Immunological evidence supporting the use of extracts from Boehmeria jamaicensis Urb for treating the common cold and sinus infections

Mixed lymphocyte responses assays were conducted at 25.0 and 250.0 microg/mL of the crude ethanolic extract of Boehmeria jamaicensis Urb (coded as BJE) using peripheral lymphocytes obtained from individuals suffering from the common cold after four days of infection and from healthy individuals (without the common cold infection). At a concentration of 25 ug/mL, gamma interferon (IFN-gamma) was increased by 24.03 fold and interleukin 4 (IL-4) by 1.71 fold for the cells obtained from individuals with the common cold (Group A). The extract suppressed IFN-gamma by 8.3% while IL-4 was stimulated by 9.90 fold from peripheral lymphocytes obtained from healthy individuals (Group B). Gamma interferon was suppressed at 250 microg/mL while IL-4 was elevated by 1.86 fold for cells obtained from individuals suffering from the common cold (Group A). In conclusion, BJE could have implications for the treatment of the common cold.

Ensayos de reacci¨®n linfocitaria mixta fueron realizados a 25.0 y 250.0 ¦Ìg/mL de extracto etan¨®lico crudo de Boehmeria jamaicensis Urb (codificado como BJE), usando linfocitos perif¨¦ricos obtenidos de individuos con catarro com¨²n luego de cuatro d¨ªas de infecci¨®n, y de individuos sanos (sin la infecci¨®n del catarro com¨²n). Se hall¨® que el interfer¨®n-gamma (IFN-¦Ã) aument¨® en 24.03 veces, y la interleucina 4 (IL-4) en 1.71 veces para las c¨¦lulas obtenidas de individuos con catarro com¨²n, a 25¦Ìg/mL. El extracto inhibi¨® IFN-¦Ã en un 8.3 % en tanto que el IL-4 fue estimulado en 9.90 veces a partirde los linfocitos perif¨¦ricos obtenidos de individuos sanos. El gamma-interfer¨®n fue inhibido a 250 ¦Ìg/mL, mientras que la IL-4 se elev¨® en 1.86 veces para las c¨¦lulas obtenidas de individuos que sufren de catarro com¨²n.

Report from the Caribbean renal registry, 2006

AIM: To develop a renal registry that will monitor renal epidemiology in the Caribbean and help determine the burden of disease. METHODS: Questionnaires were sent out to different Caribbean countries for distribution to the dialysis units. Data were obtained for patients with End Stage Renal Disease (ESRD) who were on long term renal replacement therapy in 2006. The demographic data, type of renal replacement therapy, laboratory data and causes of ESRD were obtained from the questionnaire. Data were analyzed using SPSS 11.0 RESULTS: Data were reported from six English-speaking Caribbean countries: Bahamas (n = 211), Barbados (n = 185), British Virgin Islands (n = 27), Cayman Islands (n = 41), Jamaica (n = 366) and Trinidad and Tobago (n = 436). Haemodialysis was reported in all the countries; transplantation was not reported from the Cayman Islands. Only Bahamas, Jamaica and Trinidad and Tobago reported peritoneal dialysis. In Jamaica, male to female ratio was 1.5:1. The three commonest causes of end stage renal failure were hypertension (65.5%), diabetes mellitus (27.6%) and primary chronic glomerulonephritis (12.5%). The age range was 11-94 years (mean 47.7 years). Barbados had a male to female ratio of 1.8:1, age range of 19-81 years (mean age: 52.3 years). Hypertension (55.7%) and diabetes mellitus (27.0%) were the commonest causes. Trinidad and Tobago had a male to female ratio 1.3:1. The age range was 8-84 years (mean age 52.5 years). The four commonest causes of ESRD were diabetes nAellitus (28.9%), hypertension (25.3%) and autosomal dominant polycystic kidney disease (3.9%) and chronic glomerulonephritis (3.9%). The British Virgin Islands, Tortola, had a male to female ratio 1.7:1.0. Age range was 26-86 years (mean, 57 years). Hypertension (67.9%) and diabetes mellitus (46.4%) were also the commonest causes. The Bahamas had a male to female ratio of 1:1.1 unlike the other countries. Hypertension (25.6%), diabetes mellitus (28.0%) and chronic...

