Mortality-related factors in gastroschisis - a Jamaican perspective.

OBJECTIVE: To determine the mortality rate of patients treated with gastroschisis at a Jamaican pediatric hospital, and to identify factors that contribute significantly to mortality. METHODS: Eighty-five patients were treated with gastroschisis between November 1, 2006 and November 30, 2015. Of these, 80 records were recovered and reviewed retrospectively. Records were analyzed for maternal and patient characteristics, and details of the clinical course. Death during admission was the primary outcome measure. RESULTS: 63 of the 80 patients died during admission, giving a mortality rate of 78.8%. Sepsis was the main cause of death (82.4%). 27 patients (33.8%) had complicated gastroschisis (necrosis, perforation and/or atresia), all of whom died. Only preterm gestational age, complicated gastroschisis, and the lack of parenteral nutrition were found to be statistically associated with increased mortality. CONCLUSION: Our mortality rate is higher than those quoted in high-income countries, and correlates to those found in low- to middle-income countries. Mortality in our cohort was significantly associated with prematurity, complicated gastroschisis, and the lack of parenteral nutrition. Efforts to improve outcome must focus on improving antenatal care, establishing transfer protocols, and optimizing nutrition for all patients with gastroschisis. STUDY TYPE: Prognostic/Retrospective Study LEVEL OF EVIDENCE: Level II.

Effect of pesticides used in banana and pineapple plantations on aquatic ecosystems in Costa Rica.

Current knowledge on fate and effect of agricultural pesticides comes is mainly from temperate ecosystems. More studies are needed in tropical systems in order to assess contamination risks to nontarget endemic tropical species from the extensive use of pesticides e.g. in banana and pineapple plantations. In this study, acute laboratory toxicity tests with organophosphate pesticides ethoprophos and chlorpyrifos were conducted on two Costa Rican species, cladoceran Daphnia ambigua and fish Parachromis dovii. Tests showed that chlorpyrifos was more toxic than ethoprophos to D. ambigua and P. dovii and that D. ambigua was also more sensitive than P. dovii to both pesticides. Additionally, bioassays were performed by exposing D. magna and P. dovii to contaminated water collected from the field. Chemical analyses of field water revealed that fungicides were generally the most frequent pesticide group found, followed by insecticides/nematicides and herbicides. The bioassays and values obtained from the literature confirmed that D. magna was more sensitive to pesticide contamination than P. dovii and that D. ambigua was more sensitive than D. magna, suggesting that the native cladoceran is a more suitable test species than its temperate counterpart. Species sensitivity distributions showed no significant difference in sensitivity between tropical and temperate fish and the arthropod species exposed to chlorpyrifos in this study. Choline esterase activity (ChE) was measured in P. dovii in laboratory tests in order to assess the applicability of this biomarker. ChE inhibition in P. dovii was observed in the laboratory at levels below the LC10 of both ethoprophos and chlorpyrifos, confirming that ChE is an efficient biomarker of exposure. Both indigenous Costa Rican species used in this study were found to be suitable standard tropical test species. Further studies are needed to investigate how protective the safe environmental concentrations, derived from LC50 of native tropical species, are for protecting tropical aquatic natural communities.

Changes in parents' and self-reports of behavioral problems in Brazilian adolescents after behavioral treatment with urine alarm for nocturnal enuresis.

