Prevalence of cervical cancer and associated mortality in Grenada, 2000-2010.

Objective To assess cervical cancer prevalence and associated mortality in Grenada, West Indies during 2000-2010. Methods Records of visits to hospital and clinical facilities were obtained from the histopathology laboratory of the Grenada General Hospital. Records were de-identified and electronically compiled. Cervical cancer prevalence was assessed via cross-sectional analysis of this secondary data. Of a total 12 012 records, 2 527 were selected for analysis using sampling without replacement. Cases were matched to corresponding patient data from death registries, where possible, and used to calculate associated mortality rates. Results The observed prevalence of cervical cancer was 52.4 per 100 000 women (ages 15 and above). The highest rates of cervical cancer occurred in the 35-44 age group, with the second highest among 45-64-year-olds. A total of 65 deaths were attributable to cervical cancer during 2000-2010, more than 50% of which were among women > 65 years old. The observed mortality rate was 16.7 per 100 000, almost twice the rate estimated by WHO for the region. Conclusions This study demonstrates the need for a comprehensive cervical cancer-screening program in Grenada. Results should contribute to informing future studies on how to appropriately generate and execute public health policy for education, screening, prevention, and control of cervical cancer in Grenada.

Prevalence of cervical cancer and associated mortality in Grenada, 2000–2010 / Prevalencia del cáncer cervicouterino y mortalidad asociada en Granada, 2000-2010

Objective. To assess cervical cancer prevalence and associated mortality in Grenada, West Indies during 2000–2010. Methods. Records of visits to hospital and clinical facilities were obtained from the histopathology laboratory of the Grenada General Hospital. Records were de-identified and electronically compiled. Cervical cancer prevalence was assessed via cross-sectional analysis of this secondary data. Of a total 12 012 records, 2 527 were selected for analysis using sampling without replacement. Cases were matched to corresponding patient data from death registries, where possible, and used to calculate associated mortality rates. Results. The observed prevalence of cervical cancer was 52.4 per 100 000 women (ages 15 and above). The highest rates of cervical cancer occurred in the 35–44 age group, with the second highest among 45–64-year-olds. A total of 65 deaths were attributable to cervical cancer during 2000–2010, more than 50% of which were among women > 65 years old. The observed mortality rate was 16.7 per 100 000, almost twice the rate estimated by WHO for the region. Conclusions. This study demonstrates the need for a comprehensive cervical cancer-screening program in Grenada. Results should contribute to informing future studies on how to appropriately generate and execute public health policy for education, screening, prevention, and control of cervical cancer in Grenada.

Objetivo. Evaluar la prevalencia del cáncer cervicouterino y la mortalidad asociada en Granada, Antillas Menores, entre el 2000 y el 2010. Métodos. Se obtuvieron los registros de las visitas al hospital y a consultorios clínicos a partir del laboratorio de histopatología del Hospital General de Granada. Se borraron los datos personales de los registros y se los compiló electrónicamente. La prevalencia de cáncer cervicouterino se evaluó por medio del análisis transversal de estos datos secundarios. De un total de 12 012 registros, fueron seleccionados para el análisis 2 527 mediante un método de muestreo sin reemplazo. Los casos se compararon con los datos correspondientes de pacientes en los registros de defunciones, cuando fue posible, y se usaron para calcular las tasas de mortalidad asociadas. Resultados. La prevalencia observada de cáncer cervicouterino fue 52,4 por 100 000 mujeres (de 15 años o más). Las tasas más elevadas de cáncer cervicouterino se observaron en el grupo de edad de 35 a 44 años, seguido por el grupo de 45 a 64 años. Del 2000 al 2010, 65 defunciones fueron atribuibles al cáncer cervicouterino, más del 50% en mujeres mayores de 65 años. La tasa de mortalidad observada fue 16,7 por 100 000, casi el doble de la calculada por la Organización Mundial de la Salud para la región. Conclusiones. Este estudio indica la necesidad de establecer un programa integral de detección del cáncer cervicouterino en Granada. Los resultados deben servir como base para estudios futuros sobre cómo generar y ejecutar apropiadamente políticas de salud pública para la educación en la materia, la detección, la prevención y el control del cáncer cervicouterino en Granada.

