Objective: Epicardial adipose tissue (EAT) is a metabolically active tissue and increased thickness is correlated with various cardiovascular diseases. There are various ways to estimate EAT. In this study, we investigated the predictive value of EAT thickness adjacent to the right coronary artery (RCA) for late atrial fibrillation (AF) recurrences in patients treated with cryoballoon ablation (CBA). We propose that this method is simpler than other methods for measurement of EAT on multidetector computed tomography images. Methods: Patients with symptomatic paroxysmal or persistent AF despite one or more antiarrhythmic drugs who were scheduled for CBA were prospectively recruited. Multidetector computed tomography was performed and epicardial adipose tissue thickness was measured as the fat-thickness from the epicardium to the myocardium around the RCA just after the acute marginal branch. The duration of follow-up was 12 months and AF recurrence was defined as an episode of AF longer than 30 seconds duration occurring three months after CBA. The study population included 72 patients and in 22 patients (30.5%) AF recurrence was observed. Results: Epicardial adipose tissue thickness was significantly higher in patients who had late recurrent AF compared to the patients without late recurrence (12.3 ± 3.2 vs 10.2 ± 3.2, p < 0.01). Highly sensitive C-reactive protein (Hs-CRP) level and left atrial (LA) volume index were significantly higher in the recurrent AF group compared to patients without AF recurrence. Multivariable analysis showed that LA volume index (OR 1.41, 95 % CI:1.15, 1.73, p < 0.01), hs-CRP (OR 1.42, 95% CI:1.02, 1.94, p = 0.04) and EAT thickness (OR 1.34, 95% CI:1.05, 1.71, p = 0.02) remained as independent predictors of AF recurrence in the study population. Conclusion: Epicardial adipose tissue thickness adjacent to the RCA is associated with late AF recurrences in patients treated with CBA. This method of EAT quantification seems to be simpler, less time-consuming and may be an alternative to other methods of EAT measurement.
目的:心外膜脂肪组织(EAT)是一种代谢活跃组织，其厚度增加与多种心血管疾病有关。估算EAT的方法有很多。在这项研究中，我们探讨了右冠状动脉(RCA)邻近EAT厚度对低温球囊消融(CBA)患者晚期房颤(AF)复发的预测价值。我们提出这种方法比其他方法更简单，用于测量多检测器计算机断层扫描图像上的EAT。方法:前瞻性招募有症状性阵发性或持续性房颤的患者，尽管有一种或多种抗心律失常药物，但仍计划进行CBA。进行多探测器计算机断层扫描，测量心外膜脂肪组织厚度，即心外膜到RCA周围心肌的脂肪厚度，即在急性边缘分支之后。随访时间为12个月，AF复发定义为CBA后3个月出现AF发作时间超过30秒。研究人群包括72例患者，其中22例(30.5%)出现房颤复发。结果:晚期复发房颤患者心外膜脂肪组织厚度明显高于非晚期复发房颤患者(12.3±3.2 vs 10.2±3.2,p < 0.01)。房颤复发组高敏感c反应蛋白(Hs-CRP)水平和左房容积指数明显高于无房颤复发组。多变量分析显示，LA容积指数(OR 1.41, 95% CI:1.15, 1.73, p < 0.01)、hs-CRP (OR 1.42, 95% CI:1.02, 1.94, p = 0.04)和EAT厚度(OR 1.34, 95% CI:1.05, 1.71, p = 0.02)仍然是研究人群房颤复发的独立预测因子。结论:在接受CBA治疗的患者中，RCA附近的心外膜脂肪组织厚度与房颤晚期复发有关。这种方法似乎更简单，更省时，可以替代其他方法的EAT测量。
{"title":"The Thickness of Epicardial Adipose Tissue Adjacent to the Right Coronary Artery Predicts Recurrence of Atrial Fibrillation After Cryoballoon Ablation: A Simpler Method","authors":"N. S. Yelgeç, S. Şahin, A. Alper","doi":"10.7727/WIMJ.2017.070","DOIUrl":"https://doi.org/10.7727/WIMJ.2017.070","url":null,"abstract":"Objective: Epicardial adipose tissue (EAT) is a metabolically active tissue and increased thickness is correlated with various cardiovascular diseases. There are various ways to estimate EAT. In this study, we investigated the predictive value of EAT thickness adjacent to the right coronary artery (RCA) for late atrial fibrillation (AF) recurrences in patients treated with cryoballoon ablation (CBA). We propose that this method is simpler than other methods for measurement of EAT on multidetector computed tomography images. Methods: Patients with symptomatic paroxysmal or persistent AF despite one or more antiarrhythmic drugs who were scheduled for CBA were prospectively recruited. Multidetector computed tomography was performed and epicardial adipose tissue thickness was measured as the fat-thickness from the epicardium to the myocardium around the RCA just after the acute marginal branch. The duration of follow-up was 12 months and AF recurrence was defined as an episode of AF longer than 30 seconds duration occurring three months after CBA. The study population included 72 patients and in 22 patients (30.5%) AF recurrence was observed. Results: Epicardial adipose tissue thickness was significantly higher in patients who had late recurrent AF compared to the patients without late recurrence (12.3 ± 3.2 vs 10.2 ± 3.2, p < 0.01). Highly sensitive C-reactive protein (Hs-CRP) level and left atrial (LA) volume index were significantly higher in the recurrent AF group compared to patients without AF recurrence. Multivariable analysis showed that LA volume index (OR 1.41, 95 % CI:1.15, 1.73, p < 0.01), hs-CRP (OR 1.42, 95% CI:1.02, 1.94, p = 0.04) and EAT thickness (OR 