RESUMEN
BACKGROUND AND AIM: The risk of death from coronary heart disease (CHD) in women with diabetes is more than three times that of non-diabetic women. We assessed the difference in CHD risk levels of Afro-Caribbean diabetic women provided with facilities for self-monitoring of blood glucose and their counterparts without such facilities MATERIALS AND METHODS: Forty-nine patients who never used gluco-meters were studied as intervention (23) and control (26) groups. The intervention group was trained on self-monitoring of blood glucose. At baseline, BP, anthropometric indices, and fasting blood glucose of all patients were measured. Subsequently, the intervention patients were provided with gluco-meters, testing strips, and advised to self-monitor fasting and postprandial blood glucose every other day for 6 months. CHD risk was determined with the United Kingdom Prospective Diabetes Study risk engine calculator. RESULTS: The age, duration of diagnosis of diabetes, BP, and anthropometric indices were similar in the two groups (all, P > 0.05). The majority of the patients were unemployed or retired with only primary education. After 3 months, the HbA 1c levels of the control patients did not change (8.3 ± 0.4% vs. 7.8 ± 0.4%, P > 0.05) whereas the HbA 1c levels of the intervention patients reduced significantly from the baseline at 3 (9.2 ± 0.4% vs. 7.4 ± 0.3%, P <0.001) and 6 (9.2 ± 0.4% vs. 7.3 ± 0.3%, P <0.001) months. The 10-year CHD risk level of the intervention group was remarkably reduced from the baseline level after 6 months (7.4 ± 1.3% vs. 4.5 ± 0.9%) of the study. CONCLUSION: Provision of facilities for self-monitoring of blood glucose in Afro-Caribbean women with type 2 diabetes improves both their glycemic control and CHD risk profile.
Asunto(s)
Glucemia/metabolismo , Enfermedad Coronaria/etnología , Diabetes Mellitus Tipo 2/etnología , Hemoglobina Glucada/análisis , Población Negra , Automonitorización de la Glucosa Sanguínea , Presión Sanguínea/fisiología , Estudios de Casos y Controles , Enfermedad Coronaria/complicaciones , Enfermedad Coronaria/epidemiología , Enfermedad Coronaria/fisiopatología , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/fisiopatología , Femenino , Humanos , Hipoglucemiantes/uso terapéutico , Metabolismo de los Lípidos , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Factores Socioeconómicos , Factores de Tiempo , Trinidad y Tobago/epidemiologíaRESUMEN
BACKGROUND and AIM: The risk of death from coronary heart disease (CHD) in women with diabetes is more than three times that of non-diabetic women. We assessed the difference in CHD risk levels of Afro-Caribbean diabetic women provided with facilities for self-monitoring of blood glucose and their counterparts without such facilities. MATERIALS and METHODS: Forty-nine patients who never used gluco-meters were studied as intervention (23) and control (26) groups. The intervention group was trained on self-monitoring of blood glucose. At baseline, BP, anthropometric indices, and fasting blood glucose of all patients were measured. Subsequently, the intervention patients were provided with gluco-meters, testing strips, and advised to self-monitor fasting and postprandial blood glucose every other day for 6 months. CHD risk was determined with the United Kingdom Prospective Diabetes Study risk engine calculator. RESULTS: The age, duration of diagnosis of diabetes, BP, and anthropometric indices were similar in the two groups (all, P > 0.05). The majority of the patients were unemployed or retired with only primary education. After 3 months, the HbA 1c levels of the control patients did not change (8.3 ñ 0.4% vs. 7.8 ñ 0.4%, P > 0.05) whereas the HbA 1c levels of the intervention patients reduced significantly from the baseline at 3 (9.2 ñ 0.4% vs. 7.4 ñ 0.3%, P <0.001) and 6 (9.2 ñ 0.4% vs. 7.3 ñ 0.3%, P <0.001) months. The 10-year CHD risk level of the intervention group was remarkably reduced from the baseline level after 6 months (7.4 ñ 1.3% vs. 4.5 ñ 0.9%) of the study. CONCLUSION: Provision of facilities for self-monitoring of blood glucose in Afro-Caribbean women with type 2 diabetes improves both their glycemic control and CHD risk profile.