Acute renal failure post coronary artery bypass grafting at the University Hospital of the West Indies / Fallo renal agudo tras injerto bypass de la arteria coronaria en el hospital universitario de west indies

OBJECTIVES: The purpose of the study was to determine the period prevalence of acute renal failure (ARF) after coronary bypass surgery (CABG) at the University Hospital of the West Indies and to identify risk factors. METHOD: A retrospective analysis of patients who underwent CABG during the period 1994-2004 was done. Data collected included; age, gender, weight, the presence of hypertension (HTN), diabetes mellitus (DM), hypercholesterolaemia, previous myocardial infarction (MI), blood pressure on admission, urea and creatinine one year prior to surgery, on admission for surgery and post-surgery, duration of intra-operative hypotension, duration of cardiopulmonary bypass, perfusion pressure and the perioperative medications. RESULTS: The case notes of 62 patients (68.9%) were obtained for analysis. There were 47 (75.8%) males and 15 females (24.2%)--a 3:1 ratio. The prevalence of HTN and DM in the study sample was 78% and 72% respectively, hypercholesterolaemia was 31% and a previous MI was 29%. There were no differences based on gender. Post CABG complications were: persistent postoperative hypotension (6.8%), congestive cardiac failure (CCF) (6.8%), arrhythmia (6.8%), sepsis (6.8%), lower respiratory tract infection (LRTI) and pleural effusion (5.1%), heart block (3.4%), pulmonary embolism (1.7%), cellulitis and haematoma formation were 1.7%. Three patients had increases in postoperative creatinine values > 89 micromol/L over the postoperative value resulting in a prevalence of ARF of 5%. One of the three patients died and none received dialysis. There were no statistical difference in pre-operative clinical and biochemical characteristics based on the presence or absence of ARE. The presence of diabetes and increased length of stay were significant predictors of increasing postoperative creatinine values adjusting for pre-operative creatinine values. In addition, the presence of diabetes mellitus and...

Cardiac disease in dialysis patients in a Jamaican hospital: echocardiographic findings that predict mortality / La enfermedad cardíaca en los pacientes de diálisis en un hospital de Jamaica: hallazgos ecocardiográficos que predicen la mortalidad

The aim of the study was to assess, by echocardiography, the cardiac abnormalities in a group of patients with chronic renal failure and to determine the cardiovascular predictors of mortality. The study comprised forty-five patients from the Renal Unit, University Hospital of the West Indies, Kingston, Jamaica, and was undertaken between October 1, 1998 and July 31, 2000. All echocardiography was done by a single operator. The parameters assessed were systolic dysfunction, diastolic dysfunction, ejection fraction, regional wall motion abnormalities and valvular disease. Left ventricular cavity size, septal and posterior wall thickness were measured and left ventricular mass calculated. Demographic data were obtained directly from each patient by interview. The patients were mainly of African/mixed-African origin. Their mean age was 43.2 +/- 16.0 years. The average body mass index was 23.7 +/- 6.9. Twenty-eight (60.9%) patients were male and seventeen (39.1%) female. Hypertension, chronic glomerulonephritis and diabetes mellitus were the leading causes of chronic renal failure. Blood pressure was controlled at a mean value of 145/90 mm Hg pre-dialysis and 140/90 mm Hg postdialysis. The mean duration of renal failure was 2.8 years. Echocardiographic M-mode and two dimensional apical, four chamber view measurements indicated that mean left ventricular internal diameter (LVID) diastole was 55.7 +/- 7.9 mm (normal 38-56 mm) and LVID systole was 38.9 +/- 9.8 mm (normal 24-45 mm); the mean thickness of the chamber walls was 10.3 +/- 2.8 mm and 10.6 +/- 2.4 mm for the interventricular septum (normal 6-11 mm) and left ventricular posterior wall (normal 6-11 mm) respectively. Diastolic dysfunction was seen in 15 (34%) patients and systolic dysfunction in 12 (23%) patients who had ejection fractions less than 50%. The mean left ventricular ejection fraction was 56.3% +/- 16% (normal 65-85%), mean stroke volume was 82.9 +/- 27.2 mls (normal 51-96 ml). After 21 months enrolment in the study, Kaplan Meier analysis revealed a two-year mortality of 28.3%. Cox regression analysis indicated that a history of smoking current or past, low haemoglobin level, high aorta flow velocities, severity of mitral regurgitation and a negative association with serum creatinine were independent predictors of mortality. The correction of anaemia and control of other factors that impact negatively on cardiac function in dialysis patients is vital to enhance survival.

The mean levels of adherence and factors contributing to non-adherence in patients on highly active antiretroviral therapy / Niveles medios de adhesión y factores que contribuyen a la no adhesión en pacientes bajo terapia antiretroviral altamente activa

