ABSTRACT
OBJECTIVE: To determine the distribution of cases of human myiasis admitted to the Cornwall Regional Hospital (CRH), Jamaica, between 1999 and 2003, following the inception of the National Screwworm Eradication Programme (NSEP) in 1998, and the risk factors associated with the condition. METHOD: A total of 144 cases of myiasis were retrieved from the database of the department of Medical Records at the CRH for the years 1999 to 2003. A data extraction form was devised to review the circumstances of each case. The data were analyzed using EpiInfo version 6. RESULTS: Of 144 cases, 54.9% were female and 45.1% male. The largest groups were < 10 years, 52.8% [76/144 (M-21, F-55)] and 60years and over, 18.8% [27/144 (M-16, F-I)] (p < 0.001). Case distribution for the years 1999-2003 showed 16, 39, 31, 30, and 28 cases respectively. Three-quarters (74.6%) of all cases affected the scalp/head one-fifth (20.3%) affected the lower limbs. Ninety-six per cent of those < 10 years had scalp/head myiasis (p < 0.001; OR = 23.29; CI: 6.14 < OR < 104.11). Two-thirds (66.6%) of those 60 years and over had lower limb myiasis (p < 0.001; OR = 19.09; CI: 6.20 < OR < 61.12). Mean duration of treatment was 3.5 days (SD = 1.4 days) and 69.7% required hospitalization for seven or more days. There was no difference in duration of treatment for myiasis or in length of hospitalization in relation to method used to eliminate maggots. Risk factors identified included Tinea capitis for myiasis of the scalp/head (p < 0.001) and diabetes mellitus for lower limb myiasis (p < 0.001; OR = 14.48; CI: 2.37 < OR < 133.25). CONCLUSION: Human myiasis remains a public health issue in western Jamaica with no significant decreasing trend in the number of cases admitted to the CRH since 1999. It is recommended that this zoonosis become a Class 1 notifiable disease to the Ministries of Health and Agriculture because of the existing NSEP.
Subject(s)
Child , Female , Humans , Male , Middle Aged , Antiparasitic Agents/therapeutic use , Program Evaluation , Myiasis/epidemiology , Databases as Topic , Program Development , Retrospective Studies , Risk Factors , Time Factors , Screw Worm Infection , Jamaica/epidemiology , Myiasis/drug therapy , Myiasis/therapy , Population SurveillanceABSTRACT
Angioedema (AE) is a problem that all doctors inclusive of emergency room physicians and the otolaryngologists are often asked to treat. We present a six-year experience with this disorder. In this series, angiotensin-converting enzyme inhibitors (ACEIs) were related to 60% of admissions for angioedema. Lip and tongue swelling was the most common manifestation. The discontinuation of ACEI therapy and supportive management are the recommended approaches to treatment and prevention of unfavourable outcomes. The authors strongly recommend medic alert bracelets for all patients with this disorder. The use and side effects of ACEI therapy in our population which is predominantly of African descent warrants further investigations.
El angioedema (AE) es un problema que todos los doctores incluyendo los médicos y otolaringólogos de las salas de emergencia se ven a menudo en la necesidad de tratar. A continuación presentamos una experiencia de seis años de enfrentamiento a esta afección. En esta serie, inhibidores de enzimas convertidoras de angiotensina (IECAs) se relacionaron con el 60% de los ingresos por angioedema. La hinchazón de los labios y la lengua fue la manifestación más común. La suspensión de la terapia con IECA y el tratamiento de apoyo son los métodos que se recomiendan para el tratamiento así como para la prevención de resultados desfavorables. Los autores recomiendan enfáticamente brazaletes de alerta médica para todos los pacientes con esta afección. El uso y los efectos colaterales de la terapia con IECA en nuestra población predominantemente de ascendencia africana merece investigación ulterior.