Bone mineral density in Jamaican black women after hysterectomy and bilateral oophorectomy: an observational study / Densidad mineral osea en mujeres negras jamaicanas después de histerectomía y ooforectomía bilateral: un estudio observacional

OBJECTIVE: To see if black Jamaican postmenopausal women who had hysterectomy were at increased risk of osteoporosis. To assess the risk of osteoporosis in hysterectomized Jamaican postmenopausal patients. METHOD: We reviewed 809 women (403 hysterectomized and 406 controls) for cardiovascular disease risk. We did a demographic history and examination looking at blood pressure, waist hip ratio and body mass index and investigations done included fasting blood glucose and total and high density lipoprotein (HDL) cholesterol. We also measured bone density at the heel in all women using the Achilles ultrasound bone densitometer looking at T-score and Z-score. RESULTS: There was a significant association of hysterectomy status and bone mineral density (BMD) status with a smaller than expected proportion of women with osteoporosis in the hysterectomy group (χ2 = 18.4; p = 0.001). The mean T-score was significantly higher in the hysterectomized women, adjusting for age, waist circumference and sociodemographic factors. The relationship between the various predictors and BMD was explored by stepwise regression modelling. The factors that were significantly related to low BMD were hysterectomy status, age, waist circumference and being employed. CONCLUSION: Hysterectomy was not found to be a significant risk factor for osteoporosis. The osteoporosis risk among menopausal women in Jamaica appears to be due to other risk factors which probably existed prior to the operation.

OBJETIVO: Determinar si mujeres negras jamaicanas postmenopáusicas sometidas a histerectomía corrían mayor riesgo de osteoporosis. Evaluar el riesgo de osteoporosis en pacientes jamaicanas postmenopáusicas histerectomizadas. MÉTODO: Se examinaron 809 mujeres (403 histerectomizadas y 406 controles) para evaluar el riesgo de enfermedad cardiovascular. Hicimos una historia demográfica y un examen para obtener información sobre la presión arterial, el índice cintura/cadera ratio, y el índice de masa corporal. Asimismo, realizamos investigaciones que incluyeron pruebas de glucemia en ayunas, colesterol total, y colesterol de lipoproteínas de alta densidad (HDL). También medimos la densidad ósea en el talón de todas las mujeres, usando el densitómetro óseo ultrasónico modelo Achilles para obtener el T-score y el Z-score. RESULTADOS: Hubo una asociación significativa entre el estado de histerectomía y el estado de la densidad mineral ósea (DMO) con una proporción de mujeres con osteoporosis en el grupo de histerectomía (χ2 = 18.4; p = 0,001) más pequeña de lo esperada. El T-score promedio fue significativamente mayor en las mujeres histerectomizadas, ajustando por edad, circunferencia de la cintura y factores sociodemográficos. La relación entre los distintos factores predictivos y DMO fue explorada mediante regresión gradual stepwise modelado. Los factores que estuvieron significativamente relacionados con baja DMO fueron estado histerectomía, edad, circunferencia de la cintura y siendo empleado. CONCLUSIÓN: Se halló que la histerectomía no es un factor de riesgo significativo para la osteoporosis. El riesgo de osteoporosis entre las mujeres menopáusicas de Jamaica parece deberse a otros factores de riesgo que probablemente existían antes de la operación.

Cardiovascular disease risk factors in menopausal Jamaican black women after hysterectomy and bilateral oophorectomy: an observational study / Factores de riesgo de la enfermedad cardiovascular en mujeres negras jamaicanas en la menopausia tras histerectomía y ooforectomía bilateral: un estudio observacional

OBJECTIVE: To determine differences in prevalence of cardiovascular risks and diseases in black Jamaican postmenopausal women who had hysterectomy (hysgroup) compared with those without (control). METHOD: Eight hundred and nine (809) women (hysterectomized (HYSGRP) = 403; non-hysterectomized (controls) = 406) were enrolled. Sociodemographic information and lifestyle history, measured blood pressure, waist hip ratio, body mass index, fasting blood glucose, total and HDL cholesterol were obtained. RESULTS: Of the 809 women, complete cardiovascular risk data were available in 341 controls and 328 in the HYSGRP group. There was no difference in mean age, blood pressure and body mass indices between the subjects excluded and the subjects in the data analytical sample. A significantly lower proportion ofwomen in the control group exercised, attained post-secondary education and were of higher parity. Systolic (mean difference with 95% CI; 6 (3, 9) mmHg and diastolic (3 (1, 5) mmHg) blood pressure were lower in the HYSGRP compared with controls but total cholesterol (0.2 (0.07 to 0.4) mmol/L was greater. HDL cholesterol was not different between both groups 1.3 mmol/L (SD 0.3) vs 1.3 mmol/L [SD 0.4] (p = 0.8435). There was no difference in the prevalence of diabetes, hypertension and high waist-hip ratio in hysterectomized women compared with controls adjusting for hormone replacement therapy usage, cigarette smoking, exercise and educational status. Within the HYSGRP, there was also no difference in cardiovascular disease or risk in women who had bilateral oophorectomy compared with women who had at least an ovary preserved at time ofoperation. CONCLUSION: Hysterectomy was not associated with an increased risk of cardiovascular disease. This must be taken cautiously since data did not allow for analysis on duration of menopause.