Asunto(s)
Humanos , Femenino , Enfermedad Coronaria , Índice Glucémico , Diabetes Mellitus Tipo 2 , Trinidad y TobagoRESUMEN
OBJECTIVE: Primary prevention of Coronary Heart Disease (CHD) in diabetic patients should be based on absolute CHD risk calculation. This study was aimed to determine the levels of 10-year CHD risk in Caribbean type 2 diabetic patients using the diabetes specific United Kingdom Prospective Diabetes Study (UKPDS) risk engine calculator. SUBJECTS AND METHODS: Three hundred and twenty-five (106 males, 219 females) type 2 diabetic patients resident in two Caribbean Islands of Tobago and Trinidad met the UKPDS risk engine inclusion criteria. Records of their sex, age, ethnicity, smoking habit, diabetes duration, systolic blood pressure, total cholesterol, HDL-cholesterol and glycated haemoglobin were entered into the UKPDS risk engine calculator programme and the absolute 10-year CHD and stroke risk levels were computed. The 10-year CHD and stroke risks were statistically stratified into <15%, 15-30% and >30% CHD risk levels and differences between patients of African and Asian-Indian origin were compared. RESULTS: In comparison with patients in Tobago, type 2 diabetic patients in Trinidad, irrespective of gender, had higher proportion of 10-year CHD risk (10.4 vs. 23.6%, P<0.001) whereas the overall 10-year stroke risk prediction was higher in patients resident in Tobago (16.9 vs. 11.4%, P<0.001). Ethnicity-based analysis revealed that irrespective of gender, higher proportion of patients of Indian origin scored >30% of absolute 10-year CHD risk compared with patients of African descent (3.2 vs. 28.2%, P<0.001). CONCLUSIONS: The results of the study identified diabetic patients resident in Trinidad and patients of Indian origin as the most vulnerable groups for CHD. These groups of diabetic patients should have priority in primary or secondary prevention of coronary heart disease.
Asunto(s)
Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Humanos , Masculino , Femenino , Enfermedad Coronaria , Diabetes Mellitus Tipo 2 , Inhibidores de Hidroximetilglutaril-CoA Reductasas , Atención Primaria de Salud , Accidente Cerebrovascular , Trinidad y TobagoRESUMEN
OBJECTIVE: Primary prevention of Coronary Heart Disease (CHD) in diabetic patients should be based on absolute CHD risk calculation. This study was aimed to determine the levels of 10-year CHD risk in Caribbean type 2 diabetic patients using the diabetes specific United Kingdom Prospective Diabetes Study (UKPDS) risk engine calculator. SUBJECTS AND METHODS: Three hundred and twenty-five (106 males, 219 females) type 2 diabetic patients resident in two Caribbean Islands of Tobago and Trinidad met the UKPDS risk engine inclusion criteria. Records of their sex, age, ethnicity, smoking habit, diabetes duration, systolic blood pressure, total cholesterol, HDL-cholesterol and glycated haemoglobin were entered into the UKPDS risk engine calculator programme and the absolute 10-year CHD and stroke risk levels were computed. The 10-year CHD and stroke risks were statistically stratified into <15%, 15-30% and >30% CHD risk levels and differences between patients of African and Asian-Indian origin were compared. RESULTS: In comparison with patients in Tobago, type 2 diabetic patients in Trinidad, irrespective of gender, had higher proportion of 10-year CHD risk (10.4 vs. 23.6%, P<0.001) whereas the overall 10-year stroke risk prediction was higher in patients resident in Tobago (16.9 vs. 11.4%, P<0.001). Ethnicity-based analysis revealed that irrespective of gender, higher proportion of patients of Indian origin scored >30% of absolute 10-year CHD risk compared with patients of African descent (3.2 vs. 28.2%, P<0.001). CONCLUSIONS: The results of the study identified diabetic patients resident in Trinidad and patients of Indian origin as the most vulnerable groups for CHD. These groups of diabetic patients should have priority in primary or secondary prevention of coronary heart disease.