PURPOSE: Compare parents' reports of youth problems (PRYP) with adolescent problems self-reports (APSR) pre/post behavioral treatment of nocturnal enuresis (NE) based on the use of a urine alarm. MATERIALS AND METHODS: Adolescents (N = 19) with mono-symptomatic (primary or secondary) nocturnal enuresis group treatment for 40 weeks. Discharge criterion was established as 8 weeks with consecutive dry nights. PRYP and APSR were scored by the Child Behavior Checklist (CBCL) and Youth Self-Report (YSR). RESULTS: Pre-treatment data: 1) Higher number of clinical cases based on parent report than on self-report for Internalizing Problems (IP) (13/19 vs. 4/19), Externalizing Problems (EP) (7/19 vs. 5/19) and Total Problem (TP) (11/19 vs. 5/19); 2) Mean PRYP scores for IP (60.8) and TP (61) were within the deviant range (T score > or 60); while mean PRYP scores for EP (57.4) and mean APSR scores (IP = 52.4, EP = 49.5, TP = 52.4) were within the normal range. Difference between PRYP' and APSR' scores was significant. Post treatment data: 1) Discharge for majority of the participants (16/19); 2) Reduction in the number of clinical cases on parental evaluation: 9/19 adolescents remained within clinical range for IP, 2/19 for EP, and 7/19 for TP. 3) All post-treatment mean scores were within the normal range; the difference between pre and post evaluation scores was significant for PRYP. CONCLUSIONS: The behavioral treatment based on the use of urine alarm is effective for adolescents with mono-symptomatic (primary and secondary) nocturnal enuresis. The study favors the hypothesis that enuresis is a cause, not a consequence, of other behavioral problems.

Changes in parents' and self-reports of behavioral problems in Brazilian adolescents after behavioral treatment with urine alarm for nocturnal enuresis

PURPOSE: Compare parents' reports of youth problems (PRYP) with adolescent problems self-reports (APSR) pre/post behavioral treatment of nocturnal enuresis (NE) based on the use of a urine alarm. MATERIALS AND METHODS: Adolescents (N = 19) with mono-symptomatic (primary or secondary) nocturnal enuresis group treatment for 40 weeks. Discharge criterion was established as 8 weeks with consecutive dry nights. PRYP and APSR were scored by the Child Behavior Checklist (CBCL) and Youth Self-Report (YSR). RESULTS: Pre-treatment data: 1) Higher number of clinical cases based on parent report than on self-report for Internalizing Problems (IP) (13/19 vs. 4/19), Externalizing Problems (EP) (7/19 vs. 5/19) and Total Problem (TP) (11/19 vs. 5/19); 2) Mean PRYP scores for IP (60.8) and TP (61) were within the deviant range (T score ≥ 60); while mean PRYP scores for EP (57.4) and mean APSR scores (IP = 52.4, EP = 49.5, TP = 52.4) were within the normal range. Difference between PRYP' and APSR' scores was significant. Post treatment data: 1) Discharge for majority of the participants (16/19); 2) Reduction in the number of clinical cases on parental evaluation: 9/19 adolescents remained within clinical range for IP, 2/19 for EP, and 7/19 for TP. 3) All post-treatment mean scores were within the normal range; the difference between pre and post evaluation scores was significant for PRYP. CONCLUSIONS: The behavioral treatment based on the use of urine alarm is effective for adolescents with mono-symptomatic (primary and secondary) nocturnal enuresis. The study favors the hypothesis that enuresis is a cause, not a consequence, of other behavioral problems.

Taking the next step in 2005, the year of the diabetic foot.

OBJECTIVES: To determine the age-standardized rate of lower limb amputations among Type 2 diabetics admitted to the Port of Spain General Hospital (POSGH), San Fernando General Hospital (SFGH) and Sangre Grande County Hospital (SGCH) for the period 2000-2004. To determine in-hospital mortality following amputation, for the same period. To determine the risk factors that contributed to diabetic foot complications. DESIGN AND METHODS: All patients who had a lower limb amputation at the three major public health institutions in Trinidad during the study period were enrolled. In addition patients attending the surgical out-patient clinic and currently admitted to the ward with a diabetic septic foot was selected for the administration of a questionnaire to determine the major contributing factors. Data on the type of amputation, age, sex, ethnicity, from which an age-standardized mortality rate, was determined for the age group 30-60. RESULTS: Of 822 patient files examined, 515 (80 per cent) of these major amputations were performed on Type 2 diabetics, of which 352 (68 per cent) were AKA and 163 (32 per cent) were BKA. The AKA:BKA ratio for the period 2000-2004 was 2.2:1. There was a significant difference between the mean ages at which females had a major amputation to males (p=0.001). The overall ratio of Africans to South East Asians was 1.5:1 amongst the Type 2 diabetic amputees. For major amputations the average length of stay was found to be 22.5 (0-192) days. The age-standardized rate for the age group 30-60 was 13.85 per 100,000 for 2004. Of 66 deaths, 31 (47 per cent) were septicemia cases and 14 (21 per cent) cardio-respiratory failure cases. Finally, of 97 persons interviewed, the major causative agent for diabetic foot complications and amputations was foot trauma (51 per cent). CONCLUSION: Type 2 diabetic amputation status of Trinidad would seem to have improved as shown by this study.