OBJECTIVE: To determine the mean level of adherence and factors contributing to non-adherence in patients on Highly Active Antiretroviral Therapy (HAART). METHODS: An observational study was done on 101 HIV/AIDS patients attending the Centre for HIV/ AIDS Research, Education and Services (CHARES) - University Hospital of the West Indies, between May 2006 and August 2006. A questionnaire was administered asking questions re: prescribed and actual dosing frequency and number of antiretroviral tablets for the previous week, reasons for nonadherence, duration of Highly Active Antiretroviral Therapy, age, employment status and level of education. Mean levels of adherence were calculated using self and social worker/nurse reported dosing frequency and number of tablets. Good adherence was defined as 95% or greater. Multiple regression analysis was used to determine factors impacting on adherence. RESULTS: Ninety-six patients were included for final analysis. Mean levels of adherence were as follows: 87.66%--self-report for tablets; 88.70%--self-report for dosing frequency; 87.02%--social worker/ nurse report for tablets; 88.10%--social worker/nurse report for dosing frequency. There were significant positive correlations between self and social worker/nurse reports using dosing frequency (Spearman Rho correlation coefficient 0.943, p = 0.01) or number of tablets (Spearman Rho correlation coefficient 0.955, p = 0.01). Adherence to self-reported number of tablets and dosing frequency were 58.4% and 56.4% respectively. Duration of HAART was found to have a significant negative correlation with the level of self-reported adherence to tablets (p = 0.002). CONCLUSION: Adherence to HAART is sub-optimum in patients at the CHARES. This must be urgently addressed to prevent the development of resistant HIV strains and treatment failure.

Objetivo: Determinar el nivel medio de adhesión y los factores que contribuyen a la no adhesión en pacientes bajo terapia antiretroviral altamente activa (TARAA). Métodos: Se realizó un estudio observacional a 101 pacientes con VIH/SIDA, que asistían al Centro de Investigación, Educación y Servicios de VIH/SIDA (CHARES), del Hospital Universitario de West Indies, entre mayo del 2006 y agosto del 2006. Se administró una encuesta con preguntas sobre la frecuencia de la dosificación prescrita y real y el número de tabletas antiretrovirales para las razones de la semana previa para la duración de la no adhesión al TARAA, la edad, el estatus de empleo y el nivel de educación. Los niveles medios de adhesión fueron calculados usando frecuencias de dosificación auto-reportadas, o reportadas por enfermeras o trabajadoras sociales, y el número de tabletas. Una adhesión era definida como buena si alcanzaba el 95% o más. Para determinar los factores que tienen un impacto sobre la adhesión se recurrió al análisis de regresión múltiple. Resultados: Noventa y seis pacientes fueron incluidos en el análisis final. Los niveles medios de adhesión fueron los siguientes: 87.66% ­ auto-reportes de tabletas; 88.70% ­ auto-reportes de frecuen-cia de dosificación; 87.02% reportes de tabletas por enfermeras o trabajadoras sociales; 88.10% reportes de frecuencia de dosificación por parte de enfermeras o trabajadoras sociales. Hubo correlaciones positivas significativas entre los auto-reportes y los reportes de las enfermeras y traba-jadoras sociales que usaron frecuencia de dosificación (coeficiente de correlación rho de Spearman 0.943, p = 0.01) o número de tabletas (coeficiente de correlación rho de Spearman 0.955, p = 0.01). Según los autoreportes, la adhesión al número de tabletas y a la frecuencia de dosificación fueron 58.4% y 56.4% respectivamente. Se halló que la duración del TARAA tiene una correlación negativa significativa con el nivel auto-reportado de adhesión a las tabletas (p = 0.002). Conclusión: La adhesión a la Terapia Antiretroviral Altamente Activa es sub-óptima en los pacientes del Centro CHARES. Esto es algo que requiere atención urgente si se quiere prevenir el desarrollo de cepas resistentes de VIH y el fracaso del tratamiento

Antinuclear antibodies and HLA class II alleles in Jamaican patients with systemic lupus erythematosus / Anticuerpos antinucleares y aleles HLA de clase II en pacientes Jamaicanos con lupus eritematoso sistémico

OBJECTIVE: The relationship between human leukocyte antigens class II (HLA) and antinuclear antibodies was investigated in Jamaican patients with Systemic Lupus Erythematosus (SLE). METHODS: Samples of blood of 82 patients with SLE and 75 healthy controls were tested for antinuclear antibodies using the fluorescent antinuclear antibody (FANA) test, counterimmunoelectrophoresis (CIEP) and the Crithidia luciliae immunofluorescence test (CL-IFT). A DNA-based HLA typing method was used to determine the frequencies of alleles of HLA-DRB1, DRB3, DRB4 and DRB5 in patients and healthy controls. RESULTS: The FANA test was positive in all of the sera from patients with SLE. Anti-dsDNA antibodies were present in 49% (40/82), anti-Sm/RNP 44% (36/82) and anti-Ro/La 43% (35/82) of the sera from SLE patients. The frequency of HLA-DR4 was significantly lower in SLE patients than in healthy controls (2/82, 2% vs 15/75, 20%; RR = 0.12; p = 0.0004; CP = 0.005) but no other HLA-DRB1 SLE associations were found. A positive HLA-DR3 anti-Ro/La antibody association was found in the patients with SLE (9/21, 43% vs 5/55, 9%; odds ratio (OR) = 7.5; CP = 0.01). In contrast, possession of HLA-DR6 was negatively associated with the absence of anti-dsDNA antibodies (9/32, 28% vs 27/44, 61%; OR = 0.2; CP = 0.05). CONCLUSION: The HLA-DR6 allele is associated with the absence of antinuclear antibodies and HLA-DR3 with the presence of anti-Ro/La antibodies in Jamaican patients with SLE. However, these results and those of previous studies of Jamaican patients suggest that the HLA-DR3 association with the development of SLE reported in other populations might in fact reflect the association of HLA-DR3 with anti-Ro/La antibodies. Further investigations are needed to determine whether HLA-DRB antinuclear antibody associations define clinical subsets of SLE in Jamaican patients.