Prevalence of cervical cancer and associated mortality in Grenada, 2000-2010 / Prevalencia del cáncer cervicouterino y mortalidad asociada en Granada, 2000-2010

ABSTRACT Objective To assess cervical cancer prevalence and associated mortality in Grenada, West Indies during 2000–2010. Methods Records of visits to hospital and clinical facilities were obtained from the histopathology laboratory of the Grenada General Hospital. Records were de-identified and electronically compiled. Cervical cancer prevalence was assessed via cross-sectional analysis of this secondary data. Of a total 12 012 records, 2 527 were selected for analysis using sampling without replacement. Cases were matched to corresponding patient data from death registries, where possible, and used to calculate associated mortality rates. Results The observed prevalence of cervical cancer was 52.4 per 100 000 women (ages 15 and above). The highest rates of cervical cancer occurred in the 35–44 age group, with the second highest among 45–64-year-olds. A total of 65 deaths were attributable to cervical cancer during 2000–2010, more than 50% of which were among women > 65 years old. The observed mortality rate was 16.7 per 100 000, almost twice the rate estimated by WHO for the region. Conclusions This study demonstrates the need for a comprehensive cervical cancer-screening program in Grenada. Results should contribute to informing future studies on how to appropriately generate and execute public health policy for education, screening, prevention, and control of cervical cancer in Grenada.

RESUMEN Objetivo Evaluar la prevalencia del cáncer cervicouterino y la mortalidad asociada en Granada, Antillas Menores, entre el 2000 y el 2010. Métodos Se obtuvieron los registros de las visitas al hospital y a consultorios clínicos a partir del laboratorio de histopatología del Hospital General de Granada. Se borraron los datos personales de los registros y se los compiló electrónicamente. La prevalencia de cáncer cervicouterino se evaluó por medio del análisis transversal de estos datos secundarios. De un total de 12 012 registros, fueron seleccionados para el análisis 2 527 mediante un método de muestreo sin reemplazo. Los casos se compararon con los datos correspondientes de pacientes en los registros de defunciones, cuando fue posible, y se usaron para calcular las tasas de mortalidad asociadas. Resultados La prevalencia observada de cáncer cervicouterino fue 52,4 por 100 000 mujeres (de 15 años o más). Las tasas más elevadas de cáncer cervicouterino se observaron en el grupo de edad de 35 a 44 años, seguido por el grupo de 45 a 64 años. Del 2000 al 2010, 65 defunciones fueron atribuibles al cáncer cervicouterino, más del 50% en mujeres mayores de 65 años. La tasa de mortalidad observada fue 16,7 por 100 000, casi el doble de la calculada por la Organización Mundial de la Salud para la región. Conclusiones Este estudio indica la necesidad de establecer un programa integral de detección del cáncer cervicouterino en Granada. Los resultados deben servir como base para estudios futuros sobre cómo generar y ejecutar apropiadamente políticas de salud pública para la educación en la materia, la detección, la prevención y el control del cáncer cervicouterino en Granada.

Analysis of cancer prevalence among women in Grenada

OBJECTIVE: To investigate prevalence of cancers affecting women in Grenada, a study was conducted using de-identified patient records from the Grenada General Hospital Histopathology Laboratory of women who visited hospital and clinic facilities during 2000 - 2010. DESIGN AND METHODS: De-identified records of 12,012 entries, 9,023 female (7,172 individuals) between ages 8 – 94 years presumably to seek preventative care or medical treatment were assessed during this cross-sectional study. Sampling without replacement resulted in approximately 3,000 entries for analysis. Prevalence of each type of cancer reported amongst women was determined. RESULTS: Of the 3,000 pathology diagnoses, 601 of the samples were classified as cancerous. The most prevalent cancer in Grenadian women from 2000 – 2010 was cervical cancer at (34%), followed by breast cancer at (31%). All other reported cancers were analyzed and their prevalence determined. CONCLUSION: Overall, the rate of cancer among Grenadian women for the ten-year period from 2000 – 2010 was determined to be 8.4%. There are implications for prevention and creation of health policies to address cancer burden in Grenada.

Left ventricular diastolic dysfunction in children and young adults with Marfan syndrome.

