Perinatal factors in students admitted to the university of the West Indies data from the jamaican perinatal study / Factores perinatales en estudiantes de nuevo ingreso en la Universidad de West Indies datos del estudio perinatal de Jamaica

OBJECTIVE: To compare perinatal and social factors in students admitted to The University of the West Indies (UWI), Kingston, Jamaica, at age 18 years with those in the rest of the Jamaican Perinatal Cohort. METHODS: The Jamaican Perinatal Survey recorded demographic and perinatal details in 10 527 or 97% of births in Jamaica in September and October 1986. Eighteen years later, 140 of these were admitted to the UWI in Kingston, Jamaica. The perinatal features of these UWI students have been compared with the rest ofthe Perinatal Survey Cohort. RESULTS: Mothers of UWI students were older (p < 0.001), more likely to be married at the time of birth (p < 0.001), had earlier and more complete antenatal care (p < 0.05) and greater educational achievement at time of pregnancy (p < 0.001). These mothers of UWI students were also more likely to have diabetes (p < 0.01), operative deliveries (p < 0.01) and to attend private hospitals (p < 0.01). The UWI students had fewer siblings by their mothers (p < 0.05), were less likely to be low birthweight babies (p = 0.035) and more likely to be full term (37-42 weeks) than lower gestational age (p = 0.005). Differences in Apgar scores did not reach statistical significance. CONCLUSIONS: The students of the University of the West Indies were more likely to come from smaller families with features indicative of a better quality of life. They were also of higher birthweight and tended to be full term. The lack of association of Apgar scores with educational attainment is noteworthy.

OBJETIVO: Comparar los factores perinatales y sociales en estudiantes aceptados para sus estudios en la Universidad de West Indies (UWI), Kingston, Jamaica, a la edad 18 años, con los del resto de la Cohorte Perinatal de Jamaica. . MÉTODO: El Estudio Perinatal de Jamaica registró los detalles demográficos y perinatales en el caso de 10 527 o 97% de nacimientos en Jamaica en septiembre y octubre de 1986. Dieciocho años después, 140 de ellos ingresaron a UWI en Kingston, Jamaica. Las características perinatales de estos estudiantes de UWI con el resto de la Cohorte del Estudio Perinatal. RESULTADOS: Las madres de los estudiantes de UWI eran de mayor edad (p < 0.001), presentaban una mayor probabilidad de estar casadas al momento del nacimiento (p < 0.001), tuvieron cuidados prenatales más completos y más tempranos (p < 0.05), así como mayores logros en su educación al momento del embarazo (p < 0.001). Estas madres de estudiantes de UWI presentaban también una probabilidad mayor de diabetes (p < 0.01), partos operativos (p < 0.01) y asistencia a hospitales privados (p < 0.01). Los estudiantes de UWI tenían menos hermanos y hermanas por parte de sus madres (p < 0.05), tenían una menor probabilidad de ser bebés de bajo peso al nacer (p = 0.035) y una mayor probabilidad de ser bebés de término completo (37-42 semanas) que tener una edad gestacional menor (p = 0.005). Las diferencias en puntuación de Apgar no alcanzaron a tener importancia estadística. CONCLUSIONES: Los estudiantes de la Universidad de West Indies, presentaban una mayor probabilidad de provenir de familias más pequeñas con rasgos que indicaban una mayor calidad de vida. También poseían mayor peso al nacer y tendencia a término completo. La falta de correspondencia entre la puntuación de Apgar con los logros educacionales, fue cuestión de interés.

Renal histological findings in adults in Jamaica / Hallazgos histológicos renales en adultos en Jamaica

