RESUMO
Objective: To determine if there is any association between paediatric Accident & Emergency (A&E) asthma admissions and Saharan dust cloud cover Methods: A retrospective ecological study of paediatric asthma patients who attended the A&E department of the Eric Williams Medical Sciences Complex in relation to Saharan dust visibility andother climactic variables for the period May 23 2001 to May 13 2002. A quasi-likelihood approach was used to develop a statistical model for the relationship between acute paediatric asthma A&Evisits and Saharan dust cover.Results: 2655 A&E visits for acute asthma during the study period. There were significant associations between paediatric admissions and two climate variables; Saharan dust levels (p <0.05)and barometric pressure (p <0.01). In the absence of dust however, barometric pressure by itself hadno predictive power. Dust cover & barometric pressure were most strongly associated with increased admissions the day after dust cover Conclusions: Saharan dust cloud cover over Trinidad was associated with an increase inpaediatric asthma A&E visits on the following day. The dust effect was strongly influenced by prevailing barometric pressure; heavy dust cover and low pressure were most strongly associated with increased acute asthma visits.
Assuntos
Humanos , Poeira , Asma/complicações , Asma/etiologia , Trinidad e Tobago/epidemiologiaRESUMO
A retrospective ecological study of paediatric asthma patients who attended the Accident and Emergency (A and E) department of the Paediatric Priority Care Facility at the Eric Williams Medical Sciences Complex in relation to Saharan dust visibility and other climatic variables for the period 23 May 2001 to 13 May 2002 was undertaken to determine if there is an association between paediatric A and E asthma visits and Saharan dust cloud cover. A Poisson regression model was used to determine the statistical relationship between acute paediatric asthma A and E visits and Saharan dust cover with and without other variables such as climatic parameters and month. During the study period, there were 2,655 A and E visits for acute asthma. There was an association between increased paediatric asthma admissions and increased Saharan dust cover. The best fitting model estimated that in one month, such as June, a deterioration of visibility due to increased Saharan dust cover from no dust (visibility =16 km) to very dusty (visibility =7 km) would increase a daily admission rate of 7.8 patients to 9.25 when climate variables such as barometric pressure and humidity were kept constant.
Assuntos
Asma/etiologia , Poeira , Adolescente , África , Asma/epidemiologia , Pressão Atmosférica , Criança , Pré-Escolar , Emergências/epidemiologia , Feminino , Hospitalização , Humanos , Umidade , Lactente , Recém-Nascido , Masculino , Modelos Estatísticos , Distribuição de Poisson , Análise de Regressão , Estudos Retrospectivos , Temperatura , Trinidad e Tobago/epidemiologiaRESUMO
A retrospective analysis of the 1996 DEN-1 epidemic in Trinidad was undertaken to better understand the clinical and demographic expression of dengue infection in the island during one of the larger epidemics in the past 10 years and following the reintroduction of DEN-1 into the island in 1991 after a gap of 14 years. A total of 393 laboratory-confirmed cases were identified. Of these, notes for 157 patients were available for analysis. The epidemic was island-wide, though most cases occurred in the most densely populated county of St. George. There was a slight predominance of females (51.6 per cent) among the cases, and while all age groups were affected, older children and adults comprised the majority. South Asians among the population predominated. Overall, 27 clinical symptoms were reported. The most common were: fever (98.7 per cent), generalized pain (96.2 per cent) and anorexia (63.1 per cent). Rash, arthralgia, retro-orbital pain and haemorrhage (all mentioned in the WHO clinical description for dengue fever) were reported in <50 per cent of cases. Gastrointestinal symptoms were also very common and occurred in over two-thirds of cases at presentation. Bleeding manifestations were reported in 30 per cent of patients and commonly involved the gastrointestinal tract. Features of DHF were noted in only six (4 per cent)
Assuntos
Humanos , Vírus da Dengue/fisiologia , Vírus da Dengue/patogenicidade , Trinidad e Tobago/epidemiologia , Países em DesenvolvimentoRESUMO
OBJECTIVES: To determine if there is seasonal variation in acute asthmatic visits to accident and emergency (A&E) facilities in Trinidad and to identify the climatic variables associated with such visits. DESIGN AND METHODS: A retrospective census of patients with asthma, defined as those who required emergency bronchodilator nebulization, was taken at two A&E facilities in Trinidad from 1 January 1997 to 31 December 1999. The study included patients aged 64 years and under. Patient demographic data were obtained from the A&E records. Climate variables were taken from the island's sole Meteorological Office. Multiple regression was used to identify climate variables that were independent predictors of A&E asthma visits. RESULTS: There were a total of 45 842 asthma admissions to the two facilities during the study period. Visits exhibited a cyclic pattern over the 3 years that varied according to the island's dry (January-May) and wet (June-December) seasons. There were more visits during the wet season than the dry (40 [SD=2] vs. 32 [SD=2] visits/day; P<0.001). The results of multiple regression indicated that season (P<0.001), barometric pressure (P<0.001), temperature difference (P<0.001), minimum temperature2 (P<0.001) and wind speed2 (P=0.032) were predictors of paediatric visits. Independent predictors of adult visits were season (P<0.001), relative humidity (P<0.001), minimum temperature (P=0.01), temperature difference2 (P<0.001) and minimum temperature2 (P=0.004). Season and climatic variables explained 18% of the variance of the total A&E asthma admissions. CONCLUSION: There is seasonal variation in acute asthma visits to A&E facilities in Trinidad, which remains significant after controlling for climate variables. However, while climate has a role, there are other factors that may also be responsible for increased visits during the wet season. More research is needed to identify these factors.