Adults with Marfan syndrome (MFS) demonstrate abnormal aortic elastic properties manifest by decreased aortic distensibility and increased aortic stiffness. Left ventricular (LV) diastolic dysfunction has been reported in adults with MFS. The objective of this study was to assess the frequency of LV diastolic dysfunction in a group of children and young adults with MFS and to determine whether diastolic dysfunction is associated with hemodynamic alterations of the aorta. Review of echocardiographic findings in 40 patients with MFS was performed to assess LV size, systolic function, isovolumic relaxation time (IVRT), mitral inflow velocities, deceleration time (DT) of mitral E wave, and aortic root dimension. No patient had significant valvar disease or was on any cardiac medication at the time of study. A group of 40 age and sex-matched healthy subjects undergoing echocardiography served as controls. Significant differences in LV diastolic function were found between MFS patients and controls. MFS patients had prolonged DT and IVRT and decreased mitral E/A ratio, suggesting impaired LV relaxation. No relationship between aortic root dimension and diastolic performance was identified. Left ventricular diastolic dysfunction may be an early marker of myocardial involvement in young MFS patients occurring independently of aortic root dilatation.

Exercise capacity in pediatric heart transplant candidates: is there any role for the 14 ml/kg/min guideline?

A peak oxygen consumption (VO2) of < 14 ml/kg/min has been identified as a predictor of l-year mortality in adults with congestive heart failure (CHF) and is used as a criterion for listing for cardiac transplantation (OHT). The role of VO2 measurement in children awaiting OHT has not been thoroughly evaluated. We sought to assess the degree of exercise impairment and the clinical applicability of the 14 ml/kg/min rule in children awaiting OHT. Cardiopulmonary exercise test (CPT) and cardiac catheterization data in all patients listed for OHT during the period of 1995-2003 were reviewed. Fourteen patients with a mean age of 15.5 +/- 2.9 years underwent CPT with no serious adverse events at an interval of 6.6 +/- 5.1 months prior to OHT. The etiology of CHF was multifactorial. Patients had impaired aerobic capacity with a mean peak VO2 of 20.4 +/- 6.8 ml/kg/min. Eleven of 14 patients (79%) had a peak VO2 higher than the adult cutoff value of 14 ml/kg/min. Pediatric ambulatory patients with CHF can safely undergo CPT. Because of age-related differences in oxygen consumption and varied etiologies of CHF a peak VO2 of < 14 ml/kg/min is not a useful criterion for listing for OHT in this population.

Diaphragmatic hernia.

We describe a case of acute dyspnea in a patient with Marfan syndrome secondary to bowel herniation into the thoracic cavity.

Exercise capacity in children with hypertrophic cardiomyopathy and its relation to diastolic left ventricular function.

Left ventricular diastolic impairment is often seen in children with hypertrophic cardiomyopathy regardless of left ventricular outflow tract obstruction. Such impairment in diastolic filling is related to the presence of symptoms and exercise impairment.

Late onset of accessory pathway conduction in a patient with complete AV block.

This case report discusses a patient with complete AV block in early childhood. The patient required a permanent pacemaker. At 6 years of age, intermittent preexcited beats were noted on telephonic transmissions. At 7 years of age, 1:1 preexcitation was noted in sinus rhythm. Therefore, late onset of antegrade accessory pathway function is demonstrated. This case provides evidence of developmental changes in accessory pathways. This may explain age related differences in the onset of narrow complex tachycardia in the school age years.

Long-term outcome and prognostic determinants in children with hypertrophic cardiomyopathy.

