Shaughan I Terry

Age-prevalence and household clustering of Strongyloides stercoralis infection in Jamaica

The epidemiology of Strongyloides stercoralis was studied in families of clinical (reference) cases and their neighbours at endemic foci in Jamaica. Thirteen foci were studied based on the place of residence of a reference case. For each household of a reference case, the 4 most proximal neighbourhood households (spatial controls) were included in the study. Out of 312 persons contacted 244 were followed up using questionnaires, stool examination and serology. Prevalence of infection based on stool examination was 3.5% and on ELISA 24.2%. Prevalence increased with age but was not related to gender. Reference cases were significantly older than the general study population. The prevalence of infection based on both serology and stool examination was significantly higher in reference than in neighbouring households (the reference cases, themselves, were not included in the analysis). Furthermore, prevalence of infection was highest among persons who shared a bedroom with a reference case and decreased significantly with increasing spatial separation. This is indicative of close contact transmission which has not been previously shown for a geohelminth, but which is common among microparasites.

Jamaican vomiting sickness: a study of two adult cases

An acute illness (Jamaican vomiting sickness) which affected two adults after eating unripe ackee fruit was investigated. Analyses of serum and urine samples were performed to compare the patterns of organic acidaemia and aciduria with those reported from childhood cases. The main conclusion from the comparison is that the toxic ackee constitutent, hypoglycin, produces essentially the same metabolic effects in adults as in children.

Adult Reye's syndrome after dengue.

An adult (21 year old) male is described who developed Reyes syndrome in association with dengue type 1 infection.

Ulcerative colitis in sickle cell disease

Four patients with homozygous sickle cell disease and severe proctocolitis are described. The current prevalence is three patients per 1,000 attending a sickle cell clinic. The reasons for the apparent predisposition of sickle cell disease to proctocolitis could not be determined but was revealed by the large follow-up clinic.

Tropical gastroenterology in Jamaica.

The practice of medicine in Jamaica and the rest of the Commonwealth Caribbean is modelled on the British pattern and the tendency has been to transpose a whole health care system from Britain to the Caribbean with few attempts to evaluate the relevance of British medical practice to the Caribbean. This is particularly so with regard to medical gastroenterology, a relatively new, hospital-based subspecialty which has seen rapid growth in many parts of the world. That gastroenterology should be introduced into postgraduate training in the University Hospital of the West lndies, the major medical training centre for 14 territories in the Caribbean, cannot be doubted. Before a suitable programme of training can be established more information about tropical gastroenterology is required. There is paucity of data as to what a medical gastroenterologist does in Britain (Ferguson et af. 1977), let alone whether this is relevant to the practice of tropical gastroenterology. Most national disease indices are based upon in-patient statistics, yet gastroenterology is largely an outpatient specialty. The needs of a postgraduate training programme for general and specialist physicians should be based on the pattern of gastroenterological disease occurring in the community, so that these physicians may function effectively. Would the diagnostic categorization of gastrointestinal pathology seen in one area assist in planning rationally future education, training, and research programmes? How does gastroenterology in Jamaica compare with gastroenterological practice in other parts of the world? Does a broad overview of medical gastroenterology in Jamaica provide a clearer picture of what the Caribbean region requires? 1s it necessary to train superspecialist medical gastroenterologists in less wealthy areas of the world such as the Caribbean? This study was undertaken to provide data with which to answer these questions.