OBJETIVO: Determinar las diferencias en la prevalencia de riesgos y enfermedades cardiovasculares en mujeres negras jamaicanas menopáusicas con histerectomía, en comparación con las que no tuvieron esta operación (control). MÉTODO: Se enrolaron ochocientas nueve (809) mujeres (histerectomizadas (HYSGRP) = 403; no histerectomizadas (controles) = 406). Se obtuvo información sobre datos demográficos e historia del estilo de vida, mediciones de la presión arterial, índice cintura/cadera, glucemia en ayunas, así como el colesterol total y HDL. RESULTADOS: De 809 mujeres, había disponible datos completos sobre el riesgo cardiovascular en 341 controles, y 328 en el grupo HYSGRP. No hubo diferencias significativas en relación con la edad promedio, la presión arterial, y el índice de masa corporal entre los sujetos excluidos y los sujetos en las muestras del análisis de datos. Una proporción significativamente menor de mujeres en el grupo de control practicado, tuvo educación post-secundaria y fueron de paridad más alta. La presión arterial sistólica (diferencia promedio con 95% CI; 6 (3 a 9 mmHg)) y la presión arterial diastólica (3 (1 a 5 mmHg)) fueron más bajas en el grupo de la histerectomía HYSGRP en comparación con el grupo de control, pero el colesterol (0.2 (0.07 a 0.4)) fue mayor. El colesterol HDL no fue diferente entre los dos grupos: 1.3 mmol/L (SD 0.3) frente a 1.3 mmol/L [SD 0.4] (p = 0.8435). No hubo diferencia en cuanto a laprevalencia de la diabetes, la hipertensión, y el alto índice cintura/cadera en las mujeres histerectomizadas, en comparación con los controles ajustándose en relación con el uso de la terapia de reemplazo hormonal, el hábito defumar, el ejercicio, y el nivel educacional. Dentro del grupo HYSGRP tampoco hubo diferencias con respecto a las enfermedades cardiovasculares o riesgos en mujeres operadas de ooforectomía bilateral, en comparación con las mujeres a las que se les preservó por lo menos un ovario en el momento de la operación. CONCLUSIÓN: La histerectomía no estuvo asociada con un aumento de riesgo de la enfermedad cardiovascular. No obstante, esta conclusión debe tomarse con cautela, ya que los datos no permitieron el análisis en el período de duración de la menopausia.

Dengue infection in patients presenting with neurological manifestations in a dengue endemic population / Infección de dengue en pacientes que se presentan con manifestaciones neurológicas en una población con dengue endémico

The evaluation of the contribution of neurological dengue in suspected central nervous system (CNS) viral infections is essential to better understand the impact of neurological dengue on morbidity and mortality in dengue endemic regions such as Jamaica. For this study, 401 cases of suspected viral CNS infections were investigated for evidence of dengue infection. The frequency of neurological dengue among these CNS cases was found to be 13.5% (54/401). Fifty-three cases were confirmed serologically by haemagglutination inhibition assay (HI) and IgM antibody (ELISA) and the virus was isolated in one case only. Clinical manifestations among dengue positive CNS cases included encephalitis in 51.8% (28/54), meningitis in 33.3% (18/54), seizures in 11.1% (6/54) and acute flaccid paralysis/Guillain-Barré syndrome in 3.7% (2/54). The clinical diagnosis of dengue neurological infection corresponded with laboratory confirmation in 22.2% (12/54) of cases only. Deaths occurred in 3.7% (2/54) of cases and were associated with patients with dengue neurological infection. The high risk of dengue among patients with suspected viral CNS infections in this study supports the need for an increased index of suspicion of dengue in patients presenting with neurological manifestations in dengue endemic countries.

