Profile of diabetes mellitus among immigrants from Guyana: epidemiology and implications for community action.
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OBJECTIVE: Prompted by anecdotal evidence of a higher rate of type 2 diabetes, we set out to investigate the prevalence of diabetes, its risk factors, and co-morbidities among immigrant Guyanese patients being treated in a family medicine health center in Schenectady, New York. METHODS: Patients were ascertained from a registration database of all patients aged > or = 30 years who were treated from 2004 to 2006. We then conducted a detailed retrospective chart review of all Guyanese, Caucasian, African American, and Hispanic patients with diabetes and randomly selected non-diabetic controls. RESULTS: Of 222 Guyanese patients, 67 (30.2%) had a diagnosis of diabetes, compared with 47/219 (21.5%) of Hispanics, 132/777 (17.0%) of African Americans, and 442/2834 (15.6%) of Caucasians (P<.0001). Compared with the other racial and ethnic groups, the Guyanese diabetic patients were significantly leaner and more likely to be male. CONCLUSION: We found a very high prevalence of type 2 diabetes among the Guyanese patient population studied and found unique characteristics when compared with other ethnic and racial groups. These findings have alerted local clinicians to intensify diabetes screening among Guyanese patients. Furthermore, in response to these findings, a broad coalition including public health, clinical, and community groups has been established with the goal of developing culturally appropriate strategies to prevent and control diabetes among Guyanese residents. (+info)
Socioeconomic burden of lymphatic filariasis in Georgetown, Guyana.
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Macrophage-parasite interaction in the lesions of cutaneous leishmaniasis. An ultrastructural study.
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Localized cutaneous infections with Leishmania, which demonstrate complex host-parasite interactions, were studied ultrastructurally in 16 patients at phases ranging from onset to resolution. In the early lesions the host macrophages were 1) heavily parasitized and vesiculated, 2) undifferentiated, or 3) large and active, with fewer organisms. Progressive activation and epithelioid transformation of incoming monocytes was associated with the elimination of parasites. Killing and degradation appeared to take place simultaneously within the phagolysosome, but lysosomal fusion did not prevent survival into the activated cell stage. Host cell lysis, the alternative mechanism of parasite elimination, was accomplished following contact of the macrophage with plasma cells or its engulfment by a large granular cell. Lysis was either sporadic, proceeding from the periphery, or total in a central mass; and in each case macrophage lysis was preceded by connective tissue damage. The externalized parasites appeared to enhance both the activation and lytic processes, but degraded extracellular organisms were associated with dendritic-like cells more than with macrophages. This needs further study. (+info)
Thyrotoxicosis developing within one year following migration to the United States.
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Two members of a family from Guyana, South America, developed thyrotoxicosis within one year of migration to the United States. Both patients had pre-existing multinodular goiters. Their clinical manifestation was consistent with that of iodide-induced thyrotoxicosis. This syndrome may be more common than previously reported in the United States. Physicians practicing in inner-city areas with a significant immigrant population should be more aware of this entity. (+info)