OBJECTIVES: We sought to determine clinical, angiographic, and echocardiographic predictors of survival in children with isolated hypertrophic cardiomyopathy (HCM) in a large pediatric centre. BACKGROUND: Sudden death is a catastrophic outcome of HCM in childhood but has been difficult to predict. Current therapies might provide for improved outcome if factors identifying high risk can be identified. METHODS: Records of 99 patients diagnosed with HCM from 1958 to 1997 at <18 yr were reviewed for clinical, angiographic (n = 62) and echocardiographic (n = 83) predictors of survival outcome. The effects of clinical characteristics on sudden death (including resuscitated sudden death) were individually tested in Cox's proportionate hazard modeling. RESULTS: Seventy-one subjects were male. Median age at diagnosis was 5.0 yr with a medical follow-up interval of 4.8 yr. Thirty-seven of 97 patients had a family history of HCM. Ambulatory electrocardiograms (ECG) in 78 patients demonstrated supraventricular tachycardia in 16 and ventricular tachycardia in 21. Death or resuscitated sudden death occurred in 18 patients. Sudden death rate was 2.7%/yr after age 8 yr. Cox's proportionate survival modeling revealed increased corrected QT interval (QTc) dispersion on ECG (relative risk [RR] 1.61 per 20 ms increment, p < 0.0003), ventricular tachycardia (VT) on ambulatory ECG (RR 3.75, p < 0.006) and myocardial bridging of the LAD coronary (RR 12.0, p < 0.003) to be associated with reduced time to death or resuscitated sudden death. CONCLUSIONS: Detailed assessment of ECGs, ambulatory ECGs, and coronary angiography can assist in identifying which children with HCM are at risk for sudden death.

Myocardial bridging in children with hypertrophic cardiomyopathy--a risk factor for sudden death.

BACKGROUND: Myocardial bridging may cause compression of a coronary artery, and it has been suggested that myocardial ischemia may result. The clinical significance and prognostic value of myocardial bridging of the left anterior descending coronary artery in children with hypertrophic cardiomyopathy are unknown. We sought to determine the prevalence and clinical effects of myocardial bridging in children with hypertrophic cardiomyopathy who underwent cardiac catheterization. METHODS: Angiograms from 36 children with hypertrophic cardiomyopathy were reviewed to determine whether myocardial bridging was present and, if so, to assess the characteristics of systolic narrowing of the left anterior descending coronary artery caused by myocardial bridging and the duration of residual diastolic compression. We also reviewed clinical data on these patients. RESULTS: Myocardial bridging was present in 10 (28 percent) of the patients. Compression of the left anterior descending coronary artery persisted for a mean (+/-SD) of 50+/-17 percent of diastole. As compared with patients without bridging, patients with bridging had a greater incidence of chest pain (60 percent vs. 19 percent, P=0.04), cardiac arrest with subsequent resuscitation (50 percent vs. 4 percent, P=0.004), and ventricular tachycardia (80 percent vs. 8 percent, P<0.001). On average, the patients with bridging had a reduction in systolic blood pressure with exercise of 17+/-27 mm Hg, as compared with an elevation of 43+/-31 mm Hg in those without bridging (P<0.001). The patients with bridging also had greater ST-segment depression with exercise (median, 5 vs. 0 mm, P=0.004) and a shorter duration of exercise (mean, 6.6+/-2.4 vs. 9.1+/-1.4 minutes, P=0.008). The degree of dispersion of the QT interval corrected for heart rate on the electrocardiogram was greater in patients with bridging than in those without bridging (104+/-46 vs. 48+/-31 msec, P=0.002). Kaplan-Meier estimates of the proportions of patients who had not died or had cardiac arrest with subsequent resuscitation five years after the diagnosis of hypertrophic cardiomyopathy were 67 percent among patients with bridging and 94 percent among those without bridging (P=0.004). CONCLUSIONS: Myocardial bridging is associated with a poor outcome in children with hypertrophic cardiomyopathy. Our observations suggest that bridging is associated with myocardial ischemia

Outcome in cyanotic neonates with Ebstein's anomaly.