OBJETIVO Se investigó la relación entre los antígenos de leucocito humano (human leukocyte antigens o HLAs). Clase II y los anticuerpos antinucleares en pacientes jamaicanos con lupus eritematoso sistémico (LES). MÉTODOS: Se examinaron muestras de sangre de 82 pacientes con LES y 75 controles saludables para determinar la presencia de anticuerpos antinucleares, usando la prueba del anticuerpo antinuclear fluorescente (FANA), la contrainmunoelectroforesis (CIEP) y el test de inmunofluorescencia con Crithidia luciliae (CL-IFT). Un método de tipificación HLA basado en el ADN fue usado para determinar las frecuencias de aleles de HLA-DRB1, DRB3, DRB4 y DRB5 tanto en los pacientes como en los controles saludables. RESULTADOS: La prueba FANA fue positiva en todos los sueros de pacientes con LES. Anticuerpos anti-dsADN se hallaban presentes en 49% (40/82), anti-Sm/RNP en 44% (36/82) y anti-Ro/La en 43% (35/82) de los sueros de los pacientes de LES. La frecuencia de HLA-DR4 fue significativamente más baja en los pacientes con LES que en los controles saludables (2/82, 2% vs 15/75, 20%; RR = 0.12; p = 0.0004; CP = 0.005) pero no se hallaron otras asociaciones de LES con HLA-DRB1. Se halló una asociación positiva de anticuerpos HLA-DR3 anti-Ro/La en los pacientes con LES (9/21, 43% vs 5/55, 9%; odds ratio (OR) = 7.5; CP = 0.01). En contraste con ello, la posesión de HLA-DR6m estuvo asociada negativamente con la ausencia de anticuerpos anti-dsADN (9/32, 28% vs 27/44, 61%; OR = 0.2; CP = 0.05). CONCLUSIÓN: El alele HLA-DR6 está asociado con la ausencia de anticuerpos antinucleares y el de HLA-DR3 con la presencia de anticuerpos anti-Ro/La en pacientes jamaicanos con LES. Sin embargo, estos resultados al igual que los de los previos estudios de pacientes jamaicanos, sugieren que la asociación HLA-DR3 con el desarrollo de LES reportado en otras poblaciones podría de hecho reflejar la asociación de HLA-DR3 con anticuerpos anti-Ro/La. Se requieren investigaciones ulteriores a fin de determinar si las asociaciones de anticuerpo antinuclear HLA-DRB definen subconjuntos de LES en pacientes jamaicanos.

A critical review of the therapeutic potential of dibenzyl trisulphide isolated from Petiveria alliacea L (guinea hen weed, anamu) / Un estudio crítico del potencial terapéutico del trisulfuro de dibencilo aislado a partir de petiveria alliacea l (yerba de guinea, anamú)

The data compiled in the present review on dibenzyl trisulphide (DTS) isolated from Petiveria alliacea L (the guinea hen weed or anamu) revealed that the compound and its derivatives could be of tremendous pharmaceutical interest. The mode of action elucidated for DTS revealed that it is a mitogen activated protein extracellular regulated kinases 1 and 2 (MAPKinases erk1 and erk 2) signal transduction molecule. Dibenzyl trisulphide caused hyper-phosphorylation of growth factor induced MAPKinases (erk 1 and erk 2) phosphorylation, a process critical for the improvement of long term memory, and is implicated in neuronal growth. Dibenzyl trisulphide and its derivatives exhibited potent anti-proliferation/cytotoxic activity on a wide range of cancer cell lines. The cytotoxic activity of DTS was increased by 70-1000 fold when bound to albumin in vitro. Dibenzyl trisulphide seems to have a cytokine switching mechanism in which it down regulates cytokines from the Type I helper cells (Th -1 cell) pathway which contained several pro-inflammatory cytokines and up-regulates those on the Type 2 helper cells (Th-2) pathway. The trisulphide up-regulates some reticuloendothelial system parameters eg granulocyte counts and increased thymic and Peyer's patches masses via cell proliferation processes which are known to be regulated via the MAPKinase signal transduction pathway. When the zygotes ofAsternia pectinifera (Starfish) were exposed to DTS at concentration of 10 mM, a dose lethal to all cancer cells tested, it was observed that the sensitive process of protein biosynthesis was not affected Similarly, the proliferation of the HOFA human fibroblast, a noncancerous cell line, was not severely affected by DTS at 8.9 microM over seven days, a concentration also lethal to most cancer cell lines tested The implications of the findings will be highlighted in the present review.