BACKGROUND: In 2006, it was reported that Focal and Segmental Glomerulosclerosis (FSGS), Minimal Change Disease (MCD) and Membranous Glomerulonephritis (MGN) were the commonest primary glomerular diseases identified from percutaneous kidney biopsies done in Jamaica for that year (n = 76). The sample size was thought to be small and might have affected the reported findings. So a threeyear review of percutaneous kidney biopsies in Jamaica was carried out. METHODS: Histology reports and clinical data were reviewed for percutaneous kidney biopsies performed from January 2005 to December 2007. Demographic data (age, gender), laboratory investigations such as serum urea, serum creatinine, proteinuria, haematuria, 24-hour urinary protein, and creatinine clearance, and clinical diagnosis were collected from the histology requisition form. RESULTS: There was a total of 224 native kidney biopsies performed. There were 91 males (40.6%) and 133 females (59.4%). Age distribution showed a total number of 25 paediatric cases (11.2%) and 199 adult cases (88.8%). Proteinuria was present in 171 cases (76.3%) and haematuria in 86 cases (38.4%). Of the total biopsies done, 78 cases (39.2%) had primary glomerular diseases, 110 cases (55.3%) had secondary glomerular diseases and 11 (5.5%) biopsies were reported as either normal or inadequate for histological diagnosis. The most common reasons indicated for percutaneous kidney biopsy were proteinuria, haematuria and staging of lupus nephritis. Most common histological findings for primary glomerular disease after percutaneous kidney biopsy were FSGS (n = 34), MGN (n = 15) and MCD (n = 12). In secondary glomerular diseases (n = 110), there were more females (70.8%) than males. Systemic lupus erythematosus was present in 63.3%. Histology of lupus nephritis according to the International Society of Nephrologists classification shows Membranous Lupus Nephritis [MLN] (40.2%), Diffuse Lupus Nephritis [DLN] (19.5%) and Minimal Mesangial Lupus Nephritis [MMLN] (14.3%) as the common histological types. CONCLUSIONS: The most common histological finding for primary glomerular disease following percutaneous kidney biopsy was FSGS, MCD and MGN. Membranous Lupus Nephritis was the commonest histological type for lupus nephritis in this series.

ANTECEDENTES: En 2006, se reportó que la Glomeruloesclerosis Segmentaria y Focal (GESF), la Enfermedad de Cambios Mínimos (ECM) y la Glomerulonefritis Membranosa (GNM) fueron las enfermedades glomerulares primarias más comunes identificadas a partir de las biopsias renales percutáneas realizadas en Jamaica ese año (n = 76). El tamaño de la muestra se consideró pequeño y pudo haber afectado los hallazgos reportados. De manera que se realizó un examen de tres años, de las biopsias renales percutáneas en Jamaica. MÉTODOS: Se revisaron los reportes de histología y los datos clínicos correspondientes a las biopsias renales percutáneas realizadas desde enero de 2005 a diciembre de 2007. RESULTADOS: Hubo un total de 224 biopsias de riñón nativo. Se realizaron 74, 78 y 72 biopsias renales en 2005, 2006 y 2007 respectivamente. Hubo 91 varones (40.6%) y 133 hembras (59.4%). La distribución por edades mostró un total de 25 casos pediátricos (11.2%) y 119 casos de adultos (88.8%). La proteinuria estuvo presente en 171 casos (76.3%) y la hematuria en 86 casos (38.4%). Del total de biopsias realizadas, 78 casos (39.2%) tenían enfermedades glomerulares primarias, 110 casos (55.3%) tenían enfermedades glomerulares secundarias y 11 (5.5%) biopsias fueron reportadas como normales, o como inadecuadas para el diagnóstico histológico. Las razones más comunes señaladas para la biopsia renal percutánea fueron la proteinuria, la hematuria y la estadificación de la nefritis por lupuso nefritis lúpica. Los hallazgos histológicos más comunes para la enfermedad glomerular primaria tras la biopsia renal percutánea fueron GESF (n = 34), GNM (n = 15) y ECM (n = 12). En relación con las enfermedades glomerulares secundarias (n = 110), hubo más hembras (70.8%) que varones. El lupus eritematoso sistémico estuvo presente en 63.3%. De acuerdo con la clasificación de la Sociedad Internacional de Nefrología, la histología de la nefritis por lupus muestra la nefritis lúpica membranosa (NLM) [40.2%], la nefritis lúpica difusa (NLD) [19.5%], y la nefritis lúpica mesangial mínima (NLMM) [14.3%], como los tipos histológicos más comunes. CONCLUSIÓN: Los hallazgos histológicos más comunes para la enfermedad glomerular primaria tras la biopsia renal percutánea, fueron GESF, ECM y GNM. La nefritis lúpica membranosa fue el tipo de histología más común para la nefritis por lupus en esta serie.

Hearing protector performance and standard deviation.