Taking the next step in 2005, the year of the diabetic foot.

OBJECTIVES: To determine the age-standardized rate of lower limb amputations among Type 2 diabetics admitted to the Port of Spain General Hospital (POSGH), San Fernando General Hospital (SFGH) and Sangre Grande County Hospital (SGCH) for the period 2000-2004. To determine in-hospital mortality following amputation, for the same period. To determine the risk factors that contributed to diabetic foot complications. DESIGN AND METHODS: All patients who had a lower limb amputation at the three major public health institutions in Trinidad during the study period were enrolled. In addition patients attending the surgical out-patient clinic and currently admitted to the ward with a diabetic septic foot was selected for the administration of a questionnaire to determine the major contributing factors. Data on the type of amputation, age, sex, ethnicity, from which an age-standardized mortality rate, was determined for the age group 30-60. RESULTS: Of 822 patient files examined, 515 (80%) of these major amputations were performed on Type 2 diabetics, of which 352 (68%) were AKA and 163 (32%) were BKA. The AKA:BKA ratio for the period 2000-2004 was 2.2:1. There was a significant difference between the mean ages at which females had a major amputation to males (p=0.001). The overall ratio of Africans to South East Asians was 1.5:1 amongst the Type 2 diabetic amputees. For major amputations the average length of stay was found to be 22.5 (0-192) days. The age-standardized rate for the age group 30-60 was 13.85 per 100,000 for 2004. Of 66 deaths, 31 (47%) were septicemia cases and 14 (21%) cardio-respiratory failure cases. Finally, of 97 persons interviewed, the major causative agent for diabetic foot complications and amputations was foot trauma (51%). CONCLUSION: Type 2 diabetic amputation status of Trinidad would seem to have improved as shown by this study. However, steps must be taken to improve patient awareness about prevention and care of the diabetic foot. Doctors must also seek to increase their vigilance when screening diabetic patient in the primary care setting in order to prevent the late detection and treatment of the septic lower limb.

Las lesiones placentarias en la infección humana por Trypanosoma cruzi / Placental lesions in human Trypanosoma cruzi infection

This histopathological study analyzes placentas of babies congenitally infected with T. cruzi (M+B+), or babies not infected but born from infected- (M+B-), or non infected-mothers (M-B-). Placentas M+B+ showed lesions of chorionitis, chorioamnionitis and cord edema with lymphocyte infiltration, whereas such lesions were infiltrated only with polymorphonuclear cells in M+B- and M-B- placentas. Parasites were found in M+B+ placentas, in fibroblasts and macrophages of chorion, membranes, chorionic plate, mainly in the area of membrane insertion, as well as in cells of Wharton jelly and myocytes of umbilical cord vessels. These results suggest that the materno-fetal transmission of parasites occurs mainly through the marginal sinus, spreading into the chorionic plate infecting fibroblasts and macrophages so far as to found a fetal vessel, inducing a fetal infection by hematogenous route.