Los datos compilados en el presente estudio sobre el trisulfuro de dibencilo (TSD) aislado a partir de Petiveria alliacea L (yerba de Guinea, ó anamú) revelaron que el compuesto y sus derivados podrían tener extraordinario interés farmacéutico. El modo de acción esclarecido en el TSD, reveló que se trata de una molécula de transducción de señales de proteínas kinasas 1 y 2 (MAP quinasas ERk 1 y 2) reguladas extracelularmente y activadas por mitógenos. El trisulfuro de dibencilo causó hiperfosforilación de la fosforilación de las quinasas MAP (Erk 1 y 2) inducidas mediante factor de crecimiento, un proceso crítico para el mejoramiento de la memoria a largo plazo, y que está implicado en el crecimiento neuronal. El trisulfuro de dibencilo y sus derivados mostraron una poderosa actividad citotóxica y antiproliferativa en una amplia gama de líneas celulares de cáncer. La actividad citotóxica del TSD se incrementaba de 70 á 1000 veces, cuando se vinculaba a la albúmin in vitro. El trisulfuro de dibencilo parece poseer un mecanismo conmutador citoquínico que regula por decremento las citoquinas provenientes de la vía de las células auxiliares de tipo 1 (células Th-1), que contiene varias citoquinas pro-inflamatorias y regula por incremento las de la vía de las células auxiliares de tipo 2 (Th-2). El trisulfuro regula por incremento los parámetros del sistema reticuloendotelial, p.ej. los conteos de granulocitos y el aumento tanto de las masas tímicas como de las masas de placas de Peyer, a través de los procesos de proliferación celular, de los cuales se sabe que son regulados mediante la vía de la transducción de señales de la quinasa MAP. Cuando los cigotos de Asternia pectinifera (estrella de mar) fueron expuestos al TSD a una concentración de 10 mM ­ una dosis letal para todas las células cancerosas sometidas a prueba ­ se observó que el proceso sensible de biosíntesis de la proteína no era afectado. De modo similar, la proliferación del fibroblasto humano HOFA ­ una línea celular no cancerosa ­ no fue afectada severamente por el TSD a 8.9 µM en siete días ­ una concentración letal para la mayoría de las líneas celulares cancerosas sometidas a prueba. Las implicaciones de los hallazgos se pondrán de relieve en el presente estudio

In vitro anti-proliferation/cytotoxic activity of epingaione and its derivatives on the human SH-SY5Y neuroblastoma and TE-671 sarcoma cells / Actividad citotóxica antiproliferativa in vitro de la epingaiona y sus derivados, sobre el neuroblastoma humano sh-sy5y y las células del sarcoma te-671

Epingaione (4-Methyl-1-(5-methyl-2, 3,4,5-tetrahydro-[2,3']bifuranyl-5-yl)-pentan-2-one) was isolated as one of the major lipophilic secondary metabolites from the leaves and stems of Bontia daphnoides L. The compound gave 79.24and 50.83anti-proliferation/cytotoxic activity on the human SH-SY5Y neuroblastoma and TE-671 sarcoma cells in vitro at 50 pg/mL, respectively. Epingaione was transformed into eleven derivatives under laboratory conditions using ethanol, some gave greater anti-proliferation/cytotoxic activity on the cancer cell lines tested. One of the derivatives (compound 2) with enhanced cytotoxic activity was elucidated as 5'-Ethoxy-5-methyl-5-(4-methyl-2-oxo-pentyl)-2,3,4,5-tetrahydro-5'H-[2,3']bifuranyl-2'-one. Both epingaione and compound 2 caused an accumulation of arrested or dead SH-SY5Y neuroblastoma in the m-phase of the cell cycle as revealed by the m-phase specific marker KE 67.

La epingaiona (4-Metil-1-(5-metil-2,3,4,5-tetrahidro-[2,3']bifuranil-5-il)-pentan-2-uno) fue aislada como uno de los principales metabolitos lipofilicos secundarios de las hojas y tallos de Bontia daphnoides L. El compuesto produjo 79.24 % y 50.83 % de actividad citotóxica/anti-proliferación sobre el neuroblastoma humano SH-SY5Y y las células del sarcoma TE-671 in vitro a 50 µg/mL, respectivamente. La epingaiona fue transformada en once derivados en condiciones de laboratorio, utilizando etanol. Algunos produjeron mayor actividad citotóxica y antiproliferativa sobre las líneas celulares cancerosas sometidas a ensayo. Uno de los derivados (compuesto 2) de elevada actividad citotóxica fue identificado como 5'-Etoxi-5-metil-5-(4-metil-2-oxo-pentil)-2,3,4,5-tetrahidro-5'H- [2,3']bifuranil-2'-uno. Tanto la epingaiona como el compuesto 22 causaron una acumulación de neuroblastomas SH-SY5Y muertos o detenidos en la fase m del ciclo celular, según lo revela el marcador KE 67 específico de la fase m.