The attenuation performance of a hearing protector is used to estimate the protected exposure level of the user. The aim is to reduce the exposed level to an acceptable value. Users should expect the attenuation to fall within a reasonable range of values around a norm. However, an analysis of extensive test data indicates that there is a negative relationship between attenuation performance and the standard deviation. This result is deduced using a variation in the method of calculating a single number rating of attenuation that is more amenable to drawing statistical inferences. As performance is typically specified as a function of the mean attenuation minus one or two standard deviations from the mean to ensure that greater than 50% of the wearer population are well protected, the implication of increasing standard deviation with decreasing attenuation found in this study means that a significant number of users are, in fact, experiencing over-protection. These users may be disinclined to use their hearing protectors because of an increased feeling of acoustic isolation. This problem is exacerbated in areas with lower noise levels.

Instruction and the improvement of hearing protector performance.

Too often, in spite of the encouragement of those who advocate the removal of noise from the workplace as the preferred solution to noise exposure, hearing protectors are provided as the first line of defence against noise. Unfortunately hearing protectors are too often supplied with no real instruction or education in their use. This degrades their performance considerably. In this project the attenuation performance of one particular model of earplug was compared with and without instructions to test subjects. The instructions given were the most basic as commonly supplied on the plastic packaging containing the plugs. The attenuation performance (SLC80) of the plugs with the instructions was 16 dB greater than without the instructions. Overall performance was improved in every octave band with smaller associated standard deviations. The comparison showed that even with a very modest amount of instruction attenuation performance can be significantly improved.

Does the presentation of audiometric test data have a positive effect on the perceptions of workplace noise and noise exposure avoidance?

Research and 'common knowledge' has for many years accepted that education and feedback supplied to individuals during and immediately after workplace health assessments provides valuable information to workers about their health. Further, if more relevant and detailed information could be supplied then awareness and preventative action may increase proportionately. This research carried out with a rural Australian population has shown that preventative action did not increase in proportion to a corresponding increase in the amount and variety of information provided in connection with hearing health status. Two research groups underwent hearing tests, both with pure tone audiometry (PTA) while the second group also underwent otoacoustic emission (OAE) testing. Test results were presented to the subjects at the conclusion of their test session. An analysis of questionnaire responses at six week and twelve months follow up showed that more information did not result in increased preventative action. Barriers seem to exist such that individuals feel that they are not able to effectively act to reduce overall noise exposure. While self-efficacy initially increased, it declined to close to its initial value over the longer period. Other measures such as perceived susceptibility to hearing loss and the benefits of exposure reduction significantly increased and remained at the same increased level after twelve months. So, while overall awareness of noise and the risks of exposure were increased after both types of hearing test there was no increased hearing health benefit due to additional testing and hearing information.

Observations of noise exposure through the use of headphones by radio announcers.

This study examined the potential risk of hearing loss by commercial radio announcers. This risk is developed through the regular use of headphones. These headphones are used to monitor broadcast transmission and communication information from program producers. To our knowledge there are no published studies of the noise exposure of radio announcers. The experimental method utilised a headphone parallel to the one in use mounted on a wideband, artificial ear. A Sound Level Meter was then used to measure the sound level and then calculate the exposure level. Depending on the feedback level applied to their headphones radio announcers are exposed to potentially damaging levels of noise. Levels measured correlate with results from other studies of long-term average speech spectrum and voice level measurements.

A prospective study of ward referrals for renal disease at a Jamaican and a United Kingdom Hospital

Seventy ward referrals for renal disease were prospectively studied at each of two tertiary hospitals: University Hospital of the West Indies (UHWI), Kingston, Jamaica and Nottingham City Hospital (NCH), England. At UHWI, the referral population was significantly younger, 89 percent being less than 60 years of age compared to 40 percent at NCH (p<0.05). The leading cause of acute renal failure (ARF) at UHWI was systemic lupus erythematosus (SLE) followed by acute tubular necrosis (ATN). The leading causes of ARF at NCH were ATN and obstructive uropathy. Primary renal disease and diabetes mellitus were the major causes of end-stage renal disease (ESRD) at both centres, followed by SLE and hypertension at UHWI than at NCH but the numbers were small (p<0.05). Mortality rates were similar among patients with ARF and nephrotic syndrome at both centres, but were higher for patients with chronic renal failure (CRF) at UHWI than at NCH (p<0.05). Continuous ambulatory peritoneal dialysis (CAPD) was a frequent mode of renal replacement therapy at NCH (76 percent v 19 percent on haemodialysis). At UHWI, CAPD was not available and 45 percent of patients with ESRD were not offered maintenance dialysis because of inadequate facilities. The major difference in management and outcome between the two centres occurred in cases with CRF, suggesting that survival in patients with CRF in Jamaica could be improved if this therapeutic modality was available.