1.34, 95% CI:1.05, 1.71, p = 0.02) remained as independent predictors of AF recurrence in the study population. Conclusion: Epicardial adipose tissue thickness adjacent to the RCA is associated with late AF recurrences in patients treated with CBA. This method of EAT quantification seems to be simpler, less time-consuming and may be an alternative to other methods of EAT measurement.","PeriodicalId":49366,"journal":{"name":"West Indian Medical Journal","volume":"1 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71216415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Severity and Outcomes in Relationship to Known Exposures and Susceptibilities among Afro-Caribbean Patients with Hospital-acquired Acute Kidney Injury","authors":"K. Hoe, E. Barton, T. Han, T. Hoe","doi":"10.7727/WIMJ.2018.154","DOIUrl":"https://doi.org/10.7727/WIMJ.2018.154","url":null,"abstract":"","PeriodicalId":49366,"journal":{"name":"West Indian Medical Journal","volume":"1 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71216600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G. Igrutinović, A. Jakovljevic, S. Dimić, Z. Elek, S. Milosavljevic
The presence of appendicitis in an incarcerated femoral hernia is an extremely rare occurrence, known as De Garengeot’s hernia, with potentially serious complications. An incarcerated femoral hernia was noticed intraoperatively, and the hernial sac, closely fused with femoral blood vessels, contained the phlegmonously inflamed vermiform appendix. Appendectomy and mesh hernioplasty were carried out. The postoperative period was uneventful.
{"title":"Inflamed Appendix in Incarcerated Femoral Hernia","authors":"G. Igrutinović, A. Jakovljevic, S. Dimić, Z. Elek, S. Milosavljevic","doi":"10.7727/wimj.2018.073","DOIUrl":"https://doi.org/10.7727/wimj.2018.073","url":null,"abstract":"The presence of appendicitis in an incarcerated femoral hernia is an extremely rare occurrence, known as De Garengeot’s hernia, with potentially serious complications. An incarcerated femoral hernia was noticed intraoperatively, and the hernial sac, closely fused with femoral blood vessels, contained the phlegmonously inflamed vermiform appendix. Appendectomy and mesh hernioplasty were carried out. The postoperative period was uneventful.","PeriodicalId":49366,"journal":{"name":"West Indian Medical Journal","volume":"1 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71216507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Prevelance of mutiply miliary type of osteoma cutis in the maxilal region as anincidental findings: a retrospective study.","authors":"K. Orhan","doi":"10.7727/WIMJ.2018.030","DOIUrl":"https://doi.org/10.7727/WIMJ.2018.030","url":null,"abstract":"","PeriodicalId":49366,"journal":{"name":"West Indian Medical Journal","volume":"1 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71216771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B. Orhan, G. Sönmez, Mehmet Ozgur Ozemre, C. K. Secgin, K. Kamburoğlu, A. Gulsahi
Objective: To assess the effects of different variables including implant type and thread design, bone width and height measured on cone beam computed tomography (CBCT) images, along with systemic and patient related factors on marginal bone loss around dental implants which were measured on postoperative panoramic radiographs. Methods: A total of 116 dental implants from two manufacturers were used in the study. Age, gender, history of diabetes mellitus and hypertension, smoking habit, implant thread type, implant site, length and diameter were recorded. Available alveolar bone width and height were measured on preoperative CBCT images. Marginal bone loss around dental implants was measured on the panoramic radiographs taken three months after implant placement on both mesial and distal sides. Results: There were no statistically significant differences for the measurements of marginal bone loss on both distal and mesial sides according to gender, region, jaw and implant type. While there was a significant difference between patients with and without diabetes mellitus in terms of distal marginal bone loss (p < 0.05); no significant difference was found between patients with and without diabetes mellitus for mesial marginal bone loss. The mean of marginal bone loss was 1.43 ± 0.75 mm and 1.45 ± 0.75 at the distal and mesial sides, respectively. We found statistically significant differences for alveolar width and marginal bone loss. However, no significant differences were found for the height measurements. Conclusion: Marginal bone loss increased with an increase in bone width. There were no significant differences for the measurements of marginal bone loss on both distal and mesial sides according to gender, region, jaw, and implant type.