Asunto(s)
Enfermedad Coronaria/etnología , Diabetes Mellitus Tipo 2/etnología , Angiopatías Diabéticas/etnología , Anciano , Enfermedad Coronaria/tratamiento farmacológico , Enfermedad Coronaria/prevención & control , Femenino , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Masculino , Persona de Mediana Edad , Atención Primaria de Salud , Prevención Primaria , Medición de Riesgo , Prevención Secundaria , Accidente Cerebrovascular/etnología , Trinidad y Tobago/epidemiologíaRESUMEN
In order for hepatitis B immunization programmes to be cost effective and clinically beneficial, vaccinated persons should maintain an immunity threshold titre of antibodies to hepatitis B surface antigen greater than 10 IU/l. Those who fall below this level should be boosted in order to be covered against the risk for which the vaccine was administered. Persons with sickle cell disease are included in the group for whom hepatitis B immunization is routinely prescribed. Antibody to hepatitis B surface antigen was measured in paired sera of thirty patients with sickle cell disease compared with a control group of healthy medical staff, five years post vaccination. There was no significant difference between patients with sickle cell disease and normal controls in the levels of antibody maintained or numbers that required booster vaccination. Recommendations for the maintenance of protection via revaccination should be the same for persons with sickle cell disease as for healthy persons.
Asunto(s)
Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Vacunas contra Hepatitis B , Hepatitis B , Anemia de Células Falciformes , Inmunización Secundaria , Estudios de Casos y Controles , Vacunas contra Hepatitis B , Anemia de Células Falciformes , Esquemas de Inmunización , Programas de Inmunización/economíaRESUMEN
In order for hepatitis B immunization programmes to be cost effective and clinically beneficial, vaccinated persons should maintain an immunity threshold titre of antibodies to hepatitis B surface antigen greater than 10 IU/l. Those who fall below this level should be boosted in order to be covered against the risk for which the vaccine was administered. Persons with sickle cell disease are included in the group for whom hepatitis B immunization is routinely prescribed. Antibody to hepatitis B surface antigen was measured in paired sera of thirty patients with sickle cell disease compared with a control group of healthy medical staff, five years post vaccination. There was no significant difference between patients with sickle cell disease and normal controls in the levels of antibody maintained or numbers that required booster vaccination. Recommendations for the maintenance of protection via revaccination should be the same for persons with sickle cell disease as for healthy persons.
Asunto(s)
Anemia de Células Falciformes , Vacunas contra Hepatitis B/administración & dosificación , Hepatitis B/prevención & control , Inmunización Secundaria , Adolescente , Adulto , Anemia de Células Falciformes/complicaciones , Anemia de Células Falciformes/inmunología , Estudios de Casos y Controles , Femenino , Vacunas contra Hepatitis B/inmunología , Humanos , Programas de Inmunización/economía , Esquemas de Inmunización , Masculino , Persona de Mediana EdadRESUMEN
Severe aplastic anaemia is uniformly fatal unless treated with immunosuppressive therapy or bone marrow transplantation. The latter is curative in 65% of patients and is the treatment of choice in children and young adults. Antilymphocyte globulin (ALG) and cyclosporin may be used successfully in the absence of an HLA matched sibling donor. We report the case of a twelve-year-old boy with severe aplastic anaemia who received immunosuppressive treatment with ALG and cyclosporin and is alive and well three years and six months post treatment.
Asunto(s)
Anemia Aplásica/tratamiento farmacológico , Suero Antilinfocítico/uso terapéutico , Ciclosporina/uso terapéutico , Inmunosupresores/uso terapéutico , Antiinflamatorios/uso terapéutico , Niño , Quimioterapia Combinada , Humanos , Hidrocortisona/uso terapéutico , MasculinoRESUMEN
A pre-operative autologous blood donation programme was started in 1988 and made available to all doctors offering elective surgical procedures. Two hundred and seventy-seven (277) patients presented for autologous donation over a five-year period. Nine point four per cent were rejected because of low haemoglobin ( < 10.5 g/dl). The single biggest user of the programme was the Princess Elizabeth Hospital for handicapped persons. Patients undergoing orthopaedic procedures gave 50% of the donations, and ranged in age from 10 to 73 years. The oldest donor was a 73-year-old man who had an abdominal aortic aneurysm replaced. Gynaecological surgeons in the public and private sectors together provided 43.9% of donors, 3.6% of these underwent elective Caesarean Section, each donating one unit of blood at 36 weeks. Patients undergoing general surgical procedures comprised 10.4% of donors. Autologous donors contributed 1.3% of the total number of donations over this period.