W Indian Med J
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Review Case Reports
The Ilizarov technique in the treatment of tibial bone defects. Case reports and review of the literature.
Autogenous cancellous bone grafting has long been the hallmark of skeletal defect management. Unfortunately, the small number of donor sites in the human body constitutes an absolute limit on the quantity of fresh autogenous cancellous bone available for filling a segmental defect. ⋯ Intercalary defects resulting from trauma, infection or tumour can be treated with transport of a segment of bone within the limb using the Ilizarov technique. We report on three cases of local bone transportation for intercalary tibial defects by the Ilizarov method.
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A number of studies attempting to identify specific risk factors for dementia have noted an inverse relationship between educational background and the likelihood of developing dementia. This idea has been somewhat controversial as educational background can introduce a number of confounding factors that generally affect health and lifestyle. Despite these reservations, there is mounting evidence to support the concept of education (or increased mental activity) producing a functional reserve in the brain, a process that provides some protection against the clinical manifestation of dementia. ⋯ We have shown recently that LTP reduces the sensitivity of hippocampal neurons to agonists of the neurotransmitter glutamate; additionally, we have reported that LTP protects the neurons from the effects of acute hypoxia. Given that the effect of hypoxia on neurons involves over-stimulation by glutamate, and hypoxia has been implicated in the aetio-pathology of some types of dementia, our observations suggest that LTP has a protective effect on neuronal tissue. Such an interaction offers a physiological basis for the epidemiological evidence that lifelong learning can protect a person from some types of dementia.
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The high incidence of trauma in Jamaica is well documented. Trauma accounts for approximately 40 per cent of the workload in both the Accident and Emergency Unit and the surgical wards at the University Hospital of the West Indies. The death rates for motor vehicle accidents and homicide in Jamaica are greater than those in developed countries as well as the rest of the Caribbean region. ⋯ In hospitals, most preventable deaths occur within the first few hours of admission. An organized system of care which ensures that the right patient is taken to the right hospital at the right time as well as training in Advanced Trauma Life Support should reduce the preventable death rate. Collaboration is needed between health workers and other concerned groups to stimulate an interest in injury prevention and improvement in trauma care.
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Hyperbilirubinaemia is a common neonatal problem worldwide and is the leading cause of admission to the Special Care Nursery in Antigua and Barbuda. In 1990, the Innocenti Declaration in support of breast-feeding led to the adoption of the Baby-Friendly Hospital Initiative in many countries of the Caribbean, including Antigua and Barbuda. Comparing 1989 to the years 1992 to 1994, the Special Care Nursery at Holberton Hospital experienced a 40% increase in newborns admitted with hyperbilirubinaemia (peak total bilirubin > 12 mg/dl or 205 mumol/l). ⋯ Early discharge in developed countries has led to increased readmissions for hyperbilirubinaemia. Following the appointment of a dietitian to supervise breast-feeding, admissions for hyperbilirubinaemia fell by 50% by 1998. These data suggest that exclusive breast-feeding and early discharge led to an epidemic of neonatal hyperbilirubinaemia in Antigua and Barbuda.
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Multicenter Study
Paediatric HIV/AIDS in Jamaica. A hospital-based description.
The continuing worldwide epidemic of adult HIV/AIDS has led to an increase in the number of HIV-positive children mainly through perinatal transmission. Although national data are available, there is no published report of the epidemiology of HIV/AIDS in children in Jamaica. A multicentre retrospective analysis of 183 HIV seropositive children admitted to hospitals in Jamaica between 1990 and 1996 was conducted. ⋯ From these data, it is estimated that the hospital-based HIV incidence among children in Jamaica increased from 0.149 per 10,000 person years in 1990 to 1.331 per 10,000 person years in 1996. This study demonstrates a rise in the estimated incidence of HIV/AIDS but we were unable to estimate survival reliably since the data required were not available for 75% of children identified. These data highlight the urgent need for targeted interventions to reduce vertical transmission of HIV as well as a need for prospective studies to establish reliable data on incidence and long-term outcome for HIV-infected children.