W Indian Med J
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Comparative Study
Echocardiographic findings in a contemporary Afro-Caribbean Population referred for evaluation of unexplained syncope.
Echocardiographic findings were reviewed for 106 patients (mean age 41.3 +/- 23.0 years, range 3 to 90 years, 61% female) referred for evaluation of unexplained syncope. Abnormal echocardiographic findings were seen in 36/106 (34%) patients, of which 12/106 (11%) may have an abnormality that contributed to symptoms. Abnormal echocardiographic findings (64 vs 6%, p < 0.01) and those possibly causing syncope (22 vs 0%, p < 0.05) were significantly more likely in the oldest tercile of patients compared with the youngest. No patient less than 35 years old had a possibly diagnostic abnormality.
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Increased left ventricular mass (LVM) on echocardiogram is an independent risk factor for cardiac complications from hypertension. It is associated with a four-fold increase in untoward cardiac events when present. Data were reviewed for 100 treated hypertensive Afro-Caribbean patients, aged 29 to 65 years, recruited from village health clinics. ⋯ Drug treatment was reported in 90% (69% monotherapy, 27% > one drug, 4% > 2 drugs) and no drug was associated with significant difference in LVM compared to others. Only 15% of treated hypertensive patients had systolic blood pressure below 140 mmHg and 8% had diastolic blood pressure below 90 mmHg. The major determinant of increased LVM in this group of Afro-Caribbean hypertensive patients appears to be poorly controlled hypertension with obesity being a possible contributing factor
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Case Reports
Isoniazid-resistant disseminated Mycobacterium tuberculosis in a Jamaican infant with HIV/AIDS.
A case report of isoniazid-resistant disseminated tuberculosis in a young child perinatally co-infected with human immunodeficiency virus (HIV-1) and the challenges managing this child in a resource-constrained setting.
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The HIV prevalence in the Caribbean is estimated at 1.0% (0.9% - 2%) with 230,000 persons living with HIV/AIDS. HIV rates vary among countries with the Bahamas, Guyana, Haiti and Trinidad and Tobago having HIV rates of 2% or above while Cuba's rate is less than 0.2%. However throughout the Caribbean, HIV rates are significantly higher among those groups most at risk such as commercial sex workers, men who have sex with men and crack/cocaine users. ⋯ Several challenges need to be addressed. These include reducing HIV stigma, strengthening national responses, scaling-up better quality prevention programmes with greater involvement of vulnerable populations, more supportive HIV policies and wider access to ARV treatment with better adherence. In addition, there needs to be improved coordination among PANCAP partners at the regional level and within countries.
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We aimed to describe the adherence patterns to antiretroviral therapy (ART) in a cohort of HIV-infected children. ⋯ In resource-limited settings, psychosocial factors contribute significantly to nonadherence and should complement biomedical markers in predicting adherence to antiretroviral therapy in children.