Inactivation of strongyloides stercoralis filariform larvae in vitro by six Jamaican plant extracts and three commercial antihelmintics

In vitro bioassay of (a) aqueous methanol extracts (AME) of the green leaves of mimosa (Mimosa pudica), love weed (Cuscuta americana), vervine (Stachytarpheta jamaicensis), chicken weed (Salvia serotina) and breadfruit (Artocarpus altilis); (b) methanol-water fraction (MWF) of breadfruit leaves, and (c) commercially available drugs albendazole, thiabendazole and levamisole were assayed for nematode inactivating potential, using filariform larvae of Strongyloides stercoralis. Test larvae were obtained from a 10-day-old charcoal coproculture. Bioassays were conducted in Locke's solution, using 100 larvae in each of three replicates. Inactivation was recorded microscopically at 1, 2, 6 and 12 hours, then every 24 hours up to 5 days' incubation. It(50) (time for inactivation of 50%of larvae) values read: levamisole and mimosa extract < 1 hour; love weed extract, approximately 2 hours; breadfruit (MWF), 9.5 hours; chicken weed, 20 hours; albendazole, 35 hours; breadfruit (AME), 49 hours; thiabendazole, 74 hours and vervine extract, 81.5 hours. It(95) values followed a similar trend, and were approximately double the It(50) measures. A potential role for locally available natural products in the treatment of strongyloidiasis is highlighted

Colonoscopy in Jamaica: a 12 year experience

Four hundred and nine colonoscopic examinations were performed in 335 patients over a 12-year period in Jamaica. The indications were suspected polyps (34%), rectal bleeding (22%), and suspected carcinoma (11%). Total colonoscopy was performed in 33% of cases. The ascending colon and hepatic flexure were examined in a further 25%, and the transverse colon in another 21%. Endoscopic examination of the suspected abnormal area was possible in all cases. In 142 examinations, no abnormality was detected, reflecting a false positive Barium enema in som. Polyps were found in 135 examinations, diverticula in 69 and carcinoma in 13. There were complications. Colonoscopy was more sensitive and specific than Barium enema. The Barium enema findings were incorrect in 91 of 224 examinations (41%). Colonoscopy is a safe and accurate procedure which enables improved patient management

Success of didactic gastroenterology teaching for postgraduate medical residents

Although the Doctor of Medicine programme in Internal Medicine at the U. W. I. is a structured course with several teaching formats, the optimally effective form of reaching remains unknown. An experimental didactic teaching course in Gastroenterology was preceded and followed by an examination. This was conducted to determine the effectiveness of this form of teaching. The maajority of residents ranked the course favourably. the mean examination score increased by 6.4%, form 25.4% before the course to 31.8% at the end. Although the more senior residents scored higher than their juniors in the pre-test, this difference disappeared in the post-test. Structured didactic teaching requirs close supervision, active participation by trainee and reinforcement for the full benefit to be attained

Endoscopic sclerotherapy of bleeding oesophageal varices in Jamaica

The results of oesophageal sclerotherapy (OS) in 18 patients with recurrent bleeding varices are compared with 15 patients treated medically. The total transfusion requirement pre sclerotherapy was 112 units of blood (mean 6/patient) which decreased to 46 units ( mean 2.5) after sclerotherapy treatment was started (p=0.005). In the medically treated group, total transfusion was 74 units (mean 5 units/patient). One hundred and forty-three infection sclerotherapy session were given, and all but one patient had significant reduction or eradication of varices. Three patients died of recurrent bleeding (17%) and one other required surgery. In the medically treated group, 3 patients died of bleeding (20%). Complications of sclerotherapy included mild bleeding (39%), chest pain (28%) and oesophageal ulcer (5.5%). OS reduces transfusion requirements in patients with recurrent variceal bleeding

Crohn's disease in Jamaica

Twenty patients with Crohn's disease seen in Jamaica over the past 20 years are reviewed. There were 14 women and 6 men. The mean age at presentation was 37m years, and symptoms were present for a mean of 12 months. Fourteen patients presented with lower abdominal pain, and diarrhoea was present in 11. Lower gastrointestinal bleeding was the presenting feature in 2. The distribution of disease was ileal in 6, and 8 had primary colonic involvement. Three patients had ileocolitis and one perianal disease. One had involvement of the entire small intestine and ascending colon and another had skip lesions involving several areas of the small intestine. Surgical resection was performed in 5 patients. Of the 15 patients treated medically, 6 have remained well while 8 had recurrent episodes of relapse. Crohn's disease in an uncommon disorder in Jamaica but should be considered in patients presenting with inflammatory bowel disease