Human immunodeficiency virus type-1 (HIV-1) subtypes in Jamaica / Subtipos del virus tipo-1 de la inmunodeficiencia humano (VIH-1) en Jamaica

The subtypes of 141 isolates of human immunodeficiency virus type-1 (HIV-1) from Jamaica were determined by a combination of env and gag heteroduplex mobility analysis (HMA) genotyping. The majority of HIV-1 isolates were subtype B (131/141, 93.0); one (0.8) isolate each of subtypes C, D and E was found and 7 (4.9) were indeterminate. These results and the failure of the sets of primers used to amplify some of the HIV-1 isolates provide strong evidence of genetic diversity of the HIV/AIDS epidemic in Jamaica. Surveillance of the circulating HIV-1 genetic subtypes is a pre-requisite for developing regional vaccine strategies and understanding the transmission patterns of the virus. This is the first study of its kind in Jamaica and the findings complement data from other Caribbean countries. This work supports the view of colleagues from the French and Spanish-speaking Caribbean that an epidemiological network supported by regional laboratories will help track this epidemic accurately with positive outcomes for the public.

Los subtipos de 141 aislados del virus tipo 1 de la inmunodeficiencia humno (VIH-1) en Jamaica, fueron determinados combinando la genotipificación por análisis de heterodúplex (HMA) en los genes env y gag. La mayor parte de los aislados HIV-1 fueron del subtipo B (131/141, 93.0%), se halló uno (0.8%) aislado para cada uno de los subtipos C, D y E, en tanto que 7 (4.9%) fueron indeterminados. Estos resultados y el fallo de los conjuntos de primers usados para amplificar algunos de los aislados de VIH-1, ofrecen fuerte evidencia de la diversidad epidémica del VIH/SIDA en Jamaica. La vigilancia de los subtipos genéticos de VIH-1 en circulación, constituye un pre-requisito, tanto para desarrollar estrategias de vacunas a nivel regional, como para entender los patrones de transmisión del virus. Este es el primer estudio de este tipo en Jamaica, y nuestros hallazgos complementan los datos obtenidos en otros países del Caribe. Coincidimos con nuestros colegas del Caribe francófono e hispano-parlante en cuanto a que una red epidemiológica apoyada por los laboratorios regionales, nos ayudaría a continuar rastreando esta epidemia con exactitud, y con resultados positivos para el público.

Antibiotic sensitivity of Helicobacter pylori in Jamaica

Helicobacter pylori infection is one of the commonest chronic infections worldwide. Eradication regimes usually contain two antibiotics, however resistance is increasing and this decreases treatment success. This study reports on the sensitivity and resistance of H pylori to several antibiotics in patients undergoing upper gastrointestinal endoscopy in Jamaica. The rapid urease test (CLO) was positive in 128 (38) of 336 patients. Fifty patients (39; 50/128) with positive CLO tests had positive cultures for H pylori. Two-thirds (32/48) of islolates were sensitive to metronidazole and one-third (16/48) were resistant. Ninety-seven per cent of isolates (31/32) were sensitive to erythromycin. The sensitivity for clarithromycin was 92 (11/12) with one isolate (8) resistant. All strains of H pylori (48/48) were sensitive to ampicillin and amoxicillin - clavulanate. Metronidazole resistance is present in one-third of H pylori isolates and resistance to macrolides is relatively low in Jamaican patients. It is important to monitor antibiotic resistance in order to provide clinicians with data on the most appropriate and cost effective eradication regimes for H pylori

Prevalence of chronic renal failure in the diabetic population at the University Hospital of the West Indies

