years. Almost half the patients had a hemiparesis on presentation while 60% had fever. Subdural empyema was more common than a localized intracerebral abscess which was most frequently located in the frontal lobe. The most common predisposing factors were sinusitis and congenital heart disease. Streptococci spp and Staphylococci spp were the most frequently isolated organisms. All patients underwent CT scanning and surgical intervention. The mortality rate was 20%, and 21% of the survivors had late seizures. There must be a high index of clinical suspicion and early referral to specialist centres where neuroradiological investigation and prompt neurosurgical intervention can be carried out to minimize morbidity and mortality.

Adolescent↗

PubMed2001

ERMANCIA: Epidemiology of Stroke in Martinique, French West Indies: Part I: methodology, incidence, and 30-day case fatality rate.

BACKGROUND AND PURPOSE: The ERMANCIA (Etude Réalisée en Martinique et Centrée sur l'Incidence de Accidents vasculaires cérébraux) study was designed to provide the first comparable epidemiological data on stroke in a black Caribbean population. METHODS: ERMANCIA was a prospective community-based study performed in Martinique (French West Indies) from June 1, 1998, to May 31, 1999. The black at-risk population was approximately 360 000. Multiple sources were used to identify hospitalized and nonhospitalized patients with first-ever stroke. RESULTS: Five hundred eighty patients (285 men and 295 women; mean+/-SD age, 71.2+/-14 years) suffered from a first-ever in a lifetime stroke, yielding a crude annual incidence of 164/100 000 per year (95% CI, 151 to 177). The rates adjusted by age and sex to the French population (1999 census) and to the European population were 202 (95% CI, 185 to 218) and 151 (95% CI, 139 to 164), respectively. Thirty-eight patients (6.5%) were not hospitalized during the acute phase of the stroke; 92.8% had CT scan. Pathological types of strokes were infarction (79.8%, including 23% of lacunar strokes), intracerebral hemorrhage (14.3%), subarachnoid hemorrhage (3.4%), and undetermined (2.4%). The main risk factors for stroke were hypertension (69.1%) and diabetes (29.5%). The 30-day case fatality rate was 19.3% (15.8% for cerebral infarction and 37.3% for intracerebral hemorrhage). CONCLUSIONS: In Martinique, the ERMANCIA population-based study showed a high stroke incidence and a high prevalence of hypertension and diabetes in the stroke population compared with those observed in continental France. Epidemiological data on stroke in African Caribbeans from Martinique are comparable to those reported in blacks from the United States and United Kingdom.

Adolescent↗

PubMed2000

Epidemiology of vitiligo in the French West Indies (Isle of Martinique).

BACKGROUND: The frequency of vitiligo in white populations has been generally estimated to be about 0.5-1%. The same prevalence is expected in black populations, despite the few investigations reported. No studies have been performed in black populations living in the Caribbean Islands. Therefore, our purpose was to report an epidemiologic study of vitiligo in the French West Indies (Isle of Martinique). METHODS: We performed a prospective study between October 1995 and March 1996; 2077 outpatients of the Department of Dermatology at the Fort de France University Hospital were examined to detect vitiligo. Concurrently, 32 patients (23 women and nine men), presenting with vitiligo, were questioned about their family history, personal diseases, age, and circumstances of vitiligo occurrence. RESULTS: Vitiligo was found in seven patients (five women and two men) out of 2077. The prevalence in the studied population was 0.34%. Of the 32 patients with vitiligo who were investigated, 11 (34%) had a family history of vitiligo, two (6%) suffered from thyroid disease, two (6%) from psoriasis, and one (3%) from atopic dermatitis. The median age at vitiligo onset was 29 years. CONCLUSIONS: Despite the bias due to the recruitment of patients in the Dermatology Department, this study demonstrates a prevalence in a black population comparable, or slightly inferior, to the currently accepted data in white people. Our results concerning the age of onset and pathologic associations showed no difference with the literature data related to white populations.

Adolescent↗

PubMed2004

Resistance patterns among selective Gram-negative bacilli from an intensive care unit in Trinidad, West Indies.