{"title":"The Effects of Different Variables on Marginal Bone Loss around Dental Implants","authors":"B. Orhan, G. Sönmez, Mehmet Ozgur Ozemre, C. K. Secgin, K. Kamburoğlu, A. Gulsahi","doi":"10.7727/wimj.2018.068","DOIUrl":"https://doi.org/10.7727/wimj.2018.068","url":null,"abstract":"Objective: To assess the effects of different variables including implant type and thread design, bone width and height measured on cone beam computed tomography (CBCT) images, along with systemic and patient related factors on marginal bone loss around dental implants which were measured on postoperative panoramic radiographs. Methods: A total of 116 dental implants from two manufacturers were used in the study. Age, gender, history of diabetes mellitus and hypertension, smoking habit, implant thread type, implant site, length and diameter were recorded. Available alveolar bone width and height were measured on preoperative CBCT images. Marginal bone loss around dental implants was measured on the panoramic radiographs taken three months after implant placement on both mesial and distal sides. Results: There were no statistically significant differences for the measurements of marginal bone loss on both distal and mesial sides according to gender, region, jaw and implant type. While there was a significant difference between patients with and without diabetes mellitus in terms of distal marginal bone loss (p < 0.05); no significant difference was found between patients with and without diabetes mellitus for mesial marginal bone loss. The mean of marginal bone loss was 1.43 ± 0.75 mm and 1.45 ± 0.75 at the distal and mesial sides, respectively. We found statistically significant differences for alveolar width and marginal bone loss. However, no significant differences were found for the height measurements. Conclusion: Marginal bone loss increased with an increase in bone width. There were no significant differences for the measurements of marginal bone loss on both distal and mesial sides according to gender, region, jaw, and implant type.","PeriodicalId":49366,"journal":{"name":"West Indian Medical Journal","volume":"1 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71216787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A Road to Excellence: The History of Basic Nursing Education at the University Hospital of the West Indies, Jamaica, 1949–2006","authors":"Hm Ming","doi":"10.7727/wimj.2018.130","DOIUrl":"https://doi.org/10.7727/wimj.2018.130","url":null,"abstract":"","PeriodicalId":49366,"journal":{"name":"West Indian Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45696023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Patrick, Jb Nelson, J. Weissfeld, R. Dhir, R. Phillips, J. Zmuda, C. Bunker
Objective: To compare all-cause-mortality in screening-detected prostate cancer cases versus non-cases after a median 12.2-year follow-up. Methods: In this prospective, population-based study of 3089 Afro-Caribbean men aged 40–79 years in Tobago, Trinidad and Tobago, West Indies, all men were screened for prostate cancer (serum prostate specific antigen and/or digital rectal exam) one to three times between 1997 and 2007 and followed for mortality to 2012. Among 502 men diagnosed with prostate cancer, 81 younger men underwent radical retropubic prostatectomy. Minimal treatment was available for older men. Survival curves compared all-cause-mortality in cases versus non-cases within 10-year age groups at first screening. Results: There were 350 all-cause-deaths over 34 089 person-years of follow-up. All-cause-survival curves in men aged 60 years or above at first screening did not diverge between cases and non-cases until after 10–12 years of follow-up (p > 0.36). In contrast, among men first screened at age 50–59 years, survival was lower in cases, with survival curves diverging at seven years (p = 0.003). Survival in men aged 50–59 years who underwent prostatectomy was similar to survival in non-cases (p = 0.63). Conclusion: Among men aged 60 years or above, the absence of excess all-cause-mortality among screening-detected prostate cancer cases provides argument against the utility of routine prostate cancer screening in this older population of African descent. However, the significantly poorer survival in men aged 50–59 years with screening-detected prostate cancer, compared with screened men without prostate cancer, along with the potential for prostate cancer treatment to improve survival, supports the continuation of prostate cancer screening in this age group, pending further research to assess the risks and benefits.
