RESUMO
We present a case of bone marrow granulomas in a 64-year-old West Indian man who presented with severe leucopenia, anaemia, thrombocytopenia, hepatosplenomegaly, hypercalcaemia, hypercalciuria, elevated angiotensin converting enzyme level and reticulo-nodular shadows on chest X-ray. Bone marrow biopsy revealed numerous non-caseating epithelioid granulomas. A diagnosis of sarcoidosis was made and he was treated with prednisolone 60 mg daily for four weeks and the dose was subsequently reduced to 30 mg daily. Eight months follow-up revealed persistent pancytopenia. Bone marrow granulomas are rare and, when they occur, sarcoidosis is an uncommon aetiology. This case illustrates that severe leucopenia may occur in sarcoidosis and may present therapeutic difficulties.
Assuntos
Doenças da Medula Óssea/diagnóstico , Leucopenia/diagnóstico , Sarcoidose/diagnóstico , Biópsia , Medula Óssea/patologia , Doenças da Medula Óssea/patologia , Granuloma/diagnóstico , Granuloma/patologia , Humanos , Leucopenia/patologia , Masculino , Pessoa de Meia-Idade , Sarcoidose/patologia , Índice de Gravidade de DoençaRESUMO
We present a case of bone marrow granulomas in a 64-year-old West Indian man who presented with severe leucopenia, anaemia, thrombocytopenia, hepatosplenomegaly, hypercalcaemia, hypercalciuria, elevated angiotensin converting enzyme level and reticulo-nodular shadows on chest X-ray. Bone marrow biopsy revealed numerous non-caseating epithelioid granulomas. A diagnosis of sarcoidosis was made and he was treated with prednisolone 60 mg daily for four weeks and the dose was subsequently reduced to 30 mg daily. Eight months follow-up revealed persistent pancytopenia. Bone marrow granulomas are rare and, when they occur, sarcoidosis is an uncommon aetiology. This case illustrates that severe leucopenia may occur in sarcoidosis and may present therapeutic difficulties
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Doenças da Medula Óssea/diagnóstico , Leucopenia/diagnóstico , Sarcoidose/diagnóstico , Biópsia , Doenças da Medula Óssea/patologia , Granuloma/diagnóstico , Granuloma/patologia , Leucopenia/patologia , Medula Óssea/patologia , Sarcoidose/patologia , Índice de Gravidade de DoençaRESUMO
A case of fatal strongyloidiasis associated with human T-cell lymphotropic virus type 1 (HTLV-1) infection is described in a 45-year-old West Indian man living in an area endemic for both strongyloidiasis and HTLV-1 infection. Clinical presentation was typical with severe diarrhea, vomiting, and progressive weight loss. Stool microscopy revealed Strongyloides stercoralis rhabditiform larvae. Despite treatment with thiabendazole, the patient died. Autopsy findings revealed severe ileocolitis due to Strongyloides larvae, right subdiaphragmatic pyogenic abscess, and severe pleuritis of the right lower lobe of the lung. This case illustrates that despite effective antihelmintic therapy, mortality is still high in patients with the hyperinfective state of S. stercoralis. Thus, in patients in areas endemic for both Strongyloides infection and HTLV-1, or in immigrants from these areas, repeated stool microscopy is indicated in patients positive for HTLV-1.
Assuntos
Infecções por HTLV-I/complicações , Estrongiloidíase/etiologia , Evolução Fatal , Infecções por HTLV-I/imunologia , Humanos , Tolerância Imunológica , Masculino , Pessoa de Meia-IdadeRESUMO
We describe a case of Kaposi's sarcoma in a previously healthy 35-year-old bisexual West Indian man of African descent who was seronegative for the human immunodeficiency virus (HIV) and human T-cell lymphotropic virus-1 (HTLV-1) and who presented with extensive mucocutaneous lesions, weight loss, visceral and generalized lymph node involvement, poor response to combination therapy with vinblastine and interferon alfa-2a, and a short survival of eight months from the onset of illness. This is the first documented case of Kaposi's sarcoma in Dominica. The presentation is unusual in that it is similar to the aggressive and disseminated Kaposi's sarcoma seen only in AIDS and the florid variant of the endemic disease in young men in Equatorial Africa.