La evaluación de la contribución del dengue neurológico en las infecciones virales sospechadas del sistema nervioso central (SNC) resulta esencial para un mejor entendimiento del impacto del dengue neurológico en la morbilidad y mortalidad en regiones donde el dengue es endémico tales como Jamaica. Para este estudio 401 casos de infecciones virales sospechadas del SNC fueron investigados en busca de evidencia de infección por dengue. Se haló entonces que la frecuencia del dengue neurológico entre estos casos de SNC, fue de 13.5% (54/401). Cincuenta y tres casos fueron confirmados por serología mediante ensayos de inhibición de hemaglutinación (IH) y ELISA para la detección de anticuerpos IgM, siendo el virus aislado sólo en un caso. Las manifestaciones clínicas entre los casos que resultaron positivos al dengue, incluyeron encefalitis en 51.8 % (28/54), meningitis en 33.3% (18/54), convulsiones en 11.1% (6/54) y parálisis facial aguda/síndrome Barré Guillain en 3.7% (2/54). El diagnóstico clínico de infección neurológica por dengue estuvo en correspondencia con la confirmación del laboratorio sólo en el 22.2% (12/ 54) de los casos. Se produjeron muertes en el 3.7% (2/54) de los casos, las cuales estuvieron asociadas con pacientes con infección neurológica por dengue. El alto riesgo de dengue entre los pacientes con sospecha de infecciones virales de SNC en este estudio, apunta a la necesidad de aumentar el índice de sospecha de dengue en pacientes que se presentan con manifestaciones neurológicas en países donde el dengue es endémico.

Features of isolated post-challenge hyperglycaemia in Jamaican adults

Isolated post-challenge hyperglycaemia (IPH) can be defined as a two-hour plasma glucose concentration > or = 11.1 mmol/L with a fasting plasma glucose concentration < 7.0 mmol/L. The aim of this prospective study was to determine the prevalence of IPH in a cohort of Jamaican individuals, and to determine if simple clinical features may predict the presence and subsequent diagnosis of IPH. A cohort of 1694 adults aged 25-74 years without physician-diagnosed diabetes mellitus was randomly selected. An oral glucose tolerance test (OGTT) was performed. Anthropometry, blood pressure and lipid profiles were measured. The prevalence of undiagnosed diabetes mellitus by the 1999 World Health Organization criteria was 6.4. IPH accounted for 24 of these cases and 1.4 of the entire population. Individuals with IPH were significantly older, with greater body mass index, waist-hip ratio, systolic blood pressure, fasting blood glucose, total cholesterol and LDL-cholesterol than individuals with normal glucose tolerance. Individuals with IPH were not significantly different from individuals with fasting plasma glucose levels > or = 7 mmol/L (i.e. fasting hyperglycaemia) in anthropometry or blood pressure. However, total cholesterol and LDL-C were significantly elevated in the IPH group. OGTT screening of individuals with impaired fasting glucose (i.e. 6.1-6.9 mmol/l) could reduce the IPH group by 50. Reducing the threshold for fasting glucose to 5.6 mmol/L would correctly classify 87 of the population. We concluded that individuals with IPH have features of the metabolic syndrome, which can aid in selection for screening. OGTT screening of individuals with fasting glucose values of 5.6-6.9 mmol/l is needed to identify IPH

Blood pressure in Jamaican children: relationship to body size and composition

Blood pressure levels in adults and children are related to body size and composition, but some of these relationships are unclear and they have been incompletely described in the Jamaican population. In a cross-sectional survey of 2,332 school children (6-16 years old; 1,046 boys, 1,286 girls), we measured systolic and diastolic blood pressure and pulse rate, and explored their relationship to weight, height, and waist, hip and mid-upper arm circumferences. The effect of these and other derived measures of body composition on blood pressure was explored in univariate and multivariate analysis. Blood pressure increased with age in both boys and girls, although the increase was greater for systolic than for diastolic blood pressure. The increase of systolic blood pressure among boys continued after age 11 years, but that for girls levelled off. Height and weight were the major predictors of blood pressure, but were highly correlated with each other and with all measures of body composition. Age, height and height-sex interaction explained 11.4of systolic blood pressure variation, and the largest incremental contribution to this model was provided by the addition of body mass index or hip circumference, each explaining an additional 2.6of the variance. Lean body mass made a larger contribution to blood pressure than percent fatness. Blood pressure in Jamaican children rises with age and this rise may be steeper in boys than girls. Blood pressure variation is significantly related to several measures of body composition including measures of fatness and fat free mass.

Chronic diseases: the new epidemic

Mortality statistics show that there has been a significant change in the leading causes of death in Jamaica over the last 50 years, characterized by a decrease in the infectious diseases and those due to undernutrition and an increase in the non-communicable diseases. The various patterns of this epidemiological transition worldwide are outlined and the characteristics of this 'new' epidemic are discussed. Data are presented from the findings of the recent multi-country study of hypertension and diabetes, including Jamaica, which shows that as the body mass index (BMI) increases across the African diaspora, so does the prevalence of hypertension and diabetes. Among the Jamaican population studied, the prevalence of hypertension was 19.1among males and 28.2among females. Reported prevalence of previously diagnosed diabetes was 5.3in men and 10.4in females. The gender differences are in part explained by the differences in mean BMI which were 23.8 and 27.9, respectively, for males and females. 30.6of males and 64.7of females were either overweight or obese, with obesity prevalent in 7.2of the males and 31.5of the females studied. The increasing prevalence of obesity across the Caribbean is cause for concern as it significantly impacts on the demand for health and medical care. The identification of these reversible risk factors should be used to inform public policy to tackle what will be a growing concern.