{"title":"Prostate Cancer Screening in Men of African Descent: 15-year Results of the Tobago Prostate Cancer Survey","authors":"A. Patrick, Jb Nelson, J. Weissfeld, R. Dhir, R. Phillips, J. Zmuda, C. Bunker","doi":"10.7727/wimj.2016.312","DOIUrl":"https://doi.org/10.7727/wimj.2016.312","url":null,"abstract":"Objective: To compare all-cause-mortality in screening-detected prostate cancer cases versus non-cases after a median 12.2-year follow-up. Methods: In this prospective, population-based study of 3089 Afro-Caribbean men aged 40–79 years in Tobago, Trinidad and Tobago, West Indies, all men were screened for prostate cancer (serum prostate specific antigen and/or digital rectal exam) one to three times between 1997\u0000and 2007 and followed for mortality to 2012. Among 502 men diagnosed with prostate cancer, 81 younger men underwent radical retropubic prostatectomy. Minimal treatment was available for older men. Survival curves compared all-cause-mortality in cases versus non-cases within 10-year age groups at first screening. Results: There were 350 all-cause-deaths over 34 089 person-years of follow-up. All-cause-survival\u0000curves in men aged 60 years or above at first screening did not diverge between cases\u0000and non-cases until after 10–12 years of follow-up (p > 0.36). In contrast, among men first screened at age 50–59 years, survival was lower in cases, with survival curves diverging at seven years (p = 0.003). Survival in men aged 50–59 years who underwent prostatectomy was similar to survival in non-cases (p = 0.63). Conclusion: Among men aged 60 years or above, the absence of excess all-cause-mortality among screening-detected prostate cancer cases provides argument against the utility of routine prostate cancer screening in this older population of African descent. However, the significantly poorer survival in men aged 50–59 years with screening-detected prostate cancer, compared with screened men without prostate cancer, along with the potential for prostate cancer treatment to improve survival, supports the continuation of prostate cancer screening in this age group, pending further research to assess the risks and benefits.","PeriodicalId":49366,"journal":{"name":"West Indian Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45475906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Romero-Acosta, L. Gómez-de-Regil, G. Lowe, G. Lipps
Objective: To explore the relationship between substance use and depressive symptomatology among adolescents in Colombia. Methods: Adolescents aged 13–19 years from a rural city in Colombia completed the Spanish version of the Alcohol, Smoking and Substance Involvement Screening Test and the Kutcher Adolescent Depression Scale-6 (KADS-6). Results: Regression analyses indicated that gender, having used cannabis, having used sedatives, and having a family member who used illegal drugs were predictive of higher symptom levels of depression according to KADS-6. Conclusion: The results of this study suggested that substance use was associated with depressive symptoms in this sample of Colombian adolescents.
