Helicobacter pylori infection in the Caribbean: update in management.

Helicobacter pylori infection of the stomach is one of the commonest chronic infections worldwide and in the Caribbean, over 50% of the population are affected. H pylori is probably transmitted from person to person by oro-faecal and oro-oral means. H pylori is directly associated with peptic ulcer disease, chronic antral gastritis, gastric carcinoma and B-cell lymphoma of the stomach. In patients with peptic ulcers and H pylori infection, eradication of infection with antibiotics significantly decreases recurrence of ulcers. All patients with H pylori related disease should be tested and treated if positive. The treatment of H pylori infection has evolved over the years but at present triple therapy which includes two antibiotics is recommended.

Helicobacter pylori infection in the Caribbean: update in management

Helicobacter pylori infection of the stomach is one of the commonest chronic infections worldwide and in the Caribbean, over 50 of the population are affected. H pylori is probably transmitted from person to person by oro-faecal and oro-oral means. H pylori is directly associated with peptic ulcer disease, chronic antral gastritis, gastric carcinoma and B-cell lymphoma of the stomach. In patients with peptic ulcers and H pylori infection, eradication of infection with antibiotics significantly decreases recurrence of ulcers. All patients with H pylori related disease should be tested and treated if positive. The treatment of H pylori infection has evolved over the years but at present triple therapy which includes two antibiotics is recommended.

Hepatic cirrhosis in Jamaica.

The aetiology, biochemistry, clinical features and complications of histologically confirmed hepatic cirrhosis in 45 patients (26 females, 19 males) seen at the University Hospital of the West Indies, Jamaica, between 1984 and 1994 are presented. The age range was 1 to 72 years (mean 48 years). Abdominal swelling and weight loss were the commonest symptoms, occurring in 51% and 47% of patients, respectively. Jaundice was a presenting feature in 44%. Hepatomegaly was present in 71% of patients and splenomegaly in 33%. The aetiological factors were: alcohol (36%), bush tea (18%), chronic active hepatitis (11%), drugs (7%), and haemochromatosis (2%). Hepatitis B surface antigen was detected in 2 of 20 patients tested. 24% of the patients also had diabetes mellitus., 29% were anaemic, 29% were thrombocytopenic, 4% were leukopenic, and the prothrombin time was prolonged in 22%. The albumin/globulin ratio was reversed in 71% of the patients. The alkaline phosphatase was elevated in 56%, the aspartate aminotransferase was increased in 58% and the gamma glutamyl transpeptidase in 56%. 56% of the patients had macronodular cirrhosis; the liver showed a micronodular pattern in 18%; 7% had biliary cirrhosis; 7% chronic active hepatitis with cirrhosis; and 13% showed a mixed macro-micronodular pattern. Ascites and fluid overload developed in 44% of the patients. Hepatic encephalopathy occurred in 18% and upper gastrointestinal bleeding in 18%.

Ramsay Hunt syndrome complicated by contralateral cerebral infarction.

Varicella-zoster virus has been associated with a variety of neurological manifestations. We describe a patient with the Ramsay Hunt Syndrome who developed a contralateral cerebral infarction.

Pulmonary Nocardiosis in a patient with human immunodeficiency virus disease.

Nocardiosis is an uncommon disease which occurs most often in patients with impaired cellular immunity, yet is rarely reported in patients with Human Immunodeficiency Virus Disease. We present the first case of Nocardiosis seen at the University Hospital of the West Indies, occurring in a well-controlled diabetic with Human Immunodeficiency Virus Disease.

Multicentric angiofollicular lymph node hyperplasia in ulcerative colitis. A case report.

Multicentric angiofollicular lymph node hyperplasia (MAFH) is a rare disorder which has been associated with various disease entities. This is the first report of its association with ulcerative colitis. Details of lymph node histology and views on pathogenesis are given.

Asymptomatic cardiac involvement in systemic lupus erythematosus.

Cardiologic and laboratory parameters were studied in 21 patients with systemic lupus erythematosus (SLE) with cardiopulmonary symptoms (CPS), 20 SLE patients without CPS and 45 age- and sex-matched healthy controls. The most frequent cardiac abnormalities in patients with CPS included pericardial effusion (24%), ventricular enlargement (20%), mitral regurgitation (19%) and tricuspid regurgitation (14%). No structural abnormalities were observed in SLE patients without CPS. Mean calculated and derived echocardiographic values in both groups of SLE patients differed significantly from those observed in normal controls (p < 0.004). Patients with CPS had significantly lower mean values of ejection fraction (p < 0.05) and fractional shortening (p < 0.03). However, the frequencies of functional abnormalities in patients with CPS did not differ significantly from those observed in patients without CPS. There were no remarkable laboratory findings in SLE patients with CPS compared to those without. The finding that some SLE patients may have functional cardiac abnormalities in the absence of CPS is an important one. It raises the question as to whether asymptomatic cardiac involvement in SLE is a separate entity or whether it heralds symptomatic cardiopulmonary involvement.

Thyrotoxic periodic paralysis in a Jamaican male patient.

A case of thyrotoxic periodic paralysis occurring in a Black Jamaican male patient is described. Diagnosis is based on history and confirmed by evaluation of serum electrolyte during attacks and thyroid function studies. The pathophysiology, associations, therapy and prognosis are discussed. It is important that clinicians recognise the condition as all forms of periodic paralysis are amenable to treatment, and progressive weakness can be prevented or even reversed.

Thyrotoxic periodic paralysis in a Jamaican male patient

A case of thyrotoxic periodic paralysis occurring in a Black Jamaican male patient is described. Diagnosis is based on history and confirmed by evaluation of serum electrolyte during attacks and thyroid function studies. The physiopathology, associations, therapy and prognosis are discussed. It is important that clinicians recognise the condition as all forms of periodic paralysis are amenable to treatment, and progressive weakness can be prevented or even reversed.

Polyarteritis nodosa in jamaicans

This report describes the main features of the 5 cases of polyarteritis nodosa seen at the University Hospital of the West Indies over a 10-year period. The disease manifestations are protean and only 2 of the 5 patients were diagnosed antemortem, indicating the need to increase physician awareness, especially since response to therapy has improved significantly in recent years