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GEORGETOWN, Guyana (CMC)— Guyana health minister Dr Frank Anthony has confirmed that two children— ages nine and 11— have died after being infected with dengue.

The children had been receiving treatment at the Intensive Care Unit (ICU) of the Georgetown Public Hospital. Dr Anthony said no other child is receiving critical care after being infected with dengue.

Media reports in Guyana said that one of the two children who died was a primary school pupil from Essequibo Islands-West Demerara, who spent five days in the ICU before passing away.

Based on official figures, an estimated 3,453 people in Guyana have been infected with the mosquito-borne disease so far this year, with 2,169 cases considered to be still active patients.

Dr Anthony said that local authorities have been fogging all areas to prevent people from being bitten by mosquitoes and that a substance used to kill mosquito larvae is also being distributed.

The symptoms of dengue include high fevers, head and body aches and nausea.

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Dear Dr Mitchell,

I am in my late 30s and trying hard to get pregnant, which is not happening. I was diagnosed with endometriosis and underwent surgery, and was told that I would conceive after the surgery and up to this date nothing has happened.

What would you think is my issue? My husband did several semen tests and the only findings of those were that his sperm move very slow. How can we have a child together before it's too late?

Endometriosis can definitely contribute to your inability to conceive even after you have done surgery to remove the endometriosis. There can be residual scarring or adhesions that cause the Fallopian tubes to become blocked or bound down. This could prevent pregnancy from occurring since the egg would not be able to travel into and along the Fallopian tubes from the ovary. Even if the Fallopian tubes are not blocked, women with endometriosis still have difficulty becoming pregnant because the eggs that are released each month have a higher chance than usual of being destroyed or wasted.

The fact that your partner has a problem with the sluggish movement of his sperm needs to be further investigated and treated. He should see a urologist. There are several causes of slow movement of sperm. These include a genetic problem; smoking; work induced infertility, in particular jobs which involve repeated trauma to the pelvic area; and varicocele (enlarged veins in the scrotum). Poor diet including vitamin C and B12 deficiency can also contribute to sluggish movement of the sperm. Excessive stress can also cause infertility in men.

For men who are otherwise normal except for slow movement of the sperm in the 30-40 per cent range, artificial insemination might be successful in achieving a pregnancy. The success rate is however low and most couples will need invitro fertilisation (IVF) with the direct injection of the sperm into the egg (ICSI) to achieve a pregnancy.

It is important for you to get an X-ray of the Fallopian tubes done to ensure that at least one Fallopian tube is not blocked. Artificial insemination will not work if both of your Fallopian tubes are blocked. A diagnostic laparoscopy might also be necessary to determine if there are adhesions causing the Fallopian tubes to be bound down and non-functional. If there is scarring around the Fallopian tubes this can also be corrected at the time of the laparoscopy to improve your outcome of becoming pregnant naturally or via artificial insemination.

You should consult your gynaecologist and ask for a referral to a fertility specialist trained to do IVF and ICSI. You are young and should have excellent quality eggs so do not be too anxious since you should have a good outcome.

Best regards.

Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver.com; write to All Woman, 40-42 1/2 Beechwood Avenue, Kingston 5 or fax to 876-968-2025. All responses are published. Dr Mitchell cannot provide personal responses.

DISCLAIMER:

The contents of this article are for informational purposes only and must not be relied upon as an alternative to medical advice or treatment from your own doctor.

Los Angeles.- This past August 4 was International Beer Day, a celebration that originated in a small bar in Santa Cruz, a town in California, United States.

The celebration, which began as a call exclusively for customers, was so well received that it spread worldwide and is held on the first Friday of this month.

Given the recent heat waves, people are increasing their consumption of soft drinks and beer as an alternative to cool down and lower their body temperature.

It is worth mentioning that beer is an alcoholic beverage made from the fermentation of some cereals; even though users consider it a good idea to drink some cold beers, it may be contradictory, as it eventually worsens the heat.

An article published by Healthline pointed out that excessive consumption of sugary drinks, such as soda, coffee, and some drinks made with tea, can lead to intense dehydration.

Therefore, the answer of which of the two beverages is better to consume, in this case, would be beer, as Harvard T.H. Chan School of Public Health pointed out that sugary drinks should be avoided, while alcohol can be consumed moderately.