Assuntos
Asma/epidemiologia , Asma/etiologia , Estações do Ano , Tempo (Meteorologia) , Doença Aguda , Adolescente , Adulto , Fatores Etários , Criança , Pré-Escolar , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Estudos Retrospectivos , Fatores de Risco , Trinidad e Tobago/epidemiologiaRESUMO
A retrospective analysis of culture-positive cases of S pneumoniae from normally sterile body fluids is reported. Over 40% of patients were 5 years old or less while 28% of patients were 50 years old or more. Meningitis (44%) was the commonest clinical presentation followed closely by pneumonia (31%). The commonest predisposing disorder was human immunodeficiency virus infection though there were no identifiable risk factors in the majority of patients. Mortality from invasive pneumococcal disease was significantly higher in elderly patients compared with other age groups (p = 0.0003). In this study, all S pneumoniae isolates, for which there were antibiotic sensitivity data, were penicillin and/or amoxycillin sensitive.
Assuntos
Infecções Pneumocócicas/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Infecções Pneumocócicas/etiologia , Estudos Retrospectivos , Fatores de Risco , Estatísticas não Paramétricas , Streptococcus pneumoniae/isolamento & purificação , Trinidad e Tobago/epidemiologiaRESUMO
This cross-sectional study documents the demographic features of asthmatics seeking acute asthma care at four institutions on the island of Trinidad from January 1 to December 31, 1997. More than 15,000 (15,035) different patients made 27,353 visits during the study period. Pediatric and adolescent male patients outnumbered females, but this was reversed in patients aged 20-69 years. Frequency of visits per patient ranged from 1 to 242. Significant variation in monthly admissions was observed; admission rates were highest in the last quarter of the year but were lowest in July and August. The overall crude prevalence rate was estimated at 1.71 per 100 (range 1.16-2.34).
Assuntos
Asma/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Asma/terapia , Criança , Pré-Escolar , Estudos Transversais , Demografia , Serviços Médicos de Emergência , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Prevalência , Distribuição por Sexo , Índias OcidentaisRESUMO
Dengue virus cause the non-fatal dengue fever and the life-threating dengue haemorrhagic fever/dengue shock syndrome (DHF/DSS). Early clinical features of DF and DHF/DSS are indistinguishable and it is difficult to identify early DHF/DSS using clinical and laboratory parameters. A prospective observational study (KALAYANAROOJ et al, 1997) of Thai children with fever for less than 72h revealed that, at enrolment, plasma aspartate aminotransferase (AST)levels were significantly raised in children who developed DHF but were of relatively low positive predictive value (PPV=0.27 for AST>40U/mL). MONATH (1997), in his review of the paper by Kalayanaroo et al., noted the lack of 'clear clinical prognostic indicators for DHF' and called for strategies to improve diagnosis (AU)
Assuntos
Humanos , Vírus da Dengue , Dengue , Dengue Grave , Neopterina , Prognóstico Clínico Dinâmico HomeopáticoRESUMO
The prevalence of asthma in the Caribbean is high and seems to be increasing. Asthma research in this region has been biased towards the paediatric population and there is little published on adult disease. There is a high prevalence of other allergic diseases in the patients studied, with skin reactivity to at least one allergen in 50-81of subjects. Reactivity to house dust mite, especially Dermatophagoides pteronyssinus, occurred most commonly and sensitivity to this mite correlated with high levels of mite proteins in mattress and bedroom dust. Asthmatic admissions to hospitals are highest in the last quarter of the year but fall to their lowest levels in April. Admission rates are influenced by climatic variables such as relative humidity and wind speed. In some territories current management of asthma remains reliant on the use of oral bronchodilators with underutilization of inhaled beta-agonists and corticosteroid preparations.
Assuntos
Humanos , Adolescente , Adulto , Animais , Criança , Asma/epidemiologia , Poeira , Prevalência , Região do Caribe/epidemiologia , Ácaros/imunologiaRESUMO
The prevalence of asthma in the Caribbean is high and seems to be increasing. Asthma research in this region has been biased towards the paediatric population and there is little published on adult disease. There is a high prevalence of other allergic diseases in the patients studied, with skin reactivity to at least one allergen in 50-81% of subjects. Reactivity to house dust mite, especially Dermatophagoides pteronyssinus, occurred most commonly and sensitivity to this mite correlated with high levels of mite proteins in mattress and bedroom dust. Asthmatic admissions to hospitals are highest in the last quarter of the year but fall to their lowest levels in April. Admission rates are influenced by climatic variables such as relative humidity and wind speed. In some territories current management of asthma remains reliant on the use of oral bronchodilators with underutilization of inhaled beta-agonists and corticosteroid preparations.