The prevalence of chronic renal failure (CRF) in 460 patients with diabetes mellitus attending the diabetic outpatient clinic at the University Hospital of the West Indies in Jamaica was determined from a review of medical records. The prevalence of CRF was 10 (39/386) in the diabetic clinic population. Significant positive associations with CRF were found with male gender (20/98, 20 vs 19/287, 7; odds ratio (OR), 3.24; p = 0.001); age 60 years and older (22/162; 14 vs 17/221, 8; OR, 2.01; p = 0.04); fasting blood glucose concentrations exceeding 8.0 mmol/L (22/162, 13 vs 12/182, 7; OR, 2.08; p = 0.05); the presence of significant proteinuria as a marker for outcome (13/39, 33 vs 48/346, 14; OR, 3.60; p = 0.02) and peripheral vascular disease (6/20, 30 vs 139/386, 10; OR, 4.75; p = 0.005). The prevalence of CRF did not differ significantly between patients with Type 1 and Type 2 diabetes mellitus. Also, the presence of CRF was not significantly associated with duration of diabetes mellitus, type of hypoglycaemic agents used, or history of hypertension. However, the presence of persistent proteinuria was significantly associated with duration of diabetes mellitus exceeding five years (46/255, 17 vs 11/149, 7; OR, 2.52; p = 0.005) and a history of hypertension (41/235, 17 vs 20/198, 10; OR, 1.88; p = 0.03) but not with age or gender. This study emphasizes the need to evaluate patients with diabetes mellitus for renal impairment so that intervention strategies may be adopted early to delay progression to endstage renal disease

A survey of chronic renal failure in Jamaica

The prevalence of chronic renal failure (CRF)/end stage renal disease and the accessibility of long term renal replacement therapy in Jamaica were evaluated. The study was conducted at six Jamaican healthcare facilities between July 1998 and December 1999 and included 605 patients with CRF. Men with CRF (57 of patients, mean age of 56.7 years) were significantly older than women (mean age 53.2 years). Hypertension was the most commonly associated medical condition (60.8 of patients) followed by diabetes mellitus (31.4 of patients). The estimated crude point prevalence of CRF in persons 20 years and over at the end of 1999 was 327 per million population. More than one-third of patients with CRF (39) were receiving renal replacement therapy, the most common modality being haemodialysis, and only 1.8 of patients had received kidney transplantation. The prevalence of chronic renal failure was not increased in areas known to have high soil cadmium levels. Chronic renal failure is a significant public health problem in Jamaica and is placing an increasing financial burden on the healthcare sector

A serosurvey of hepatitis B virus, hepatitis C virus, human T lymphotropic virus type-1 and syphilis in HIV-1-infected patients in Jamaica

The seroprevalences of hepatitis B virus (HBV), hepatitis C virus (HCV), human T lymphotropic virus type-1 (HTLV-1) and syphyilis were determined in 129 HIV-1-infected patients using commercially prepared reagents. The seroprevalences were HCV, 0 (0/129); HBV, 37 (48/129); HTLV-1, 5 (6/129) and syphilis, 20 (26/129). Fifteen per cent (19/129) of the patients had active/chronic HBV infection. The seroprevalence of HBV was statistically significantly higher in HIV-1 infected men (24/49, 50 versus 17/80, 21; p = 0.005), while the seroprevalence of syphilis was statistically significantly increased in HIV-1 infected patients in the over-40 age group (10/31, 32 versus 6/53, 11; p = 0.05). These findings throw the spotlight on HBV infection and syphilis and suggest that these two sexually transmitted infections should be carefully surveyed in patients with HIV/AIDS in Jamaica. It is essential for management protocols in Jamaica to include screening for evidence of these co-infections

Autoantibodies, human T lymphotropic virus type 1 and type 1 diabetes mellitus in Jamaicans

The clinical characteristics, autoantibody profiles and seroprevalence of human T lymphotropic virus Type 1 (HTLV-1) were assessed in 30 Jamaican patients with Type 1 diabetes mellitus. Two hundred and fifty-two blood donors and 108 patients with Graves' disease were included as controls for the HTLV-1 component of the study. The mean age of onset of diabetes mellitus was 20.5 +/- 9.2 years and the mean duration of diabetes mellitus was 10.5 +/- 6.1 years. The remarkable clinical data included an absence of other associated organ-specific autoimmune diseases, and clinical evidence and history of congenital rubella in one patient. Islet cell cytoplasmic antibodies (ICA) were absent but 17 (5/30) of the diabetic patients tested positive for glutamic acid decarboxylase (GAD) antibodies. No other organ-specific autoantibodies were detected but non-organ-specific autoantibodies were present in 9 (30) of the sera of diabetic patients. The seroprevalence of HTLV-1 in the patients with diabetes mellitus was significantly higher than that in the healthy controls (17 (5/30) versus 4 (11/252), p = 0.05). Autoantibodies were found in the sera of 4/5 (80) of the diabetic patients who were positive for HTLV-1. None of the patients with onset of diabetes mellitus below age 15 years was HTLV-1 positive. The likely polyaetiological nature of Type 1 diabetes mellitus in Jamaicans is being further investigated at the molecular level.