{"title":"The Relationship between Substance Use and Depressive Symptoms among Colombian Adolescents","authors":"K. Romero-Acosta, L. Gómez-de-Regil, G. Lowe, G. Lipps","doi":"10.7727/wimj.2018.143","DOIUrl":"https://doi.org/10.7727/wimj.2018.143","url":null,"abstract":"Objective: To explore the relationship between substance use and depressive symptomatology among adolescents in Colombia. Methods: Adolescents aged 13–19 years from a rural city in Colombia completed the Spanish version of the Alcohol, Smoking and Substance Involvement Screening Test and the Kutcher Adolescent Depression Scale-6 (KADS-6). Results: Regression analyses indicated that gender, having used cannabis, having used sedatives, and having a family member who used illegal drugs were predictive of higher symptom levels of depression according to KADS-6. Conclusion: The results of this study suggested that substance use was associated with depressive symptoms in this sample of Colombian adolescents.","PeriodicalId":49366,"journal":{"name":"West Indian Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45067975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: To assess viral and atypical bacterial agents using polymerase chain reaction in patients presenting with signs of acute respiratory tract infection (RTI) to Erzincan Mengucek Gazi Education and Research Hospital, Turkey. Methods: Viral and atypical bacterial agents were explored in patients presenting with RTI between February 1 and June 1, 2017. Genomic isolation was performed using a SolMag®12 fully-automated nucleic acid isolation system and SolMag® Virus Nucleic Acid Isolation Kit. Amplifications were performed using a SmartCycler-II thermocycler (Cepheid) device in accordance with the instructions provided by the manufacturer. Results: Of the 120 patients, 44 (36.6%) were found to have at least one agent. Polymerase chain reaction detected influenza viruses in 28 patients, respiratory syncytial virus in seven, cytomegalovirus (CMV) in six, Herpes simplex virus 1 (HSV1) in two, Chlamydophila pneumonia in two, Human Herpesvirus 6 in one, and Herpes simplex virus 2 in one. Also, coexistent HSV1 and CMV positivity was found in two cases. One patient had positivity in both influenza A and CMV. Among atypical bacterial agents, only two patients were found to have Chlamydophila pneumonia. There was at least one comorbid condition in 48 patients (40%). Of these subjects in whom an agent could be identified, 21 were found to have co-morbidity, while 23 were free of comorbid conditions. Antibiotherapy had been started in 109 (90.8%) of the patients after initial assessment. Sixty-four patients were admitted, and two patients died. Conclusion: Polymerase chain reaction allowed rapid detection of agents responsible for acute RTIs. We believe that this technique may contribute to appropriate use of antibiotics in patients diagnosed with atypical bacterial infection and may prevent unnecessary antibiotherapy in infections caused by viral agents.
{"title":"Assessment of Viral and Atypical Bacterial Agents Using Polymerase Chain Reaction in Patients Presenting with Signs of Acute Respiratory Tract Infection","authors":"Edhem Unver, F. Karakeçili, A. Çikman","doi":"10.7727/wimj.2018.025","DOIUrl":"https://doi.org/10.7727/wimj.2018.025","url":null,"abstract":"Objective: To assess viral and atypical bacterial agents using polymerase chain reaction in patients presenting with signs of acute respiratory tract infection (RTI) to Erzincan Mengucek Gazi Education and Research Hospital, Turkey. Methods: Viral and atypical bacterial agents were explored in patients presenting with RTI between February 1 and June 1, 2017. Genomic isolation was performed using a SolMag®12 fully-automated nucleic acid isolation system and SolMag® Virus Nucleic Acid Isolation Kit.\u0000Amplifications were performed using a SmartCycler-II thermocycler (Cepheid) device in\u0000accordance with the instructions provided by the manufacturer. Results: Of the 120 patients, 44 (36.6%) were found to have at least one agent. Polymerase chain reaction detected influenza viruses in 28 patients, respiratory syncytial virus in seven, cytomegalovirus (CMV) in six, Herpes simplex virus 1 (HSV1) in two, Chlamydophila pneumonia in two, Human Herpesvirus 6 in one, and Herpes simplex virus 2 in one. Also, coexistent HSV1 and CMV positivity was found in two cases. One patient had positivity in both influenza A and CMV. Among atypical bacterial agents, only two patients were found to have Chlamydophila pneumonia. There was at least one comorbid condition in 48 patients (40%). Of these subjects in whom an agent could be identified, 21 were found to have co-morbidity, while 23 were free of comorbid conditions. Antibiotherapy had been started in 109 (90.8%) of the patients after initial assessment. Sixty-four patients were admitted, and two patients died. Conclusion: Polymerase chain reaction allowed rapid detection of agents responsible for acute RTIs. We believe that this technique may contribute to appropriate use of antibiotics\u0000in patients diagnosed with atypical bacterial infection and may prevent unnecessary antibiotherapy in infections caused by viral agents.","PeriodicalId":49366,"journal":{"name":"West Indian Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2018-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42344211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Mohammed, H. Mohammed, S. Sakhamuri, A. Bhowmik, T. Seemungal