OBJECTIVE: To determine the prevalence of antimicrobial resistance among gram-negative aerobic bacteria isolated from infected patients on the intensive care unit (ICU) and the outcome of infected patients. METHODS: Over a 5-year period (January 1998 to December 2002), all gram-negative aerobic bacteria (GNB) consecutively isolated from infected ICU patients at General Hospital, San Fernando, Trinidad and Tobago, West Indies. were tested for susceptibility to 10 commonly prescribed antimicrobial agents. Bacterial strains were identified according to standard microbiological procedures. The antimicrobial agents used and the amounts consumed by patients on the ICU were obtained from the hospital pharmacy records. Hospital discharges and deaths due to infectious complications were obtained from the medical records office and the ICU. RESULTS: During the study period, there were 1160 admissions to the ICU. From this, 530 (45.7%) were suspected episodes of nosocomial infection and 445 (84%) were culture positive for GNB. Sputum, urine and blood accounted for approximately 85% of isolates. Pseudomonas aeruginosa (P. aeruginosa), Klebsiella pneumoniae (K. pneumoniae), Citrobacter spp and Enterobacter spp were the predominant isolates from sputum, while from urine; it was P. aeruginosa and K. pneumoniae. The major isolate from bloodstream infection on the ICU was Citrobacter spp. Of the 10 antimicrobial agents, the least effective was ampicillin that showed 87.8% resistance, while the most effective against GNB were imipenem (94.2%), ciprofloxacin (93.9%) and piperacillin-tazobactam (88.5%). The most common isolate was P. aeruginosa which is sensitive to >82% of the antimicrobials. Antimicrobial consumption was 2282 grams and the most frequently prescribed drugs were ampicillin, cefuroxime and amoxicillin-clavulanic acid, with consumption of the beta-lactam antimicrobials being 87.3% of the total. There were 280 (24.1%) deaths on the ICU during the study period and 42.9% (120 of 280) were said to be due to, or associated with overall hospital-acquired infectious complications. Mortality associated with GNB infection was approximately 33%. All fatal cases were associated with pneumonia and bloodstream infections. The predominant organisms were Citrobacter spp, Enterobacter spp, Acinetobacter spp and P. aeruginosa, with Citrobacter spp associated with both pulmonary and bloodstream fatalities. CONCLUSION: In general, the isolates were relatively antimicrobial susceptible. Imipenem, ciprofloxacin and piperacillin-tazobactam were found good empiric choices for treatment of most GNB infection in the ICU. The study showed that resistance among ICU pathogens depended on the site of infection and that increased drug consumption of any antimicrobial agent may lead to increase resistance to those drugs. The need for policies governing the prudent use of antimicrobial agents cannot be overemphasized. Many endeavors aimed at introducing an antibiotic policy have encountered repeated failure and attempts at rational prescribing through educational programs have met with limited success. Hope is seen however, in proper implementation of infection control procedures aimed specifically to curtail lateral transmission of resistant organisms.

Drug Resistance, Bacterial↗

PubMed2005

Knowledge and use of electronic information resources by medical sciences faculty at The University of the West Indies.

OBJECTIVE: The objective was to determine faculty's knowledge of electronic resources, access to a computer, use of electronic resources (both number and frequency) available at the Medical Sciences Library (MSL), and the areas of training needed and to identify areas for further research. METHODS: A survey was administered to faculty in medicine, pharmacy, dentistry, and veterinary sciences at The University of the West Indies. The questions covered computer literacy, computer access and location, knowledge and use of electronic resources, and training needs. RESULTS: The response rate was 70%, of whom 97% were computer users. Seventy-three percent used computers daily, and 82% felt that their computer literacy level was average or beyond. Overall, it was found that faculty had high awareness of the electronic resources made available by the MSL but low use of MSL-specific resources supporting the suggested problem of underutilization. Many respondents felt that e-resources were important, and, though many felt that they were competent users, 83% were self-taught and many still expressed a need for training. Over 60% felt that a workshop with a hands-on component was the preferred format for training. It was recommended that there be greater promotion of the library's e-resources.

Attitude to Computers↗

PubMed2004

Infections in neurosurgical patients admitted to the intensive care unit at the University Hospital of the West Indies.

Patients admitted to the Intensive Care Unit (ICU) are at risk of developing life-threatening nosocomial infections, especially with organisms resistant to commonly used antibiotics. Neurosurgical patients are particularly vulnerable because of the serious nature of their illness, the frequency of associated trauma and the presence of invasive devices. Of 120 neurosurgical patients admitted to the ICU of the University Hospital of the West Indies (UHWI) between September 1995 and December 1999, the records of 73 patients were available for analysis. All had prophylactic antibiotics. Twenty-one of these 73 patients (28.8%) developed 22 infections after a mean of five days in the ICU: nine with chest infection, seven with urinary tract infection, four with central nervous system (CNS) infection and one each with wound and skin infection. This is an incidence of 11.6/1000 patient-days. The responsible organisms included Pseudomonas (7/21), Acinetobacter (3/21), E. coli 2/21, Enterobacter (2/21), and Klebsiella (2/21), and one each with Staphylococcus aureus, methicillin resistant Staphylococcus aureus, coagulase negative Staphylococcus, group D Streptococcus and bacteroides (1/21). Infection was significantly related to length of hospital stay, length of ICU stay, duration of intubation, duration of ventilation and the presence of diabetes mellitus. All patients who had surgery after ICU admission developed infection, seven with chest infection, two with urinary tract infection, two with CNS and one with skin infection. The three patients who were admitted with intracranial infections all developed other infections. Infected patients had a significantly longer hospital stay. Five patients died, none directly attributable to infection, while 55 (75.5%) made a good recovery. The problem of ICU infection may be expected to escalate with the increased use of intensive care, increasingly more complex surgical procedures and the growing problem of antibiotic resistance. Since infection is related to the length of ICU stay, earlier discharge of neurosurgical patients to an appropriately staffed high dependency unit is likely to result in reduction of the infection rate. Reinforcement of infection control strategies within the ICU may be expected to further minimize the infection rate.

