W Indian Med J
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Between January 1990 and May 1995, 117 patients were admitted to the Intensive Care Unit at Holberton Hospital, Antigua, for chest pain due to suspected acute myocardial infarction. 39 (45%) of 86 patients whose records were available for retrospective review had confirmed (27 patients) or probable (12 patients) acute myocardial infarction. Risk factors identified among the patients included hypertension, diabetes, tobacco smoking, hypercholesterolaemia and obesity. On admission, 82% were Killip class I and 18% were Killip class II. ⋯ No thrombolytic agents were available. The average hospital stay was 10 days and the in-hospital mortality rate was 13%. These data indicate that early mortality from acute myocardial infarction can be reduced in developing countries by early admission to an Intensive Care Unit and use of drugs known to be effective in its treatment.
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In order to determine the experiences with health services of caregivers of children with disabilities (CWDs), and the attitudes of health care workers (HCWs) towards CWDs and their caregivers, a survey was conducted of 26 caregivers of clients of 3D Projects, St. Mary, Jamaica, using a checklist, and of 113 HCWs in St Mary and Kingston who completed a questionnaire. ⋯ These problems led to unrealistic expectations about the outcome of rehabilitation. 13 caregivers attributed disability of their CWDs to negligence, carelessness or poor treatment by HCWs during pregnancy or the early neonatal period. 87% of the HCWs, particularly Community Health Aides (CHAs), acknowledged at least some responsibility for the care of CWDs; but 10%, notably some nurses and midwives, denied responsibility. 90% referred patients for further care and 90% thought that they had made an impact on caregivers' 'beliefs'; but more than half the CHAs, and 25 to 30% of the other groups, expressed dissatisfaction with their management of CWDs. This study has highlighted inadequacies in the care of CWDs in St Mary and indicates that more appropriate preparation of all health staff for this important aspect of their work is required.
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A 24-hour glycaemic profile following streptozotocin (80 mg/kg. i.p.) injection was investigated in fasted rats. The most prominent changes in blood glucose were hyperglycaemia associated with low levels of plasma insulin after two hours followed by hypoglycaemia associated with high levels of plasma insulin after six hours; subsequently hyperglycaemia progressively developed and this was associated with decreasing levels of plasma insulin. Further probing revealed that at two hours after streptozotocin injection, the pancreatic beta-cells could not respond to an oral glucose load while, at six hours after, there was an apparent return of beta-cell responsiveness, but subsequently beta-cell responsiveness was progressively lost and histological examination revealed cellular damage. From these results, it is concluded that within six hours of injection, streptozotocin initiates pancreatic beta-cell damage which leads to the development of diabetes mellitus.
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An observational cross-sectional survey showed that 21.1% of private motor vehicle drivers and 13.5% of front seat passengers voluntarily wore seat belts in Kingston, Jamaica, where there is no law requiring this. Rear passenger utilisation was not examined. Compared to males, females were significantly more likely to wear seat belts when driving but not as front seat passengers. ⋯ Drivers of older vehicles were significantly less likely to use seat belts even when the vehicles were equipped with belts. Implementation of legislation can reduce mortality, morbidity and costs from road traffic accidents which are relatively frequent in Jamaica. Male drivers, drivers of older vehicles and all passengers may require specific targeting in an educational and enforcement campaign should legislation, which is highly desirable, be implemented.
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One hundred and twelve patients with penetrating abdominal injuries seen at the Kingston Public Hospital, Jamaica, over a twelve month period from January 1 to December 31, 1992 were reviewed. Seventy-five (67%) patients had stab wounds and thirty-seven (33%) sustained gunshot wounds. There were 10 deaths (27%) from gunshot wounds, and seven deaths (9%) due to stab wounds. ⋯ The male to female ratio was 10:1 with 88% in the age group 16-35 years. A decision to perform laparotomy was based entirely on clinical diagnosis of peritonitis. In gunshot wounds a policy of mandatory laparotomy was used and is recommended.