Finally, the intake of natural water continues to be the best option to hydrate the body since about 70% of the body is made up of this element.

Likewise, Mayo Clinic recommends consuming at least eight glasses of water a day with the primary objective of avoiding the appearance of dehydration symptoms.

This potentially catastrophic complaint, arising from heart vessel blockage, is perilously underestimated. Ignoring chest pain due to heart issues can lead to dire consequences including death. Recognising the gravity of this condition and seeking timely medical care is of paramount importance.

Heart attacks manifest in various ways, but a common symptom is chest pain accompanied by shortness of breath, profuse sweating, nausea, and vomiting. Some describe it as an overwhelming heaviness, like an elephant sitting on their chest. This intense discomfort can trigger a feeling of impending doom. When such dramatic symptoms arise, individuals instinctively seek immediate medical assistance, understanding the urgency.

However, the real danger lies in the cases where the presentation is less dramatic. Chest pain may not always follow the classic pattern but can still be ominous. It might be a dull ache, discomfort, or even mistaken for stomach upset or "gas". Tragically, many Jamaicans attribute these symptoms to benign causes, resorting to ineffective remedies like tea or ginger. This misconception can lead to fatal delays in seeking proper treatment.

It is crucial to understand that any degree of chest discomfort, no matter how mild, requires prompt medical attention. Relying on home remedies or hoping the pain will pass is a dangerous gamble. The pain might temporarily subside, but the underlying threat remains. Chest pain is not to be taken lightly; it can and will lead to severe consequences, including loss of life. Early intervention is the key to saving lives and preventing further complications.

While various factors can cause chest pain, assuming it's benign without a thorough medical evaluation is risky. Sudden chest pain, especially if severe, accompanied by breathlessness, nausea, or vomiting, demands immediate medical attention. Traditionally, risk factors like age, hypertension, diabetes, smoking, and obesity have been associated with heart attacks. However, even individuals without these risk factors can still be susceptible. Recognising one's risk and having a plan for emergency situations is crucial.

When faced with chest pain, seeking medical evaluation promptly is vital. Distinguishing between benign and dangerous forms of chest pain requires expertise. Even cardiologists face challenges in making accurate distinctions without proper diagnostic tests. Dismissing chest pain without evaluation is a grave mistake, as certain types of chest pain pose life-threatening risks. These include chest pain resulting from blocked blood flow to the heart muscle, tear of a major blood vessel, or blood clot in the lungs. The urgency to seek medical care cannot be overstated.

Choosing where to seek medical evaluation for chest pain is equally critical. Not all facilities are equipped to handle heart-related emergencies. Swift response and appropriate care are paramount when dealing with heart-related issues. Waiting lists and delays are unacceptable in cases of potential heart attacks. Rapid, decisive, and efficient response is the only way to ensure positive outcomes.

The prevalence of heart attacks in Jamaica has been on the rise, attributed to changing lifestyles and increased risk factors. Despite this, awareness and urgency in responding to chest pain remain deficient. Too many lives are needlessly lost due to delayed or inappropriate care. Chest pain cannot be underestimated or dismissed. Immediate attention and proper evaluation are non-negotiable.

Two real-life cases at the Heart Institute of the Caribbean underscore the critical nature of timely intervention. In one instance, delayed presentation resulted in a tragic outcome, while in the other, swift action saved a life. Door-to-balloon time, referring to the time from hospital admission to heart treatment, is crucial. Efforts must be made to reduce this time to save lives and minimise complications.

Transitioning from traditional practices to evidence-based standards of care is imperative. Technology and knowledge have evolved, and health care must keep pace. Just as we've embraced smartphones over flip phones, we must adopt advanced techniques and technologies in heart care. Chest pain is a 24/7 emergency, and delays should not be normalised. Collaborative efforts are needed to overcome barriers and improve access to timely and effective care.

In conclusion, chest pain is a serious matter that demands urgent attention. The distinction between tradition and evidence-based standards of care cannot be overlooked. It's time to bridge the gap between existing practices and international best practices. Lives are at stake, and it's our responsibility to ensure that rapid, effective intervention is the norm, not the exception. We have long been strong advocates for a structured response to chest pain and acute cardiac emergencies in Jamaica. Now is the time for us to work together to prioritise the swift and appropriate response to chest pain, ultimately saving lives and preventing unnecessary suffering or death.