Assuntos
Soronegatividade para HIV , Sarcoma de Kaposi/diagnóstico , Neoplasias Cutâneas/diagnóstico , Adulto , Antineoplásicos Fitogênicos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Evolução Fatal , Humanos , Interferon alfa-2 , Interferon-alfa/uso terapêutico , Masculino , Proteínas Recombinantes , Sarcoma de Kaposi/tratamento farmacológico , Neoplasias Cutâneas/tratamento farmacológico , Vimblastina/uso terapêuticoRESUMO
We describe a case of Kaposi's sarcoma in a previously healthy 35-year-old bisexual West Indian man of African descent who was seronegative for the human immunodeficiency virus (HIV) and human T-cell lymphotropic virus-1 (HTLV-1) and who presented with extensive mucocutaneous lesions, weight loss, visceral and generalized lymph node involvement, poor response to combination therapy with vinblastine and interferon alfa-2a, and a short survival of eight months from the onset of illness. This is the first documented case of Kaposi's sarcoma in Dominica. The presentation is unusual in that it is similar to the aggressive and disseminated Kaposi's sarcoma seen only in AIDS and the florid variant of the endemic disease in young men in Equatorial Africa.
Assuntos
Adulto , Humanos , Masculino , Sarcoma de Kaposi , Soronegatividade para HIV , Neoplasias Cutâneas/diagnóstico , Sarcoma de Kaposi , Vimblastina , Interferon-alfa , Antineoplásicos Fitogênicos/uso terapêutico , Evolução Fatal , Neoplasias Cutâneas/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêuticoRESUMO
Attention to intracultural diversity in anthropological research has increased, but the implications of that diversity for research design and data analysis in medical anthropology have not proceeded as far. An examination of diversity and its use in guiding data analyses is given here, based on the study of blood pressure and its social and psychological correlates. It is argued that in the specific ethnographic setting of a small West Indian town, social class structures the diversity of the meanings of beliefs and behaviors. Diversity of meanings, in turn, alters the associations of those beliefs and behaviours with blood pressure. Data analyses guided by this orientation demonstrate that the social patterning of blood pressure varies between and within social class. Specifically, it is shown that one model of social and psychological influences on blood pressure applies only to middle-class persons in a small Jamaican community and not to lower-class persons. Medical anthropologists need to be more sensitive to the range of intracultural diversity and to how that diversity can influence the results of research.
Assuntos
Atitude Frente a Saúde , Negro ou Afro-Americano/psicologia , Pressão Sanguínea , Diversidade Cultural , Comportamentos Relacionados com a Saúde , Adulto , População Negra , Feminino , Humanos , Jamaica , Estilo de Vida , Masculino , Pessoa de Meia-Idade , População Rural , Classe Social , Valores Sociais , Fatores SocioeconômicosAssuntos
Setor Privado , Saúde Pública , Universidades , Atenção à Saúde , Educação em Saúde , Prioridades em Saúde , Humanos , Valor da Vida , Índias OcidentaisRESUMO
Research on the factors mediating social class differences in blood pressure was carried out in a Jamaican community. It was found in a previous report that higher social class is related to lower blood pressure for females, while for males higher social class is related to higher blood pressure. These differences are examined in greater detail here, especially in terms of the historical context of the specific community studied, which is on the fringe of the Kingston urban area, and in terms of the continuing importance of a social class system established under colonial rule. In the current study it is shown that social class differences in blood pressure for males are mediated by perceptions of social support. Social class differences in blood pressure for females are mediated by perceptions of economic stress. It is suggested that specific patterns of the growth of the city, and the historically-based social class system, have resulted in the juxtaposition of lower and middle class Jamaicans within this community, who in turn are influenced by different factors affecting blood pressure.
Assuntos
Hipertensão/epidemiologia , Classe Social , Adulto , Feminino , Humanos , Hipertensão/etiologia , Hipertensão/psicologia , Jamaica/epidemiologia , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Prevalência , Análise de Regressão , Fatores Sexuais , Apoio Social , Estresse Psicológico/complicaçõesRESUMO
The aim of comparative research in social epidemiology is to determine how risk factors for disease may vary within and between sociocultural and ethnic groups and in relation to outcomes. This aim assumes that measurement equivalence within and between social groups can be established, an assumption usually left untested. A model is presented here for deriving cross-culturally valid measures that are also intraculturally sensitive. Measurements so derived can then be used to compare cross-cultural and intracultural effects in a single analytic model. This approach is illustrated by pooling data on social stressors, social supports, and blood pressure from three studies.
Assuntos
Comparação Transcultural , Métodos Epidemiológicos , Hipertensão/etnologia , Metanálise como Assunto , Adulto , Pressão Sanguínea , Brasil/epidemiologia , Feminino , Humanos , Jamaica/epidemiologia , Estilo de Vida , Masculino , México/epidemiologia , Fatores de Risco , Apoio Social , Estresse Psicológico/etnologiaRESUMO
Neuropsychiatric manifestations of typhoid fever are not uncommon, occurring in 18 of 40 consecutive patients at the University Hospital of the West Indies. The clinical presentation ranges from a confusional state to hallucinations or meningism, and the diagnosis may be missed or unduly delayed unless there is a strong index of suspicion.
