Lead pollution and amelioration measures in the community of Frazers Content, St Catherine, Jamaica

Lead poisoning, especially in children, is a preventable disease. Many children are exposed to this hazard, especially in poor communities, because of a paucity of information on lead poisoning and increasing economic hardships. In 1994, the case of the poor suburban community of Frazers Content, St Catherine, Jamaica, came to the public attention because of the high frequency of hospital admissions, or outpatient treatment, of children for lead poisoning. This paper reviews a Blue Cross of Jamaica-led-initiative aimed at the clean up and education of the Frazers Content community. The following four-pronged approach was employed: environmental and biological sampling and sample analysis, health education, decontamination and community clean up and entrepreneurial activities. The project outputs included: training of 17 community wardens and 22 schoolteachers; the clean up of 64 residences which had lead levels in excess of 500 ppm; the establishment of an entombment site for the contaminated soil in accordance with the Jamaica Natural Resources Conservation Authority and training of residents in entrepreneurial skills, chicken and rabbit rearing and nursery establishment. The paper includes discussion of the lessons learnt and recommendations for future action.

Jamaican patients' understanding of diabetes mellitus

Ambulant and hospitalized patients with diabetes mellitus were interviewed by two trained interviewers to obtain information about their knowledge of the illness and the communication they had received about it. Sixty to seventy per cent of patients claimed that no explanation about the illness was given to them at the time of diagnosis. This poor communication occurred in both public and private medical services. Fifty-seven per cent of the patients' knowledge of the illness was in general poor. The hospitalized patients did learn about the illness while there, but still claimed that they learnt nothing. These data are examined in the context of the nature of the doctor-patient communication style and effect. Jamaican diabetic patients need to be better informed about their illness; despite short patient-physician contact time, an effort to explain the nature of the illness at the time of diagnosis would be worthwhile. This will need subsequent assessment and reinforcement by involving a team approach.

Insulin receptor studies of erythrocytes and mononuclear leucocytes in phasic insulin diabetes mellitus

This study was designed to investigate any diferences in cellular binding of insulin between phasic insulin-dependent (malnutrition-related) diabetes mellitus (PIDDM) and insulin-dependent, non-insulin-dependent, and normal controls. Isolated, washed red and white blood cells obtained after 12 - 14hr fast, were separately incubated with varying concentrations of non-radioactive insulin, and a fixed quantity of radioactively labellede insulin. After the 3hr incubation, cells were washed with buffer, and radioactivity determined on an autogamma counter. Percentage binding, receptor sites number and affinity were all determined by linear regression of the Scathard plot. Fasting plasma insulin and glucose levels were were also assayed. The results obtained showed decreased binding of insulin in red blood cells (11.3+or -1.3%) and white blood cells 2.9 + or -o.5%) in PIDDM. This was due to decreased receptor sites (red blood cells 39+ or -11; white blood cells 0.5+ or -0.11x 10 to the 4th) as well as decreased affinity (red blood cells 0.14+ or -0.03 x 10 to the 9th M-1; white blood cells 0.17 + or -0.04 x10 to the 9th M-1) when compared to the normal and diabetic (both insulin and non-insulin-dependent) controls. Phasic insulin-dependent diabetes (malnutition-related diabetes mellitus) is characterized by decreased red and white cellular binding to insiulin, in addition to decreased production of insulin

The Mauriac syndrome

An insulin-dependent diabetic was diagnosed at the age of 7 years. After two years of satisfactory control she began to have several bouts of hospitalization with hyperglycaemic ketoacidosis, and developed tender hepatomegaly, which persisted to age 11 years. With restabilisation of her diabetes, the liver regressed and she continued to maintain good health for another 1 1/2 years when she died suddenly while asleep. Post-mortem examination by the coroner revealed ascites in the abdomen, hepatomegaly and fatty metamorphosis of the liver. Her diabetes control required up to 2.3 i. u. insulin per Kg body weight per day plus a 1,900 calorie diet. Her growth was well below the tenth percentile, weight for height (Harvard charts). This clinical picture of high insulin dosage, hepatomegaly, unstable diabets and growth failure approximates to the Mauriac syndrome

Renal subcapsular islet cell transplantation in the dog: a preliminary report

During the last two decades, islet cell transplantation has been pursued both experimentally and clinically in an effort to ameliorate diabetes mellitus. At present, however, islet cell transplantation still remains at the experimental stages as far as the treatment of diabetes is concerned. Also, culture of islet cells has proved to be rather frustrating and difficult. No consistent techniques have been developed, and simplified methods for islet cell preparation and adequate sites for islet cell placement would allow for further progress in this area. Ultimately, rejection remains the greatest obstacle to success. We report a simplified technique for enriching dog pancreatic islet cells. This preparation was injected into the renal subcapsular space in both homograft (3 experiments) and heterograft (3 experiments) situations. After six weeks, nephrectomy was performed, and histochemical techniques demonstrated many groups of live islets in between the tubules in the renal cortex. No acinar cells were observed. Blood samples from the renal artery and renal vein at the time of nephrectomy revealed an average 36.9% increase in insulin concentraction on the renal veins, supporting an active secretory role of these transplanted islet cells. This technique points to (i) the possible role of a "renal factor" in promoting growth of islet cells and (ii) the feasibility of successful transplantarion of enriched islet cells as a potential approach to the curative treatment of diabetes mellitus

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

Em-plaque subdural sarcoidosis: a rare neurological entity

En-plaque subbdural sarcoidosis is reported in a 74-year-old black woman. The diagnosis was mad at autopsy. The patient also had adenocarcinoma of the sigmoid colon with liver metastases. Subdural sarcoidosis is very rare in that only four cases have been previously reported, all of which were diagnosed clinically and treated

Toxicity of the hyperglycaemic-inducing extract of the Annatto (Bixa orellana) in the dog

The Annatto seed coat extract, which is commonly used in folklore in treating diabetes mellitus, has been investigated for its effects on blood sugar levels in the dog. An alkali-soluble hyperglycaemia-inducing fraction was detected, and detailed studies revealed toxic effects in the pancreas and liver accompanied by hyperglycaemia and apparent tendency to increased insulin levels. The toxicity was diminished by feeding riboflavin. The relevance of this finding points to a possible aetiological role in the development of amlnutrition-related diabetes mellitus and also to the potential toxicity inherent in the widespread use of folklore medicines