RESUMO
OBJECTIVES: To compare incidence rates of childhood-onset IDDM among black African-heritage populations age 0-19 years in the Caribbean region. RESEARCH DESIGN AND METHODS: Population-based registries for IDDM were established on the eastern Caribbean islands of Antigua, Barbados, Dominica, St. Croix, S t. Kitts, St. Thomas, and Tortola using standardized criteria from the World Health Organization (WHO) Multinational Project for Childhood Diabetes (DiaMond). Average annual incidence rates (IR) with 95 percent CI for 0-19 years olds were computed using the DiaMond Registry program for the 5-year period from 1989 to 1993. Poisson regression analysis was used to determine differences in incidence rates. RESULTS: The highest incidence rate for 0-19 year olds was for the black African-heritage population of St. Croix (IR 10.99 per 100,000; 95 percent CI 4.35-19.89), one of the U.S. Caribbean islands. A significant (P < 0.05) 3.9 variation in IDDM incidence across the registries was found when the IR for St. Croix was compared to the IR for Barbados (IR 2.57 per 100,000; 95 percent CI 0.90-4.64). CONCLUSION: The variation in childhood-onset IDDM incidence rates among the black population of the eastern Caribbean islands is consistent with the geographic variation in IDDM incidence seen among African Americans in the U.S. Variation in incidence rates of childhood diabetes in black populations may reflect difference in level of white genetic admixture or exposure to environmental diabetogenic agents. (AU)
Assuntos
Adolescente , Criança , Pré-Escolar , Humanos , Lactente , Negro ou Afro-Americano , Diabetes Mellitus Tipo 1/epidemiologia , África/etnologia , Diabetes Mellitus Tipo 1/etnologia , Incidência , Estudos Prospectivos , Índias Ocidentais/epidemiologiaRESUMO
Childhood origins of adult disease may be important in the Caribbean, for instance in the later sequelae, if any, of under and malnutrition. Several such hypotheses can be tested for diabetes, including severity of the initial episode(s) leading to pancreatic fibrosis, and weight gain after puberty, causing further B-cell stress. The 1985 WHO criteria defined a malnutrition-related diabetes (MRDM) category, but causal evidence is slim. We examined a series from a chort (N=311) of survivors of infant marasmus (M), Kwashiorkor (K) and age-matched controls (C), all followed since presentation, for over 20 years. Cases were defined on infant weight for age < 2 SDs below expected. Of the first 90 subjects invited, 84 (93 percent) attended for a standardized portocol by trained observers, of a full 2-hour glucose tolerance test and anthropometric measures. (The results are shown in a table). These preliminary results show that average catch-up growth was complete in these previously severely malnourished young adults. While fasting blood glucose (FG) results were similar, following challenge the 2 hr values (2hr G) were significantly higher in female M than respective C(t=3.25, p<0.001) not accounted for by their greater weight, and higher in all M than C (p=0.02). Waist/Hip ratios were no different. Thus, despite these young people being well-adapted in a generally favourable socioeconomic setting, there is some evidence of glucose intolerance following challenge. This could be a prodrome for later development of diabetes. As they are also the first to have responded to the follow-up invitation, those who may not respond may be less well-adapted and hence at even greater risk of glucose intolerance and perhaps other problems (AU)
Assuntos
Humanos , Adolescente , Transtornos da Nutrição Infantil , Barbados , Diabetes Mellitus , Desnutrição Proteico-Calórica , Kwashiorkor , Peso-Idade , Peso-Estatura , Teste de Tolerância a Glucose/estatística & dados numéricos , Fatores SocioeconômicosRESUMO
Two fatal cases of haemophagocytic syndrome diagnosed on the basis of autopsy findings at the Queen Elizabeth Hospital, Barbados, are presented. They were both young patients, a male 20 years of age and a female 28 years of age, with common clinical features of severe constitutional symptoms, pharyngeal haemorrhages, pancytopenia, and fever. The female patient had elevated titres to herpes simplex virus indicative of recent infection as well as postmortem evidence of overwhelming mixed bacteria sepsis. In both cases, histopathological studies showed lymphoid depletion and histiocytes displaying haemophagocytosis. (AU)
Assuntos
Humanos , Adulto , Masculino , Feminino , Histiocitose de Células não Langerhans/diagnóstico , Histiocitose de Células não Langerhans/patologia , Herpes Simples/complicações , Histiocitose de Células não Langerhans/etiologia , Diagnóstico Diferencial , AutopsiaRESUMO
This paper reports the results of a pilot study done to investigate the glycaemic response (glycaemic index or G.I.) of fifteen (15) Type II Barbadian diabetics to different test foods. Subjects were fed four test meals of white bread, white rice, split peas and rice and split peas alone. Each meal contained 50gm of carbohydrate. Using white bread as the standard, Glycaemic Indices (G.I) were determined for each food from blood glucose measurements done over a three-hour period following the meal. Glycosylate haemoglobin (HbAlc) levels were measured as a monitor of diabetic control and were found to correlate well with the fasting blood sugar. White rice is shown to have a very high Glycaemic Index, more than four times that of split peas (102 compared to 24). A mixture of split peas and white rice, in a ration of 1:3, produces a significant decrease in G.I. (15.1+6.3, p < 0.05), although the change varied widely. Well-controlled diabetics (with the lowest HbAlc levels) all had a consistent decrease in G. I. on the food combination 28, (p<0.001), whereas poorly-controlled diabetics showed a small but unexpected increase in the G. I. mean 12.7, (p<0.02). There is an inverse relationship between change in G. I. and HbAlc levels, i.e. the better the diabetic control the greater the "split pea effect". In view of the high use of white rice in the Caribbean, there is an urgent need to dermine glycaemic indices of as many common cheap foods being eaten in the Caribbean as possible, and to ensure that these reference values are available to all those involved in diabetic care (AU)