Assuntos
Delírio/etiologia , Febre Tifoide/complicações , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Delírio/epidemiologia , Feminino , Hospitais Universitários , Humanos , Incidência , Jamaica , Masculino , Pessoa de Meia-IdadeRESUMO
Neuropsychiatric manifestations of typhoid fever are not uncommon, occurring in 18 of 40 consecutive patients at the University Hospital of the West Indies. The clinical presentation ranges from a confusional state to hallucinations or meningism, and the diagnosis may be missed or unduly delayed unless there is a strong index of suspicion
Assuntos
Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Humanos , Masculino , Feminino , Febre Tifoide/complicações , Delírio/etiologia , Estudos de Coortes , Delírio/epidemiologia , Jamaica , Hospitais UniversitáriosRESUMO
Although the Doctor of Medicine programme in Internal Medicine at the U.W.I. is a structured course with several teaching formats, the optimally effective form of teaching remains unknown. An experimental didactic teaching course in Gastroenterology was preceded and followed by an examination. This was conducted to determine the effectiveness of this form of teaching. The majority of residents ranked the course favourably. The mean examination score increased by 6.4%, from 25.4% before the course to 31.8% at the end. Although the more senior residents scored higher than their juniors in the pre-test, this difference disappeared in the post-test. Structured didactic teaching requires close supervision, active participation by trainee and reinforcement for the full benefit to be attained.
Assuntos
Educação Médica Continuada/normas , Gastroenterologia/educação , Ensino/métodos , Competência Clínica , Humanos , JamaicaRESUMO
Although the Doctor of Medicine programme in Internal Medicine at the U. W. I. is a structured course with several teaching formats, the optimally effective form of reaching remains unknown. An experimental didactic teaching course in Gastroenterology was preceded and followed by an examination. This was conducted to determine the effectiveness of this form of teaching. The maajority of residents ranked the course favourably. the mean examination score increased by 6.4%, form 25.4% before the course to 31.8% at the end. Although the more senior residents scored higher than their juniors in the pre-test, this difference disappeared in the post-test. Structured didactic teaching requirs close supervision, active participation by trainee and reinforcement for the full benefit to be attained
Assuntos
Humanos , Ensino , Educação Médica Continuada/normas , Gastroenterologia/educação , Competência Clínica , JamaicaRESUMO
A study of social factors and blood pressure was conducted in a Jamaican community among a sample of 199 persons ages 30 to 50. After controlling for obesity, age, and respondent tension (and other covariates), interaction effects of social class x sex for systolic and diastolic blood pressure were found. Blood pressure increased with increasing social class for males and decreased with increasing social class for females.
Assuntos
Pressão Sanguínea , Classe Social , Adulto , Feminino , Inquéritos Epidemiológicos , Humanos , Jamaica , Masculino , Pessoa de Meia-Idade , Estresse PsicológicoAssuntos
Pressão Sanguínea , Eritrócitos/análise , Hipertensão/tratamento farmacológico , Potássio/uso terapêutico , Sódio/sangue , Bendroflumetiazida/efeitos adversos , População Negra , Pressão Sanguínea/efeitos dos fármacos , Quimioterapia Combinada , Feminino , Humanos , Hipopotassemia/induzido quimicamente , Jamaica , Masculino , Potássio/sangueRESUMO
This report of a 30-year-old male Jamaican presenting with severe refractory hypertension describes the uncommon association between renal artery stenosis and neurofigromartosis, and seves to focus attention upon this potentially secondary cause of hypertension in such patients
Assuntos
Adulto , Humanos , Masculino , Obstrução da Artéria Renal/complicações , Neoplasias Cutâneas/complicações , Neurofibromatoses/complicações , Hipertensão/etiologia , JamaicaAssuntos
Poliarterite Nodosa , Adulto , Feminino , Humanos , Jamaica , Masculino , Pessoa de Meia-Idade , Poliarterite Nodosa/patologiaRESUMO
This report describes the main features of the 5 cases of polyarteritis nodosa seen at the University Hospital of the West Indies over a 10-year period. The disease manifestations are protean and only 2 of the 5 patients were diagnosed antemortem, indicating the need to increase physician awareness, especially since response to therapy has improved significantly in recent years