Adolescent↗

PubMed2004

Disseminated histoplasmosis and AIDS at the University Hospital of the West Indies. A case report.

Disseminated histoplasmosis is rare in Jamaica. However, with the increase in the number of immunocompromised patients in the population, the prevalence of this infection is likely to increase. We present a case of disseminated histoplasmosis in a 16-year-old girl with the acquired immune deficiency syndrome who presented to the Paediatric Infectious Diseases Service of the University Hospital of the West Indies, with cervical lymphadenitis progressing to ulcers and abscesses showing granulomatous inflammation likely to be of fungal aetiology. She later presented to the Emergency Room, with respiratory and gastrointestinal symptoms and was admitted to hospital, disoriented and with a persistent fever. She developed nuchal rigidity while in hospital and was anaemic, leukopaenic and thrombocytopaenic. She died of gastrointestinal bleed ten days post admission. She was the oldest known survivor of mother-to-child-transmission of human immunodeficiency virus in Jamaica. The slow growing fungus, Histoplasma capsulatum, was isolated from the patient's blood three weeks after the specimen was sent to the laboratory.

AIDS-Related Opportunistic Infections↗

PubMed2004

Paravertebral anaesthesia for breast surgery an initial experience at the University Hospital of the West Indies.

Paravertebral blockade (PVB) is a regional anaesthetic technique that allows the injection of local anaesthetic agents into the paravertebral space. It has been used for acute and chronic pain relief and as an anaesthetic technique for unilateral surgery of the chest, breast, shoulder, kidney, and inguinal region. Paravertebral blockade has been performed on a limited basis for breast surgery at the University Hospital of the West Indies (UHWI) since 1998. This retrospective review was undertaken to report the initial experience with this block. We reviewed the notes of all patients who were given a PVB alone, or in combination with general anaesthesia (GA). Twenty-one patients had P VB: twenty females and one male, with age range of 24 to 90 years. Six were attempted with PVB alone, but two of these needed supplementation with a GA. Fifteen were done in combination with GA. No complications were recorded The initial experience shows that the performance of PVB is both possible and safe; it may offer an alternative to GA for breast surgery. A randomized prospective study is underway to allow a detailed comparison between the two methods.

Anesthesia, Spinal↗

PubMed2002

Internalized racism, body fat distribution, and abnormal fasting glucose among African-Caribbean women in Dominica, West Indies.

The current study examined the relationship of internalized racism to glucose intolerance in a population of Afro-Caribbean women aged 18 to 55. Also of interest was whether this relationship would be differentially influenced by the type of body fat distribution or confounded by the level of hostility. A total of 244 women were selected from a systematic sample of households on the island of Dominica, West Indies. Demographic data together with information on internalized racism were collected by questionnaire. Anthropometric information and fasting blood glucose were also measured. Women with high levels of internalized racism exhibited an increased risk of elevated fasting glucose compared to those with low levels of internalized racism (odds ratio (OR) = 2.4; 95% confidence interval (CI) = 1.1-5.5). There was no difference in mean body mass index (BMI) by level of internalized racism. However those with high internalized racism had a significantly larger waist circumference after adjusting for age, education, hostility, and elevated fasting glucose status. In multivariate analyses controlling for age, education, hostility, and either weight or BMI, internalized racism remained independently associated with elevated fasting glucose. However, once waist circumference was included in the model, the relationship of internalized racism to elevated fasting glucose was not statistically significant. This study demonstrates a significant relationship between internalized racism and abnormal levels of fasting glucose which may be mediated through abdominal fat. The exact nature of the relationship of internalized racism to glucose intolerance may be an important area of future study.

Adolescent↗

PubMed2004

Extended spectrum beta-lactamase producing organisms at the University Hospital of the West Indies.

Extended spectrum beta-lactamases (ESBL) represent a major group of beta-lactamases that have the ability to inactivate beta-lactam antibiotics containing an oxyimino group such as third generation cephalosporins and monobactams. These enzymes are produced by gram negative organisms, especially members of the Enterobacteriaceae family such as Klebsiella pneumoniae and Escherichia coli. The prevalence of these organisms varies widely internationally, as well as within the same country. This is the first study on ESBL production in K pneumoniae and E coli at the University Hospital of the West Indies, a tertiary care hospital in Jamaica. Two-hundred and sixty-four isolates of K pneumoniae and 300 isolates of E coli were collected over the study period January 2002 to December 2002. Forty-eight (18.2%) K pneumoniae isolates were confirmed to be ESBL producers, while there was no ESBL producing E coli. Infections with ESBL producing organisms can pose a therapeutic challenge, leading to treatment failure if the wrong class of antibiotics is used. With increasing resistance to all classes of antibiotics, there is a narrowing of available treatment options. It is very important that these organisms be monitored and antibiotic policies as well as infection control policies be in place to curtail their spread.

Cross Infection↗

PubMed1975