Upper gastrointestinal bleeding: a Jamaican perspective

BACKGROUND

Upper gastrointestinal bleeding (UGIB) remains one of the most common clinical life-threatening emergencies which is associated with a high morbidity, mortality and medical care costs.

OBJECTIVES

This study reviews the clinical features, management and outcomes of patients with UGIB seen at the University Hospital of the West Indies (UHWI), Jamaica, between January 2006 and December 2008.

METHODS

Patients with UGIB admitted to the medical wards of the UHWI, Jamaica, between January 2006 and December 2008 were reviewed. Consecutive patients admitted with a confirmed diagnosis of UGIB were selected for analysis. Data collected included age, gender presenting complaints, risk factors, clinical features and management. Endoscopic findings, treatment and outcomes were also reviewed.

RESULTS

There were 104 patients, with a mean age of 55 years, admitted with UGIB. There were significantly more men than women (73 vs 31). Retching and vomiting were the most common presenting complaints followed by melaena and haemetemesis. Non-steroidal anti-inflammatory drug use was present in 28% of patients. Overall, 80% of patients had upper GI endoscopy (EGD) and 40% were done within 24 hours of admission. The median time for performing EGD was 24 hours (mean 46 hours). The leading causes of UGIB were duodenal ulcer (28%), erosive gastritis (20%) and gastric ulcer (13%). Proton pump inhibitors (PPI) were given to 95 (91%) patients intravenously. Blood transfusion was given to 40% of patients. The mortality was 5.7%, rebleeding occured in 4.8% of patients and 5% underwent surgery. The average duration of hospital stay was 6.6 days.

CONCLUSION

Upper gastrointestinal bleeding was more common in men of middle age in this study. Proton pump inhibitors were used in most patients. The overall mortality of 5.7% is similar to other series. Early EGD and use of endoscopic therapy may lead to a decrease in mortality in high risk patients.

Gender Roles, Gender (In)equality and Fertility: An Empirical Test of Five Gender Equity Indices

The division of gender roles in the household and societal level gender (in)equality have been situated as one of the most powerful factors underlying fertility behaviour. Despite continued theoretical attention to this issue by demographers, empirical research integrating gender roles and equity in relation to fertility remains surprisingly sparse. This paper first provides a brief review of previous research that has examined gender roles and fertility followed by a comparison of six prominent gender equality indices: Gender-related Development Index (GDI), Gender Empowerment Measure (GEM), Gender Gap Index (GGI), Gender Equality Index (GEI), the European Union Gender Equality Index (EU-GEI) and the Social Institutions and Gender Index (SIGI). The paper then tests how five of these indices impact fertility intentions and behaviour using a series of multilevel (random-coefficient) logistic regression models, applying the European Social Survey (2004/5). The GDI, with its emphasis on human development, adjusted for gender, has the strongest and significant effect on fertility intentions. The EU-GEI, which focuses on the universal caregiver model, uncovers that more equity significantly lowers fertility intentions, but only for women. The remaining indicators show no significant impact. The paper concludes with a reflection and suggestions for future research.

Preferences for the sex-composition of children in Europe: a multilevel examination of its effect on progression to a third child

Comparative research on the preferred sex of children in Western societies has generally focused on women only and ignored the role of gender equity and the need for children's economic support in old age. A multilevel analysis extends existing research by examining, for both men and women and across 24 European countries, the effect of the preferred sex-composition of offspring on whether parents have or intend to have a third child. Using the European Social Survey (2004/5), a multilevel (random coefficient) ordered logit regression of that intention (N = 3,323) and a binary logistic multilevel model of the transition to a third child (N = 6,502) demonstrate the presence of a mixed-sex preference. In countries with a high risk of poverty in old age, a preference for sons is found, particularly for men. In societies where there is lower gender equity, both men and women have a significant preference for boys.

Steatohepatitis due to antiretroviral therapy

Jamaica has recorded the largest increase in the rate of HIV/AIDS infection in the English-speaking Caribbean since 1985. Treatment has significantly improved recently with approximately 50% availability of antiretrovirals (ARVs) to patients. The incidence of drug induced hepatotoxicity is not well known for most ARV drugs and few studies have assessed adverse drug effects in clinical practice. A patient with HIV on highly active antiretroviral therapy (HAART) presented with a one year history of progressive abdominal distension. Abdominal examination revealed a 17 cm, smooth, non-tender liver with a rounded edge; 12 cm of which was below the right costal margin. Liver enzymes were grossly abnormal. The liver biopsy revealed parenchymal distortion by fibrosis with macrovesicular fatty change and Mallory's hyaline in keeping with steatohepatitis. Follow-up studies after discontinuation of stavudine revealed that the liver enzymes improved within four months. Physicians should be mindful of the hepatotoxic potential of ARVs and monitor liver enzymes in HIV-infected patients on therapy.

