Chronic Kidney Disease in the Caribbean Island of Antigua: Causes, Morbidity and Mortality Factors / Enfermedad renal crónica en la isla caribeña de Antigua: causas, morbilidad y factores de mortalidad

ABSTRACT Background: Chronic kidney disease (CKD) and its associated high morbidity and mortality cause a significant economic burden and decreased quality of life in affected patients in Antigua, the rest of the Caribbean and globally. The causes of CKD in Antigua, morbidity and mortality factors affecting the sampled patients were evaluated with a view to formulating interventions to minimize the occurrence and the impact of these factors. Objective: To determine the causes of CKD over a nine-year period and the causes of morbidity and mortality among patients with CKD at the two main hospitals in Antigua. Methods: A retrospective review was done of the medical records of patients with CKD who were diagnosed between January 1, 2005 and December 1, 2013. Chronic kidney disease was defined as a glomerular filtration rate of less than 60 mL/minute/1.73 m2. The causes of CKD, the patients 'admission diagnoses, the causes of death and laboratory investigations were evaluated. Results: The documented causes of CKD in these patients were diabetes mellitus (51% of the patients), hypertension (26%), glomerulonephritis (5%) and lupus nephritis (4%). The causes of morbidity among the patients with CKD were myocardial infarction (5.1%), unstable angina (12.7%) and ischaemic stroke (12%). Contributing significantly to the patients 'morbidity were catheter-associated sepsis (8.1%, p < 0.001) and lower respiratory tract infections (5.4%). The main factors contributing to the patients 'mortality were myocardial infarction (16.7%) and catheter-associated sepsis (16.7%). Conclusion: This study documented that the most common causes of CKD among the sampled patients in Antigua were diabetes mellitus and hypertension. Ischaemic heart disease and infections were the major causes of morbidity and mortality among the patients. Early recognition and aggressive management of CKD and its risk factors and complications are important in reducing the clinical and economic burden associated with CKD.

RESUMEN Antecedentes: La enfermedad renal crónica (ERC) y su alta morbilidad y mortalidad asociadas, son causa de una importante carga económica y disminución de la calidad de vida entre los pacientes afectados en Antigua, el resto del Caribe y en todo el mundo. Se evaluaron las causas de la ERC en Antigua, así como los factores de morbilidad y mortalidad que afectan a los pacientes muestreados, con el fin de formular intervenciones encaminadas a minimizar la ocurrencia y el impacto de estos factores. Objetivo: Determinar las causas de la ERC durante un período de nueve años y las causas de morbilidad y mortalidad entre pacientes con ERC en los dos principales hospitales de Antigua. Métodos: Se realizó una revisión retrospectiva de las historias clínicas de los pacientes con ERC diagnosticados entre el 1 de enero de 2005 y el 1 de diciembre de 2013. La enfermedad renal crónica se definió como una tasa de filtración glomerular inferior a 60 ml/minuto/1.73 m2. Se evaluaron las causas de la ERC, los diagnósticos de admisión de los pacientes, así como las causas de muerte y las investigaciones de laboratorio. Resultados: Las causas documentadas de la ERC en estos pacientes fueron la diabetes mellitus (51% de los pacientes), la hipertensión (26%), la glomerulonefritis (5%), y la nefritis lúpica (4%). Las causas de morbilidad entre los pacientes con ERC fueron el infarto de miocardio (5.1%), la angina inestable (12.7%) y el accidente cerebrovascular isquémico (12%). La sepsis asociada con catéter (8.1%, p < 0.001) y las infecciones de las vías respiratorias inferiores (5.4%) contribuyeron significativamente a la morbilidad de los pacientes. Los principales factores que contribuyeron a la mortalidad de los pacientes fueron el infarto del miocardio (16.7%) y la sepsis asociada con catéter (16.7%). Conclusión: Este estudio documentó que las causas más comunes de ERC entre los pacientes incluidos en la muestra en Antigua fueron la diabetes mellitus y la hipertensión. La enfermedad cardíaca isquémica y las infecciones fueron las principales causas de morbilidad y mortalidad entre los pacientes. El diagnóstico temprano y el tratamiento agresivo de la ERC y sus factores y complicaciones de riesgo, son asuntos de importancia a la hora de reducir la carga clínica y económica asociadas con ERC.

Germline genetic testing to predict drug response and toxicity in oncology--reality or fiction?

In addition to 6-mercaptopurine, 5-fluorouracil and irinotecan, the United States Food and Drug Administration (US FDA) has recently recommended label change for tamoxifen, to include pharmacogenetic information on treatment outcome. With the increasing availability of pharmacogenetic testing, on germline as well as somatic mutations, oncologists are now able to identify individuals at risk of severe treatment toxicity or poor treatment response. However, there are still knowledge gaps to fill before rationalised therapy based on pharmacogenetics can be fully integrated into clinical practice. This review provides an overview on the application of pharmacogenetic testing for germ line mutations in oncology to predict response and toxicity.

