W Indian Med J
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In the face of the continuing pandemic of HIV/AIDS, the burden of the disease is now largest in the resource-poor developing world. The Joint United Nations Programme on HIV/AIDS (UNAIDS) has listed the adult prevalence rate for the Caribbean as second only to Sub-Saharan Africa. ⋯ HIV/AIDS represents a significant human and financial burden on a developing country such as Jamaica and this underscores the need for urgent and sustained interventions to stem the epidemic.
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This study aims to determine the number and age distribution of pregnant women testing positive for HIV at 16 selected clinics in Jamaica between 2001 and 2002; the utilization of therapeutic interventions to minimize the risk of mother-to-child transmission (MTCT) and the current status of the HIV-exposed infants and, finally, the number of children who received testing for detection of HIV and to calculate the incidence of MTCT in these children. ⋯ One hundred and twenty-three of 8116 pregnant women newly tested positive during the period January 2001 to December 2002; however, 176 HIV+ women delivered. Fifty-three (30%) knew their HIV status prior to participating in the programme. Sixty-two (1.4%) and 61 (1.6%) tested positive in 2001 and 2002, respectively. One hundred and ten (77%) and 113 (83%) mothers and infants, respectively, received ARV therapy, (92% - nevirapine, 8% - zidovudine). Twenty-three per cent of pregnant women received no ARV Forty-four (25.0%) of the 176 infants had a documented ELISA HIV test before eighteen months of age, none had a PCR test. The health status of 40 (23%) of these children was known: 30 (75%) were alive and well, five of whom did not receive any ARV, one (2.5%) was alive and ill and nine (22.5%) were reported dead, five of whom received ARV; 28.6% of infants who did not receive ARV were reported as either dead or ill compared to 13.8% of those receiving ARV CONCLUSION: Though the majority of pregnant women discovered their HIV status during pregnancy, a significant number got pregnant knowing that they were HIV+. The majority of mothers and infants received ARV but the follow-up and testing of infants was limited. Nevirapine is clearly protective in the prevention of MTCT of HIV and should be made universally accessible. All infants delivered to HIV+ mothers should be identified and tested for HIV.
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Nursing care has been the "grass roots" of healthcare management even before nursing became a profession. Literature on the nursing experience with HIV is minimal and so it is challenging to comment on, or to compare experiences. ⋯ Nursing intervention is a vital part of a pMTCT HIV programme; however, ongoing education and training of the entire healthcare team needs to be continued in order to strengthen the programme. It is hoped that much of what is done in the Kingston Paediatric and Perinatal HIV/AIDS Programme will become integrated in the nursing management of maternal and child health nationally.
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Gunshot injuries are an escalating social and medical dilemma in many Western and some developing countries. Of 40 patients arriving at the University Hospital of the West Indies (UHWI), Jamaica, from 1993 to 1998, with gunshot wounds of the head, 30 were admitted. Six of those admitted died within 24 hours, five with poor Glasgow Coma scores. ⋯ Fourteen patients had associated injuries, four of which were in the neck. Surgery was considered inappropriate for moribund patients and those with inaccessible bone and bullet fragments. Young males were the most common victims of this devastating form of assault.
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Controversy has arisen regarding the length and nature of the preoperative fast that should be required of patients with normal gastric emptying time undergoing elective surgery. Various studies and editorials have indicated that the traditional preoperative fasting policy of "NPO after midnight" may be illogical as it makes no distinction between solid foods and clear fluids. Successive National Surveys conducted in the United States of America (USA) have shown an increasing number of Ambulatory Surgery Hospitals adopting more liberal preoperative fasting guidelines. ⋯ Also, 66%, 68%, and 73% of respondents stated that, in the future, they were prepared to allow their patients a solid meal up to eight hours, light breakfast up to six hours, and clear fluids up to three hours, respectively. We concluded that, whilst the traditional NPO policy remained firmly entrenched at the institutional level, many anaesthetists and surgeons show a positive inclination towards more liberal fasting practices. We recommend the formation of a local task force to determine what aspects of the new liberal guidelines may be safely and effectively adopted, taking account of local circumstances.