W Indian Med J
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The susceptibility of 39 toxin producing Clostridium difficile isolates from stools of hospitalized patients was determined, by disc diffusion, to six antibiotics. All but one isolate (toxin A negative) produced toxin A and toxin B. A wide variation in susceptibility to clindamycin, tetracycline and chloramphenicol was noted. ⋯ All erythromycin sensitive strains found at the NCH were from patients transferred to that hospital. These findings suggest that there is a common strain of C difficile (erythromycin resistant) at the NCH different from that found at the UHWI; the resistant pattern seen with isolates from the NCH was typical of toxigenic serogroup C strain and could be typed by the the disc diffusion method. Patients at the NCH who were colonized with either of the two strains of C difficile were likely to get diarrhoea, once there was suppression of the normal microflora by antibiotics and colonic overgrowth with C difficile.
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Postoperative nausea and vomiting (PONV) in patients in the recovery room can delay transfer of such patients to the wards, preventing a smooth inflow of patients into the recovery area. The high incidence of these complications in developed countries has led to the introduction of management strategies that may be too expensive for developing countries. An investigation of the incidence and factors associated with PONV in the recovery room of the Public Hospital, Georgetown, Guyana, was undertaken with a view to developing an approach to its management based on local data. ⋯ PONV in the recovery room was associated with female gender, gynaecological surgery, extra-abdominal surgery and lack of anti-emetic medication (p < 0.05), as well as prolonged duration of recovery room stay (p < 0.01). A management strategy for PONV in the recovery room involving continued use of present anaesthetic agents, increased use of inexpensive anti-emetic drugs currently available in Guyana, and targeting of patients found to be more at risk is suggested. Increased regional techniques may also be appropriate.
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With the heavy burden of diabetes mellitus among American Indians and Alaskan Natives, lower-extremity amputation (LEA) has become a common complication. Rates of diabetes-related LEA are 2-3 times those observed in other diabetic populations. During the past 12 years, the Indian Health Service (IHS) has made LEA prevention a public health priority. ⋯ Follow-up studies in Alaska and northern Minnesota saw 25-50% reductions in LEA rates associated with these interventions. In settings where these efforts were augmented with system changes, such as team coordination, patient-tracking systems, comprehensive footcare practice guidelines, flowsheets, and outreach programmes, LEA incidence was reduced by 50-75%. Efforts are currently underway to disseminate system-based approaches for comprehensive diabetic footcare and to expand the availability of foot care resources to tribal communities served by the IHS.
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A retrospective analysis of the spectrum and relative frequency of salivary gland lesions diagnosed in the Department of Pathology, University of the West Indies, Kingston, Jamaica, between 1965 and 1994, is reported. Four hundred and sixty-four salivary gland biopsies were received. Of these 99 (21.3%) were non-neoplastic and the remaining 365 (78.7%) were neoplasms: 261 (71.5%) were benign and 104 (28.5%) malignant. ⋯ The increased frequency of MEC over ACC is at variance with other reported series but the preponderance of pleomorphic adenoma is consistent. In the major salivary glands, benign neoplasms predominate at a ratio of 3:1, while a higher proportion of minor salivary gland neoplasms was malignant, ratio 1.2:1 (p = 0.003). These data represent the first attempt to document the spectrum of disease related to oral and maxillofacial pathology in Jamaica.