Chronic renal failure from the English-speaking Caribbean: 2007 data / Fallo renal crónico en el Caribe anglófono: datos del 2007

AIM: Development of the renal registry to include patients at different stages of chronic kidney disease (CKD). BACKGROUND: The 2007 renal registry include cases at different stages of CKD based on the current guidelines according to the National Kidney Foundation (NKF) Kidney Disease Outcome Initiative (K/DOQI) staging. There was an increase in the number of participating countries, with the addition of Antigua and Barbuda, St Lucia and Turks and Caicos. METHODS: Data were collected using a questionnaire form. Data were stored and analysed in Words Excel for Windows or SPSS 12.0. RESULTS: Data were available for Antigua and Barbuda (n = 43), British Virgin Islands (n = 69), Cayman Islands (n = 45), Trinidad and Tobago (n = 564), Jamaica (n = 920), Turks and Caicos (n = 64), St Lucia (n = 51) and Bahamas (n = 121). The registry identified hypertension, diabetes mellitus and Chronic Glomerulonephritis (CGN) as the commonest causes of chronic kidney disease (CKD) and end-stage renal disease (ESRD) in these countries. The leading cause of death reported was listed as ischaemic heart disease/heart failure, sepsis and cerebrovascular accident. CONCLUSIONS: The majority of patients with CKD and ESRD had hypertension, diabetes mellitus and CGN as the major causes. Collection of data for patients with CKD at different stages was met with some challenges, and resulted in underestimation of the true number of persons with CKD across these Caribbean countries. More emphasis will continue to be placed on improving data collection so the true incidence, prevalence and healthcare burden of CKD is known in the Caribbean. A web based programme is being developed to improve data collection.

OBJETIVO: Desarrollar el registro renal incluyendo pacientes en diferentes etapas de la enfermedad crónica del riñón (ECR). ANTECEDENTES: El registro renal 2007 incluye casos en diferentes etapas de la ECR, sobre la base de los lineamientos actuales de la estadificación según la iniciativa para los resultados de la enfermedad crónica renal (K/DOQI) propuesta por la Fundación Nacional del Riñón (NKF). Hubo un aumento en el número de países participantes, al añadirse Antigua y Barbuda, Santa Lucia e Islas Turcas y Caicos. MÉTODOS: Los datos fueron recogidos utilizando un cuestionario. Luego fueron almacenados y analizados usando Excel para Windows, o mediante SPSS 12.0. RESULTADOS: Hubo a disposición datos para Antigua y Barbuda (n = 43), Islas Vírgenes Británicas (n = 69), Islas Cayman (n = 45), Trinidad y Tobago (n = 564), Jamaica (n = 920), Islas Turcas y Caicos (n = 64), Santa Lucia (n = 51) y Bahamas (n = 121). El registro identificó la hipertensión, la diabetes mellitus y la glomerulonefritis crónica (GNC) como las causas más comunes de la enfermedad crónica del riñón (ECR) y la enfermedad renal terminal (ERT) en estos países. La principal causa de muerte según los reportes, fueron la cardiopatía isquémica/fallo cardíaco, la sepsis y el accidente cardiovascular. CONCLUSIONES: La mayoría de los pacientes con ECR y ERT sufrían de hipertensión, diabetes mellitus y GNC como causas mayores. La recogida de datos para los pacientes con ECR tuvo algunas dificultades, por lo que se subestimó el número real de personas con ECR en todos estos países caribeños. Se seguiría haciendo un mayor énfasis en mejorar la recogida de datos, de modo que la verdadera incidencia, prevalencia y carga de atención a la salud de la ECR sea conocida en el Caribe. Se halla en curso el desarrollo de un programa en la red de Internet, a fin de mejorar la recogida de datos.

A modified thionin acridine-orange stain for mast cells.

For in vitro studies in mesentery, toluidine blue and thionin dyes are generally used. We have tried thionin and acridine orange stains and found it to be good as it showed good colour contrast between mast cells and the background tissue. The two dyes were selected to give good colour contrast.

Development of a distress inventory for cancer: preliminary results.

CONTEXT: Advances in cancer treatment have led to cure and prolongation of patients' lives; however associated psychosocial problems, including distress, can detrimentally affect patients' compliance with treatment and ultimately, their outcome. Symptom distress has been well addressed in many studies; however, psychological distress has only been quantified by using depression or anxiety scales/checklists or quality of life scales containing a distress sub scale/component or by the use of scales that are not psychological distress-specific. AIMS: The present study is an attempt to construct a psychological distress inventory for specific use with cancer patients. SETTINGS AND DESIGN: The standardisation sample consisted of 63 randomly selected patients with head and neck cancer who had undergone/ were undergoing curative treatment at the Regional Cancer Centre, Trivandrum. PATIENTS AND METHODS: The Distress Inventory for Cancer contained 57 positively and negatively toned items. An item analysis was conducted, followed by a factor analysis, thereby identifying the domains influencing distress. RESULTS: The final questionnaire contained 26 items subdivided into four domains viz. the personal, spiritual, physical, and the family domains, with each domain providing a sub score. The reliability coefficient (Cronbach's alpha) of the scale was found to be 0.85. CONCLUSIONS: These are the preliminary results of an ongoing study on global distress and tool development process. Reported here is the first step towards development of such tool.

