Distribution of nosocomial organisms and their resistance patterns in the Intensive Care Unit of the University Hospital of the West Indies, Kingston, Jamaica / Distribución de los organismos nosocomiales y sus patrones de resistencia en la Unidad de Cuidados Intensivos del Hospital Universitario de West Indies, Kingston, Jamaica

OBJETIVES: To determine the distribution and antibiotic susceptibility patterns of nosocomial pathogens in the Intensive Care Unit (ICU) at the University Hospital of the West Indies (UHWI). METHODS: A retrospective review of the laboratory records of all ICU patients from 2002-2004 was done. All organisms isolated from blood, urine, sputum, wound swabs and CVP tips were recorded. Sensitivity reports for organisms isolated in 2004 were also obtained. Results were analysed according to source of isolates and type of infection. RESULTS: Gram-negative organisms account for the majority of ICU isolates and show resistance to multiple antibiotics. The common Gram negative pathogens in the ICU are Pseudomonas aeruginosa, Acinetobacter spp and Stenotrophomonas maltophilia while the common Gram positive nosocomial organisms are Group D Streptococcus and coagulase negative Staphylococcus. CONCLUSION: The organisms isolated in the ICU at the UHWI are similar to those isolated in many ICUs all over the world. Surveillance data are necessary to monitor nosocomial pathogens and their resistance patterns to guide empirical antibiotic therapy.

OBJETIVOS: Determinar la distribución y los patrones de susceptibilidad antibiótica de los patógenos nosocomiales en la Unidad de Cuidados Intensivos (UCI) del Hospital Universitario de West Indies (HUWI). MÉTODOS: Se realizó una revisión retrospectiva de las historias clínicas de laboratorio de todos los pacientes de la UCI de 2002-2004. Se registraron todos los organismos aislados a partir de sangre, orina, esputo, hisopos de heridas, y las puntas de catéteres de PVC. Los resultados fueron analizados de acuerdo con las fuentes de los aislados y el tipo de infección. RESULTADOS: Los organismos gramnegativos representan la mayor parte de aislados de la UCI y muestran resistencia a múltiples antibióticos. Los patógenos gramnegativos comunes en la UCI son Pseudomonas aeruginosa, Acinetobacter spp y Stenotrophomonas maltophilia mientras que los organismos nosocomiales grampositivos comunes son Group D Streptococcus y coagulase negative Staphylococcus. CONCLUSIÓN: Los organismos aislados en la UCI en el HUWI son similares a los aislados en muchas UCIs en todo el mundo. La información sobre la vigilancia es necesaria a fin de monitorear los patógenos nosocomiales y sus patrones de resistencia para guiar la terapia antibiótica empírica.

Selective suppression of leukocyte recruitment in allergic inflammation

Allergic diseases result in a considerable socioeconomic burden. The incidence of allergic diseases, notably allergic asthma, has risen to high levels for reasons that are not entirely understood. With an increasing knowledge of underlying mechanisms, there is now more potential to target the inflammatory process rather than the overt symptoms. This focuses attention on the role of leukocytes especially Th2 lymphocytes that regulate allergic inflammation and effector cells where eosinophils have received much attention. Eosinophils are thought to be important based on the high numbers that are recruited to sites of allergic inflammation and the potential of these cells to effect both tissue injury and remodelling. It is hoped that future therapy will be directed towards specific leukocyte types, without overtly compromising essential host defence responses. One obvious target is leukocyte recruitment. This necessitates a detailed understanding of underlying mechanisms, particularly those involving soluble che-moattractants signals and cell-cell adhesion molecules.

Gastrointestinal bleeding--diagnosis and management.

Gastrointestinal (GI) bleeding in infants and children provokes alarm in parents, and often anxiety in pediatricians. While this clinical situation has not changed over the years, advances in endoscopy and radiology, as well as new therapeutic modalities allow more accurate identification of the cause of bleeding and more effective treatment. Although the majority of GI bleeding in the pediatric population is self limiting, a systematic approach including prompt assessment, diagnosis, and treatment is necessary to preclude undue morbidity.

A study of hepatitis B and C prevalence and liver function in multiply transfused thalassemic and their parents.

A series of clinics were conducted in Delhi, India, in January, 1990. Of 54 patients with beta thalassemia major (mean age 7.6 years), 11.1% (6 out of 54) tested positive for antibodies to hepatitis C virus (anti HCV antibodies) and 66.6% (36 out of 54) showed evidence of hepatitis B virus (HBV) infection. Only 7.4% (4 out of 54) were hepatitis B surface antigen (HBsAg) positive. Of their parents, 2.2% (2 out of 90) tested positive for anti HCV antibodies, 28.9% (26 out of 90) showed evidence of previous HBV infection and 11.1% (10 out of 90) were HBsAg positive. We argue that HCV constitutes a greater long term threat than HBV in these patients due to the higher incidence of chronic liver disease. We would advocate the introduction of HCV screening of donated blood as well as reinforcing the importance of HBV screening and immunization.

Freshwater crabs and Simulium neavei in east Africa. III. Morphological variation in Potamonautes loveni (Decapoda: Potamidae)

Potamonautes loveni (Colosi) is the valid name for the species also described as P. granviki; P. harvardi and P. loveni longimerus; and incorrectly identified as P. berardi berardi. Potamonautes jeanelli and P. idjwiensis may be allied to P. loveni; but are geographically separated and show sufficient morphological distinction not to be considered conspecific. Potamonautes loveni occurs in the upper reaches of rivers on the highlands of western Kenya and eastern Uganda. Its replacement by other species; principally P. niloticus; at lower altitudes is probably determined by the temperature range of the water. Potamonautes loveni has been observed to coexist with P. niloticus within the range of altitude 1280-1950 m. Distinct forms of P. loveni; differing in colour; size and the expression of the post-frontal crest; occur on the western side of Mt. Elgon and in the former ochocerciasis foci of Kenya. Hybridization is evident in populations from between these areas. Morphological divergence within P. loveni may be the result of past climatic change. Periods of generally lower temperature have been accompanied by increased aridity and reduction of forest cover. It is suggested that these conditions are such as to promote a disjunct distribution of P. loveni; and in particular the isolation of the Mt. Elgon population

El desafio cientifico: la atención de la salud del anciano

Dadas las caracteristicas demograficas y epidemologicas de la poblacion de mas de 65 anos de edad, en este informe se exploran las principa les vias hacia las cuales se encaminan la investigación cientifica y los servicios medico-sociales