Kidney function in phasic insulin dependent diabetes mellitus in Jamaica

In Jamaica, malnutrition related diabetes mellitus (MRDM) presents the clinical picture of phasic insulin dependence. This study was undertaken to investigate nephropathic changes associated with this group of patients. Fourteen phasic insulin dependentdiabetes mellitus (PIDDM) patients were compared with 10 insulin dependent (IDDM) and 10 non-insulin dependents (NIDDM) diabetes mellitus patients, and 10 normal controls. Each group was matched for age, sex, body mass index (BMI) and, in the case of the diabetic patient controls, duration of diabetes. Urinary microalbumin concentration was significantly (p < 0.05) higher in the PIDDM group (mean + SD: 153 + 48.3 mg/dl) than in the groups of NIDDM (35.7 + 9.6 mg/dl) or IDDM (38.6 + 15.8 mg/dl) patients. Serum urea and creatinine concentration (mean + SE 7.6 + 1.0 mmol/l and 130.0 +20.3 umol/l, respectively) were higher in the PIDDM patients than in the NIDDM and IDDM groups. Confounding factors such as hypertension and urinary tract infections were excluded as causes for these differences. We conclude that PIDDM patients have more severe renal dysfunction than NIDDM patients and, since glycosylated haemoglobin concentrations are comparable in these groups, we attribute this to a renal insult due to malnutrition predating the onset of PIDDM.

Assessment of patient compliance in a diabetic clinic using glycated proteins compared with blood sugar measurements

Thity non-insulin-dependent (NID) and 10 insulin-requiring (IR) patients were randomly selected in the Diabetic Outpatients Clinic at the University Hospital of the West Indies. There were 29 (72.5%) female and 11(27.5%) male patients with a median age of 53.1 years (range 11-79) and a mean body mass indez of 25.5 (range 17.7-35.3). Mean duration of diabetes 10+ years (range 2-25 years). They had all been attending the diabetic clinic for minimum of two years. The patinets were followed up at 30-day intervals for 90 days and at each visit, detailed checks were done of their blood count, chemistry and metabolic profile; in particular, the fasting blood sugar, fructosamine in the IR group, glycosylated haemoglobin and fasting insulin levels in the NID group were determined. Deposite the close moniring of this select group, their control as assessed by fasting blood sugar and glycated protein levels revealed uniformaly unsatisfactory results. These findings have an important implication on recent Pan American World Health data which reveal that diabetes mellitus is now the leading cause of death in the Caribbean

Plasma thiocyanate and free radicals in jaaraparesis

Tropical Spastic Paraparesis (TSP) in West African contries is countries is caused by combination of excess cyanide from the ingestion of Cassava and a deficiency of the sulphur-containing amino-acids required to detosify the cyanide. Free radical damage to long axons has also been reported to results in damage similar to that seen in Jamaican TSP. To investigate the possibility that these mechanisms may be responsible for Jamican TSP, venous blood from non-smoking blood donors and 22 patients with TSP were analysed for thiocyanate, superoxide dismutase and glutahione. Serum thiocyanate is an index of cyanide exposure. Superoxide dismutase protects against free radical damage, and glutathione in addition to rotecting against free radical damage is ana important sulphur-containing peptiae. Levels of thiocyanate in the patients with TSP were similar to those in control patients. Glutathione was elevated in all the patients, and superoxide dimutase activity was normal. The low levels of thiocyanate suggest that cyanide toxicity is not the primary cause of Jamaican TSP and, in any event, sufficient amounts of sulphur-containing amino-acids are present to detoxify cyanide. Free radical mechanisms ara also unlikely to be responsible for damage to the neurons in thes patients

Year-round total serum IgE and IgG4 levels in allergic and non-allergic West Indian Medical Students

Twenty-four allergic and non-allergic West Indian medical studients and pathology technologists had repeated serum IgE and IgG4 levels determined over a one-year period. Contrary to previously published reports on this type of population, total serum IgE levels were usualaly consistently normal (18 of 24 subjects) with little variation throughout the year. The remaininh six subjects, all allergic, showed moderately elevated levels (620 - 1096 KU/1). Total serum IgG4 was elevated in most of the allergic and non-allergic subjects (18 of 24). Perinnial exposure to molds and house dust mite in this tropical environment could possibly produce the chronic antigenic stimulation responsible for the elevation in serum IgG4 levels found in this study