Dermatoglyphics in 46, XY females.

Dermatoglyphics is known to be one of the best available diagnostic tools in genetic disorders. This paper aims to find out the diagnostic characteristic dermatoglyphic features in cytogenetically confirmed 46, XY female patients. The total number of patients studied (46, XY females) were 31 and the control consisted of 30 males and 30 females. Dermatoglyphic features, studied and tabulated, were: (a) Finger pattern frequency, (b) total finger ridge count (TFRC), absolute finger ridge count (AFRC), a-b ridge count, 'atd' angle and (c) palmar patterns eg, simian crease, Sydney line, hypothenar pattern, interdigital patterns. Results confirmed significant differences between the 46, XY females and the control groups: (i) 46, XY females had increased ulnar loops but decreased whorls as compared to control males (overall finger pattern frequency). (ii) The right thumb in 46, XY females had less whorls and more ulnar loops than both male and female control groups (individual finger pattern frequency). (iii) 46, XY females had lowered TFRC, AFRC, a-b ridge count than corresponding control groups (both control males and females). Significant differences were not observed for the 'atd' angle, interdigital patterns, hypothenar pattern, simian crease and Sydney line.

An unusual case of haemophilia--a case report.

Haemophilia in a female is very rare. We report a case of haemophilia in a female with a male sex chromosome pattern.

Structural chromosomal anomaly in mental retardation.

This article reports the structural chromosomal anomaly in three patients with mental retardation: (i) Proband was a five year old girl with reciprocal retardation (1; 2) (p32; q11) (ii) Proband, female of 14 years. Her karyotype showed translocation (1; 3) (q42; q13). The translocations were de novo in origin (iii) Proband showed variant 13 as the giant satellite over its short arm, and this was paternal in origin. Proband, eighteen months old male child had microcephaly and seizures. These two features may be because of autosomal recessive condition. This report emphasises the need for kayotyping to provide a clear cut diagnosis and appropriate counselling.

Partial 1q and 21p trisomies in a male child due to maternal t(1;21).

Proband 7 years old male child referred for cytogenetic investigation revealed 47, XY + der (21), t(1;21) (q32;q11) mat.

Primary amenorrhea with Xq duplication.

Two female patients aged 16 and 17 years with Turner features short stature, amenorrhea and gonadal dysgenesis were referred for cytogenetic confirmation and counselling. Their karyotypes were 46, X, dup (X) (q13-->q22). The clinical and the cytogenetic picture have been correlated.

Spontaneous Expression Of Fragile Site at Xq27.3 In a Fragile X patient.

Fragile site at Xq27.3 is classified as a rare fragile site which is observed only under conditions of folate depletion Here we report a case where fragile site at Xq27.3 was detected in normal RPMI 1640 medium without induction, in the lymphocytes of a patient clinically diagnosed as fragile X patient. At the molecular level both an expansion and methylation of (CGG)n repeat at FMRI was detected.

Consanguinity, non-disjunction, parental age and Down's syndrome.

The effect of consanguinity on the non-disjunction mechanism in Down's syndrome, was examined in 417 cytogenetically confirmed Down's syndrome patients. The incidence of parental and grandparental consanguinity was 17.5% (n = 73), while that of only parental consanguinity was 17.2% (n = 71). First cousin marriages occurred more frequently, than uncle-niece and 2nd cousin marriages. With regard to parental age, only the mean age difference between consanguineous couples significantly differed from non-consanguineous couples. The inbreeding coefficient did not differ between trisomy 21 and translocation Down's families. From this study, it is concluded that consanguinity does not predispose to Down's syndrome.

A simple device for embalming cadavers.

A simple design of a mobile embalming unit is presented that offers better quality embalming and is fairly economical. The technique is faster and consistently more reliable than the conventional gravity aided embalming.

Down syndrome associated malformations.

This paper reports the associated malformations and the clinical findings that were observed in 417 cytogenetically confirmed Down Syndrome patients. Among them congenital heart defects have occurred more frequently [75; 17.98%] than osteoarticular malformations [23; 5.52]; eye anomalies [22; 5.27%]; and gastroenterological malformations [n 16; 3.84%]. With regard to prognosis and treatment appropriate counselling has been given to Down Syndrome patients and their families.

Finger ridge count and finger print pattern in maturity onset diabetes mellitus.

Total finger ridge count, absolute finger ridge count and finger print pattern were studied in 150 maturity onset diabetes mellitus patients and compared to 120 controls. Significant findings were: in males, with both hands combined and separately (i) an increase in radial and ulnar loops and arches (ii) A decrease in whorls. (iii) In females, an increase in ulnar loops and a decrease in whorls in the left hand was observed.