From quadruplex to helix and back: meta-stable states can move through a cycle of conformational changes

Strand displacement cycles can be driven by sequential addition of short oligonucleotide sequences. Successive inter- and intra-molecular interactions based on the rules of Watson-Crick base pairing allow us to design self-assembling molecular systems with predictable folding pathways and conformational changes. Here we present a particular strand displacement cycle that starts from a tethered quadruplex-forming sequence from the human telomere repeat (T(2)AG(3))(4) that forms a G-quartet within a stem-loop structure. Adding an almost matching single strand converts the four-stranded section into a defective double helix. This is the first step of the cycle. The subsequent addition of a "fuel strand" removes the single strand from the loop sequence in favor of a perfect double helix. This displacement frees the hairpin-loop to go back to its initial state. Analysis of this cycle, that resembles an enzyme-substrate pathway as far as the initial state will be regained at the end of the cycle, advances our understanding of the interchanges between meta-stable states that underlie some fundamental steps in molecular biology, and allow for the construction of nano-molecular machines.

Progress in designing nucleic acid structures and fine-tuning their interactions

The prediction of the structure of biological macromolecules at the atomic level and the design of new meta-stable structures and secondary interactions are critical tests of our understanding of the structures and the inter-atomic forces that underlie molecular biology. The capacity to accurately predict and design new structures and interactions will allow us to create nucleic acid sequences that will fold in new and useful ways. Here, we present some results to demonstrate the progress we have made in designing and assembling new nucleic acid structures that will make an increasingly important contribution to biology and medicine. We call the reaction cycle that exemplifies our approach 'A handshake from a hairpin on the way to a double helix.'

The Consequences of Parental Divorce on the Life Course Outcomes of Canadian Children

Applying the theory of the intergenerational transmission of divorce, this paper examines the consequences of parental divorce on three aspects of the life course of children: union formation, nonmarital fertility, and marital dissolution. The 1995 Canadian General Social Survey (GSS) is used to estimate various regression models (Cox proportional hazards). Results show that children of divorced parents have a significantly higher likelihood to have births outside of marriage, enter into cohabiting unions, and to experience higher levels of divorce. Throughout the paper, attention is placed on the markedly different behaviour observed in Quebec compared to elsewhere in Canada.

Relation of contraceptive and reproductive history to ovarian cancer risk in carriers and noncarriers of BRCA1 gene mutations

In the general population, ovarian cancer risk is inversely associated with oral contraceptive use, tubal ligation, and childbearing. Among carriers of BRCA1 gene mutations, the data are conflicting. The authors identified women diagnosed with incident invasive epithelial ovarian cancer in the San Francisco Bay Area of California from March 1997 through July 2001. They compared the contraceptive and reproductive histories of 36 carrier cases and 381 noncarrier cases with those of 568 controls identified by random digit dialing who were frequency matched to cases on age and race/ethnicity. In both carriers and noncarriers, reduced risk was associated with ever use of oral contraceptives (odds ratio = 0.54 (95% confidence interval (CI): 0.26, 1.13) for carriers and 0.55 (95% CI: 0.41, 0.73) for noncarriers), duration of oral contraceptive use (risk reduction per year = 13% (p = 0.01) for carriers and 6% (p < 0.001) for noncarriers), history of tubal ligation (odds ratio = 0.68 (95% CI: 0.25, 1.90) for carriers and 0.65 (95% CI: 0.45, 0.95) for noncarriers), and increasing parity (risk reduction per childbirth = 16% (p = 0.26) for carriers and 24% (p < 0.001) for noncarriers). These data suggest that BRCA1 mutation carriers and noncarriers have similar risk reductions associated with oral contraceptive use, tubal ligation, and parity.

Urinary compounds in autism

BACKGROUND

Although earlier claims to identify specific compounds in the urine of people with autism had been discredited, it was subsequently suggested that there might be biochemical characteristics that were specific to early childhood, particularly in those who also did not have a severe degree of intellectual disability This study was to establish whether autism might have a distinctive chromatographic profile on urinary analysis.

METHOD

Thirty-four prepubertal boys with autism were matched with two groups of boys without autism--one on ability and chronological age and the other on chronological age alone, being within the normal range of ability. Laboratory analysis of their urine samples was carried out blind as to the clinical diagnosis.

RESULTS

The analysis correctly identified 53% of the autism group as against misidentifying 33% and 18% of the other two groups. When children with a severe learning disability (both with and without autism) were excluded from the comparisons, the laboratory then identified 77% of the 13 boys left in the autism group and misidentified 8% and 18% of the other two groups.

CONCLUSIONS

The results would support the idea of a biological marker in prepubertal children and that it may be absent in, or obscured by the presence of severe LD.