Objective: To determine the relationship between severity of chronic obstructive pulmonary disease (COPD) and quality of life as well as COPD’s correlation with depressive symptoms in West Indian subjects. Methods: This is a cross-sectional, observational study of outpatients with COPD in tertiary care. The severity of COPD was determined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage, GOLD group, and body mass index, airflow obstruction, dyspnoea and exercise capacity (BODE) index. Quality of life was assessed by the St George Respiratory Questionnaire (SGRQ) and COPD Assessment Test (CAT), and depression was assessed by the Center for Epidemiologic Studies Depression Scale (CES-D). Results: A total of 105 patients (85.7% male, 37.1% Indo-Trinidadian, 42.9% Afro-Trinidadian, 64.8% primary level education) were recruited with a mean age of 66.9 years (standard deviation: 9.60 years). The median body mass index was 25 kg/m2; 26.7% were underweight. Risk factors identified were: ever-smokers (27.6%), marijuana (20%), biomass (81.9%), passive smoke (70.5%), occupational exposures (80%). The CES-D of 25% of the patients was ≥ 16. Co-morbidities included diabetes (22%), hypertension (29%), gastro-oesophageal reflux disease (10%) and previous myocardial infarction (15%). A total of 59% of the patients reported a monthly household income of less than US$800. Lower level of education was associated with worse SGRQ (total and impact), lower forced expiratory volume in one second, modified Medical Research Council scale (mMRC) of ≥ 2 and higher BODE index. Higher GOLD group correlated with worse SGRQ, CAT and CES-D. Higher CES-D was associated with shorter six-minute walk distance, worse SGRQ, CAT and mMRC scores, higher GOLD group and increased COPD admissions per year. Patients with a CES-D of ≥ 16 walked shorter distances. Higher BODE quartile was associated with worse SGRQ, CAT and CES-D scores. Conclusion: Higher GOLD group and higher BODE quartile were associated with worse quality of life scores and higher depression scores. Patients in higher GOLD groups should be screened for depression. Education on COPD should be targeted at those of lower socioeconomic status.
{"title":"A Descriptive Study of Chronic Obstructive Pulmonary Disease in Tertiary Care Clinics of a Caribbean Island","authors":"S. Mohammed, H. Mohammed, S. Sakhamuri, A. Bhowmik, T. Seemungal","doi":"10.7727/wimj.2018.125","DOIUrl":"https://doi.org/10.7727/wimj.2018.125","url":null,"abstract":"Objective: To determine the relationship between severity of chronic obstructive pulmonary disease (COPD) and quality of life as well as COPD’s correlation with depressive symptoms in West Indian subjects. Methods: This is a cross-sectional, observational study of outpatients with COPD in tertiary care. The severity of COPD was determined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage, GOLD group, and body mass index, airflow obstruction, dyspnoea and exercise capacity (BODE) index. Quality of life was assessed by the St George Respiratory Questionnaire (SGRQ) and COPD Assessment Test (CAT), and depression was assessed by the Center for Epidemiologic Studies Depression Scale (CES-D). Results: A total of 105 patients (85.7% male, 37.1% Indo-Trinidadian, 42.9% Afro-Trinidadian, 64.8% primary level education) were recruited with a mean age of 66.9 years (standard deviation: 9.60 years). The median body mass index was 25 kg/m2; 26.7% were underweight. Risk factors identified were: ever-smokers (27.6%), marijuana (20%), biomass (81.9%), passive smoke (70.5%), occupational exposures (80%). The CES-D of 25% of the patients was ≥ 16. Co-morbidities included diabetes (22%), hypertension (29%), gastro-oesophageal reflux disease (10%) and previous myocardial infarction (15%). A total of 59% of the patients reported a monthly household income of less than US$800. Lower level of education was associated with worse SGRQ (total and impact), lower forced expiratory volume in one second, modified Medical Research Council scale (mMRC) of ≥ 2 and higher BODE index. Higher GOLD group correlated with worse SGRQ, CAT and CES-D. Higher CES-D was associated with shorter six-minute walk distance, worse SGRQ, CAT and mMRC scores, higher GOLD group and increased COPD admissions per year. Patients with a CES-D of ≥ 16 walked shorter distances. Higher BODE quartile was associated with worse SGRQ, CAT and CES-D scores. Conclusion: Higher GOLD group and higher BODE quartile were associated with worse quality of life scores and higher depression scores. Patients in higher GOLD groups should be screened for depression. Education on COPD should be targeted at those of lower socioeconomic status.","PeriodicalId":49366,"journal":{"name":"West Indian Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2018-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47101452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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