Systemic lupus erythematosus, rheumatoid arthritis and HLA phenotypes in Jamaicans

The HLA phenotypes were investigated in 30 Jamaican patients with systemic lupus erythematosus (SLE), 30 with rheumatoid arthritis (RA) an d forty healthy controls. HLA phenotypes were determined by the microcytotoxicity technique, using commercially prepared typing trays. In this study, the HLA phenotypic associations with SLE (HLA-B14, RR 4.3: HLA-A28, RR 4.3) were not statiscally significant. However, a statistically significant lack of HLA-A9 (p<0.01;CP<0.1) was observed in SLE patients compared to healthy controls. In RA patients, a statistically significant associations was noted with HLA-A2 (RR5.1; CP<0.01). No HLA class 11 associations were noted with SLE. Class 11 associations with RA did not achieve statistical significance but included those previously established in other populations. The preliminary data obtained from this study indicate differences in the patterns of HLA phenotypes in Jamaican patients with SLE and RA compared to those observed in such patients elsewhere. Further studies involving larger groups of patients and typing at the serological, cellular and molecular levels are clearly warranted

Thyroid-Gonad relationship in systemic lupus erythematosus

Thirty women with systemic lupus erythematosus (SLE) were examined to assess the thyroid-gonad relationship. Significant decreases in mean serum tri-iodo-thyronine and testerone levels and increases in mean serum estradiol and luteinizing hormone levels were observed in SLE patients as compared to control subjects. The serum levels of thyroxine, thyrotropin, tri-iodo-thyronine uptake, free thyroxine index and prolactin were, however, not significantly different in both groups. The interpretation of these findings is unclear but SLE could be regarded as one of the nonthyroidal systematic illness since low serum tri-iodo-thyrotropin levels were observed in our patients. Furthermore, high levels of estradiol and low levels of testosterone in our female patients may indicate involvement of sex steroids in the pathogenesis of SLE.

Polyarteritis nodosa in jamaicans

This report describes the main features of the 5 cases of polyarteritis nodosa seen at the University Hospital of the West Indies over a 10-year period. The disease manifestations are protean and only 2 of the 5 patients were diagnosed antemortem, indicating the need to increase physician awareness, especially since response to therapy has improved significantly in recent years

Renal pathology in adults over 40 with sickle-cell disease

In a retrospective study of hospital necropsies, we examined the kidneys of 21 patients with homozygous sickle-cell disease who died at the age of 40 or over. Renal failure had caused or contributed to death in ten cases. All kidneys showed changes of papillary damage to a variable extent. In three cases, there was mild cortical irregularity, and in thirteen, there was moderate to severe cortical irregularity, including scarring in some with obvious loss of functioning tissue. Light microscopic examination revealed hypertrophic glomeruli with increased cellularity, lobulation and capilary basement membrane splitting. Glomerulosclerosis was common, and patchy deposits of fibrin were present in glomerular capilaries in complex glomerulonephritis, we suggest that sclerosis consequent upon longstanding hyperfiltration may be more important. Glomerular filtration rate is abnormally high in children with sickle-cell disease but in later childhood renal insufficiency, proteinuria and eventually death from renal failure become common

Diagnóstico preoperatorio con eco bidimensional del canal atrioventricular común: estudio de 19 pacientes operados sin cateterismo previo / Preoperative diagnosis with two-dimensional echocardiography of communis atrioventricular canal study of 19 patients operated without previous catheterization

Se estudiaron 19 pacientes con el diagnóstico de atrioventricularis communis tratados quirúrgicamente. El diagnóstico preoperatorio se basó en los datos clínicos, electrocardiográficos, radiológicos y de ecocardiografía bidimensional. En todos los pacientes se confirmó el diagnóstico de canal AV persistente durante la cirugía. En uno, se halló una coartación aórtica que pasó inadvertida en el estudio ecocardiográfico. Esta serie, aun siendo corta, apoya la idea de que no son indispensables los estudios invasivos para diagnosticar correctamente esta entidad. Sin embargo, los ecocardiogramas bidimensionales deberán incluir un examen cuidadoso del arco aórtico. Se analizan las bases para la selección preoperatoria de estos pacientes sin el empleo de métodos invasivos