Clinical, angiographic, radiographic, and echocardiographic data on 46 neonates with Ebstein's anomaly presenting with cyanosis between 1954 and 1996 were reviewed to determine possible risk factors for mortality. Most patients (67%) presented at birth with 3 cases diagnosed in utero. Mean systemic oxygen saturation was 62+/-12%. An atrial septal defect > or = 4 mm was noted in 20 patients (44%). The patent right ventricle to pulmonary artery connection was present in 10 (22%), and pulmonary atresia was functional in 25 (54%) and anatomic in 11 patients (24%). Fifteen patients (35%) underwent surgical interventions. Total mortality was 70% (vs 14% in acyanotic patients diagnosed during the same time period; p <0.0001) and was related to low cardiac output and hypoxia in 20 patients (62%), postoperative complications in 8 (25%), and sudden death in 4 (13%). Kaplan-Meier survival estimates were 61% at age 1 week (95% confidence interval [CI], 47% to 75%), 48% at age 1 month (95% CI, 34% to 62%), and 36% at both 1 and 5 years of age (95% CI, 22% to 50%). Mortality improved from 81% in 1954 to 1985 to 47% in 1986 to 1996 (p = 0.04). Significant independent predictors of mortality included an atrial septal defect > or = 4 mm (odds ratio [OR] 2.39; p = 0.04), reduced left ventricular function (OR 4.10; p = 0.002), and functional or anatomic pulmonary atresia (OR 2.44, p = 0.003; and OR 5.97, p = 0.004, respectively). An echocardiographic ratio of the combined right atrial and atrialized right ventricular area to the area of the functional right ventricle and left heart >1.0 was 100% predictive of mortality.

From functional pulmonary atresia to right ventricular restriction. Long term follow up of Uhl's anomaly.

We report a 14 year old boy who presented as a neonate with functional pulmonary atresia due to Uhl's disease with emphasis on the later detection of restrictive right ventricular physiology.

Balloon angioplasty of recurrent coarctation: a 12-year review.

OBJECTIVES: This study was undertaken to investigate the long-term outcome of balloon angioplasty for recurrent coarctation of the aorta in a large series of patients. BACKGROUND: Balloon angioplasty has become the standard treatment for residual or recurrent aortic coarctation. Despite the widespread use of this treatment modality, there are few data outlining the long-term outcome of a large patient cohort. METHODS: Clinical, echocardiographic, hemodynamic and angiographic data on 90 consecutive patients who underwent balloon angioplasty between January 1984 and January 1996 were reviewed. RESULTS: Mean systolic pressure gradients were reduced from 31 +/- 21 to 8 +/- 9 mm Hg after dilation (p = 0.0001). The mean diameter of the stenotic site, measured in the frontal and lateral views, increased by 38% and 35%, respectively (p = 0.001). Neurologic events occurred in two patients, with one death. An aortic tear occurred in one patient, requiring surgical intervention. Optimal results were defined as a postprocedure gradient < 20 mm Hg and were obtained acutely in 88% of patients. At long-term follow-up (12 years), 53 (72%) of 74 patients with an early optimal result remained free from reintervention. Transverse arch hypoplasia, defined as an arch dimension < 2 SD below the mean for age, was the primary predictor of the need for reintervention. CONCLUSIONS: Although the majority of patients undergoing percutaneous balloon angioplasty for recoarctation of the aorta will achieve long-term benefit, the need for further surgical intervention in those with transverse arch hypoplasia remains high.

Acute hemodynamic and neurohoromonal effects of furosemide in critically ill pediatrics patients.

OBJECTIVES: To study the acute hemodynamic effects of furosemide in critically ill pediatrics patients, the temporal relationship between hemodynamic changes and changes in neuroendocrine axis, and the temporal relationship between hemodynamic changes and urine output. DESIGN: Prospective study. SETTING: Pediatric intensive care unit in a tertiary care university center. PATIENTS: Fourteen critically ill pediatric patients who clinically required diuretic therapy. INTERVENTIONS: Before and after furosemide administration, hemodynamic and neurohormonal measurements were taken. MEASUREMENTS AND MAIN RESULTS: Hemodynamic and neurohormonal responses to acute diuretic therapy were measured in 14 pediatric patients treated with furosemide (1 mg/kg/dose). Cardiac index deteriorated by 10 mins after drug administration (-9.4+/-3.9%, p<.05) and was associated with an increase in systemic vascular resistance (17.1+/-4.8%, p<.05). There was a subsequent increase in cardiac index (20+/-4.9%, p<.05) at 30 mins, with a decrease in systemic vascular resistance (-11.5+/-5.2%, p<.05). These hemodynamic changes were associated with marked increases in renin and norepinephrine concentrations and an increase in urinary prostaglandin release. The hemodynamic and neurohormonal effects had their onset before maximum diuresis. CONCLUSION: Intravenous furosemide administration in acutely ill pediatric patients results in an acute but transient deterioration in cardiac function that appears to parallel the neuroendocrine changes rather than the acute diuresis.