Dr Ernest Madu, MD, FACC and Dr Paul
Edwards, MD, FACC are consultant cardiologists for the Heart Institute of the Caribbean (HIC) and HIC Heart Hospital. HIC is the regional centre of excellence for cardiovascular care in the English-speaking Caribbean and has pioneered a transformation in the way cardiovascular care is delivered in the region. HIC Heart Hospital is registered by the Ministry of Health and Wellness and is the only heart hospital in Jamaica. Send correspondence to info@caribbeanheart.com or call 876-906-2107.

WASHINGTON DC, United States (PAHO/WHO) — WHILE the incidence of dengue increases acro
ss regions, especially in parts of the Americas, experts recently reviewed the global situation and methods to help control the spread of the mosquito-borne disease.

During the EPI-WIN Webinar: Managing Dengue: a rapidly expanding epidemic, experts from around the world highlighted that about half of the world's population is now at risk of dengue, with an estimated 100–400 million infections occurring each year.

"Incidence has increased by almost eight-fold since 2000," said Dr Raman Velayudhan, unit head for veterinary public health, vector control and environment and neglected tropical diseases at the World Health Organization (WHO) at the opening of the webinar. Before 1970, the mosquito-vector of the disease was present in only half a dozen countries, he added, but it is now found in over 130 countries.

Situation in the Americas

In the Americas, dengue is transmitted primarily by the Aedes aegypti mosquito and the disease is endemic to many countries. Outbreaks tend to be cyclical every three to five years, following seasonal patterns corresponding to the warm, rainy months, when mosquitoes breed.

In 2023, however, the Americas have seen a sharp increase in dengue cases. Over three million new infections have been recorded so far, surpassing figures for 2019 — the year with the highest recorded incidence of the disease in the region, with 3.1 million cases, including 28,203 severe cases and 1,823 deaths.

Most cases — over 2.6 million — are registered in the southern cone, with Brazil accounting for 80 per cent. But unusually high transmission has also been seen in other areas of the continent, including the Andean region, with over 400,000 cases and a higher case fatality rate. In March and June of this year, the Pan American Health Organization (PAHO) issued recommendations to help countries tackle the increase.

"Urbanisation and climate change have had a huge impact in spreading dengue," Velayudhan said during the webinar. The movement and agglomeration of people in urban areas have helped to spread the vector, he added, but COVID-19 disruptions have also impacted mosquito control measures and the reporting of cases.

"Post-COVID, we need to realign programmes to be more integrated and ensure health systems can manage," Velayudhan said. "We should implement the lessons learned from the pandemic, such as in diagnosis and use of PCR tests, enhanced surveillance, good communication and community involvement."

As the southern hemisphere enters the colder and drier months, cases are declining in parts of the region, but greater transmission is expected in Central America and the Caribbean during the second half of the year. PAHO recently issued an alert providing guidance to national authorities to boost surveillance and prepare health systems for an uptick in cases.

Community engagement for effective vector control

There is no specific treatment for dengue, and prevention depends on the control of the vector. Measures to curb mosquitoes include the use of chemicals, such as insecticides and repellents, and mechanical methods to remove breeding sites or provide a barrier, such as treated nets, window screens and protective clothing.

Programmes that use a combination of these methods can be effective, but engaging communities to apply them is critical for their success, especially to remove or clean potential breeding habitats. Old, disused tires, for example, offer shade and a preferred dark space for Aedes mosquitoes to lay their eggs, which can resist drought and develop only once they meet water many months later.

PAHO has developed a series of initiatives to support such local prevention activities, including Mosquito Awareness Week, which spurs community-level actions to provide information on the links between mosquitoes and the diseases they transmit, such as dengue, but also chikungunya, Zika, malaria, and yellow fever.

"Several messages on prevention have been developed and countries can adapt them to their local needs," said Giovanini Coelho, from PAHO's public health entomology team.

Dengue is a viral infection that spreads from mosquitoes to people. While most infections are asymptomatic or produce mild illness, the disease can occasionally become severe and even cause death. Symptoms range from mild to debilitating high fever, with severe headache, pain behind the eyes, muscle and joint pain, and a rash. The illness can evolve into severe dengue, characterised by shock, respiratory distress, bleeding, and possible organ impairment.

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