The mid-forearm arteriovenous fistula as vascular access for haemodialysis

Successful chronic haemodialysis requires permanent vascular access. The Scribner procedure which utilizes an external arteriovenous shunt, the internal synthetic arteriovenous shunt and the direct arteriovenous fistula as described by Cimino and Brescia have all been used for haemodialysis. Of the three methods, the arteriovenous fistula is the most trouble-free and durable. However, as originally described and constructed in the distal forearm, the morbidity associated with this method is significant. The cubital fossa fistula has even more problems. The mid-forearm fistula was designed by the authors and has been used for chronic haemodialysis over the past eighteen years. This article compares the various methods of access used in the haemodialysis units of the University Hospital of the West Indies and the Kingston Regional Hospital. The mid-forearm fistula was found to have the lowest initial failure rate and was associated with fewer complications than any of the other methods used for access.

Antibiotic susceptibility of Clostridium difficile isolates from adult patients at two Jamaican hospitals. Clinical and epidemiological implications

The susceptibility of 39 toxin producing Clostridium difficile isolates from stools of hospitalized patients was determined, by disc diffusion, to six antibiotics. All but one isolate (toxin A negative) produced toxin A and toxin B. A wide variation in susceptibility to clindamycin, tetracycline and chloramphenicol was noted. Erythromycin and cotrimoxazole showed a clear-cut discrimination in resistance and susceptibility, while all isolates were sensitive to vancomycin. Erythromycin sensitive isolates demonstrated a significant association with diarrhoea (60.9, 14/23, p < 0.001). These strains were predominantly found at the University Hospital of the West Indies (UHWI, 94.1, 16/17). Strains resistant to erythromycin and clindamycin together were commonly found at the National Chest Hospital (NCH, 68.2, 15/22). All erythromycin sensitive strains found at the NCH were from patients transferred to that hospital. These findings suggest that there is a common strain of C difficile (erythromycin resistant) at the NCH different from that found at the UHWI; the resistant pattern seen with isolates from the NCH was typical of toxigenic serogroup C strain and could be typed by the the disc diffusion method. Patients at the NCH who were colonized with either of the two strains of C difficile were likely to get diarrhoea, once there was suppression of the normal microflora by antibiotics and colonic overgrowth with C difficile.

Medical admissions of oncology patients to the University Hospital of the West Indies

A prospective study of 80 oncology patients (42 men, 38 women; mean age 50.3 years) admitted to the University Hospital of the West Indies, Jamaica, was conducted over a six month period (August 1, 1995 to January 31, 1996). There were 103 admissions representing 8.7of total admissions to the medical wards. Solid tumours and haematological malignancies accounted for equal proportions of admissions. 62were emergency admissions. Investigation of constitutional symptoms, abnormal physical findings, infection and chemotherapy were the commonest reasons for admission. Complications developed in 42.7of admissions, the commonest being renal and/or hepatic impairment; anaemia, leukopaenia and thrombocytopenia; and nosocomial infections. 35of the patients died during the study period. The mean length of stay was 12.9 days (SD 12.8). Mean hospital stay was significantly longer in admissions involving an initial diagnosis of cancer and in those resulting in complications (p < 0.001).

The seroprevalence of hepatitis and retroviral infection in Jamaican haemodialysis patients

63 haemodialysis (HD) patients and 63 age and gender matched controls were investigated for hepatitis B surface antigen (HbsAg) and antibodies to hepatitis B virus (anti-HBV), hepatitis C virus (anti-HCV), hepatitis D virus (anti-HDV), human immunodeficiency virus types 1 and 2 (anti-HIV-1 and 2) and human T-cell lymphotropic virus type-1 (anti-HTLV-1). The notable finding was an increase in hepatitis B markers, 34.9in HD patients compared to 19.0in controls (p < 0.02). The seroprevalence of anti-HCV (7.9, p < 0.03) and anti-HTLV-1 (9.5; p < 0.006) was also increased in the patients. Four of the five patients positive for anti-HCV were also seropositive for HBV. Anti-HIV and anti-HDV were not detectable in the HD patients in this study. The possibility of HTLV-1 being transmitted by organ transplantation is raised. The seropositivity rate for hepatitis B and C increased with duration on dialysis, but it is unlikely that it was related to the number of blood transfusions since 50with no transfusion were HBV seropositive.

Thymectomy in myasthenia gravis. The Jamaican experience

Forty-five patients with myasthenia gravis (MG) were subjected to thymectomy by the median sternotomy technique and were followed up for 4,380 patient months. No operative deaths occurred and 93.3%of the patients benefited from surgery with 28.8%achieving remission. Forty pptients (88.5%) showed improvement within one month, and 73%of those who achieved remission did so in the first 2 years. Outcome was not affected by thymic pathology except in one patient who had a thymoma removed. These results confirm the value of thymectomy in the management of MG patients with generalised disease and the efficacy of the simple median sternotomy procedure.

Arsenic: the forgotten poison?

Chronic arsenic poisoning is an uncommon cause of peripheral neuropathy in Jamaica. A patient with this disorder is described. The insidious nature of chronic arsenic poisoning, with its disabling complications, is emphasised.