Efectos de la infección aguda y crónica por Trypanosoma cruzi en la gestación de los ratones / Effects of acute and chronic Trypanosoma cruzi infection in pregnant mice

Pathogens may impair reproduction in association or not with congenital infections. We have investigated the effect of acute infection with Trypanosoma cruzi, the protozoan agent of Chagas disease, on reproduction of female mice. In the acute, parasitemic, phase of the infection, female mice were totally unable to reproduce. Most of them (80%) were infertiles and did not develop any gestation. In the few gravid infected mice, implantation numbers were as in uninfected control mice. However, their fetuses presented a weight meanly reduced by 40% as compared to those of uninfected females, and all of them died during the gestation or whithin 48 h after birth. Such massive mortality did not result from congenital infection, which did not occur. The infertility and the fetal mortality occuring early in gestation (resorptions) were significantly correlated with a high maternal parasitemia, whereas later fetal mortality was associated with the presence of intracellular parasites in the utero-placental unit. The decidua was particularly receptive to T. cruzi multiplication, since this tissue harboured 125 fold more amastigotes than the maternal heart or other placental tissues. In addition, placentas of dead fetuses presented histopathological lesions (inflammatory infiltrates, fibrine deposits and ischemic necrosis). Such harmfull effects of acute infection were not observed when female mice were in the chronic phase of the infection, since these reproduce normally. Their fetuses only suffered from moderate and reversible growth retardation. These results indicate that, following the maternal parasite burden, T. cruzi infection may induce very deleterious effects on gestation.

Riesgo de enfermedades transmisibles por alimentos en el Combinado Cárnico de la Empresa de Producción Agropecuaria / Risk for Transmissible Diseases by Foods in the Meat Complex of the Agricultural Production Company

Se efectuó un estudio descriptivo y transversal en el Combinado Cárnico de la Empresa Provincial de Producción Agropecuaria de Santiago de Cuba en el trimestre junio agosto del 2001, dirigido a identificar, mediante una encuesta, los posibles factores de riesgo que favorecen la aparición de enfermedades transmitidas por alimentos, para lo cual se escogió a un total de 15 trabajadores de la fábrica (11 ubicados en el área de elaboración de productos cárnicos, 2 con funciones administrativas y 2 técnicos). A los efectos se realizó una inspección sanitaria con los diferentes expertos en Epizootiología y Control Sanitario de los Alimentos del Ministerio del Interior, Instituto de Medicina Veterinaria, Fuerzas Armadas Revolucionarias y Centro Provincial de Higiene, Epidemiología y Microbiología, la cual reveló dificultades con los exámenes de salud de los manipuladores, poco conocimiento sobre las medidas higiénicas en los puestos de trabajo, así como insuficiencias en la higiene personal. Se concluyó que los trabajadores no mostraron un desempeño adecuado durante el proceso de manipulación de las carnes y subproductos, lo que aumentaba las probabilidades de contraer enfermedades transmisibles por medio de los alimentos, al violar las normas cubanas establecidas al respecto. Se dictaminó un plan de medidas para eliminar las deficiencias y dificultades encontradas

Riesgo de enfermedades transmisibles por alimentos en el Combinado Cárnico de la Empresa de Producción Agropecuaria / Risk for Transmissible Diseases by Foods in the Meat Complex of the Agricultural Production Company

Se efectuó un estudio descriptivo y transversal en el Combinado Cárnico de la Empresa Provincial de Producción Agropecuaria de Santiago de Cuba en el trimestre junio – agosto del 2001, dirigido a identificar, mediante una encuesta, los posibles factores de riesgo que favorecen la aparición de enfermedades transmitidas por alimentos, para lo cual se escogió a un total de 15 trabajadores de la fábrica (11 ubicados en el área de elaboración de productos cárnicos, 2 con funciones administrativas y 2 técnicos). A los efectos se realizó una inspección sanitaria con los diferentes expertos en Epizootiología y Control Sanitario de los Alimentos del Ministerio del Interior, Instituto de Medicina Veterinaria, Fuerzas Armadas Revolucionarias y Centro Provincial de Higiene, Epidemiología y Microbiología, la cual reveló dificultades con los exámenes de salud de los manipuladores, poco conocimiento sobre las medidas higiénicas en los puestos de trabajo, así como insuficiencias en la higiene personal. Se concluyó que los trabajadores no mostraron un desempeño adecuado durante el proceso de manipulación de las carnes y subproductos, lo que aumentaba las probabilidades de contraer enfermedades transmisibles por medio de los alimentos, al violar las normas cubanas establecidas al respecto. Se dictaminó un plan de medidas para eliminar las deficiencias y dificultades encontradas.

Prevalence of astrovirus infection among Chilean children with acute gastroenteritis.

The frequency of astrovirus infection in 456 Chilean children with diarrhea was determined by enzyme-linked immunosorbent assay, reverse transcriptase PCR, and cell culture. Astrovirus was detected in 16.5% of rotavirus-negative and 7% of rotavirus-positive samples obtained from emergency rooms or hospitals and in 11% of samples from day care centers. HAst-1 was the predominant serotype identified.

A prospective study of astrovirus diarrhea of infancy in Mexico City.

AIM: To describe the epidemiologic and clinical characteristics of astrovirus-associated diarrhea in a cohort of young children from a periurban community in Mexico City. METHODS: From November, 1988, through December, 1991, a total of 214 children were enrolled in a longitudinal study of diarrhea and monitored from birth to 18 months of age. A stool specimen was collected during each episode of diarrhea. Specimens from a total of 510 diarrhea episodes were tested for astrovirus by enzyme immunoassay and examined for other enteric pathogens. The antigenic types of astrovirus were determined by a typing enzyme immunoassay. RESULTS: Astrovirus was detected in 26 (5%) of 510 diarrhea episodes, with an incidence rate of 0.1 episode/child year; the highest rate was in children 13 to 18 months of age. Astrovirus-associated diarrhea was characterized by a median of 4 stools (range, 2 to 10) during the first 24 h, a median duration of 3 days (range, 1 to 21), vomiting (20%), and fever (7%). No cases of dehydration or repeat symptomatic infections were observed. Coinfection with another pathogen was detected in 11 of the 26 episodes (42%). Serotype 2 (35%) was most common, followed by serotypes 4 (15%), 3 (11%), and 1 and 5 (4% each); 31% were nontypable. Astrovirus-associated diarrhea was less severe, as measured by the number of stools (4.3 +/- 1.9), than diarrhea caused by rotavirus (7.1 +/- 2.8) or when coinfections occurred (5.5 +/- 1.6; P = 0.008). CONCLUSIONS: Astrovirus was associated with 5% of the episodes of diarrhea in this cohort of young Mexican children and presented as a mild secretory diarrhea. Five predominant antigenic types were detected with type 2 being the most common.

Surface adenosquamous carcinoma of the penis. A report of three cases.

Three patients, aged 37, 72, and 74 years, with adenosquamous carcinoma of the penis are described. The duration of disease was 6, 9, and 144 months, respectively. Grossly a firm, white-gray granular exophytic mass was noted (7.6 cm average diameter). Microscopically, a mixed carcinoma showing squamous and glandular elements was present; the squamous component predominated. In two cases the adenocarcinoma was located in the perimeatal area of the glans. The periurethral glands were not involved. The glandular foci were discrete and had minimal admixture with the squamous carcinoma. Mucin material was present in the lumina, apical border, and cytoplasm. Immunohistochemically, cells showed positivity for carcinoembryonic antigen in glandular areas. The squamous cell carcinomas were of the "warty" variant in two cases and of the usual squamous cell type in the other case. In one patient, metastatic adenosquamous carcinoma was noted in one inguinal node and showed mucin secretion. This patient is alive and well 102 months after diagnosis. Another patient is alive with no evidence of disease 12 months after surgery, and the third was lost to follow-up. Adenosquamous carcinomas of the penis are unusual neoplasms probably originating in penile surface epithelium and in embryologically misplaced mucus glands of the perimeatal region of glans mucosa.

Spontaneous comments

A selection of spontaneous comments by patients collected over 26 years is presented. The duration/cure ratio was calculated

Case records in general practice

The author regularly collected histories of patients receiving homoeopathic treatment, over a 30-year period, using a standardized case record. The case record is described. Analysis of 1,500 such records yields useful data on patients, prescribing patterns and rate of improvement