David Corbin - Academia.edu (original) (raw)
Papers by David Corbin
The Pan African Medical Journal, 2021
Millions of patients, with suspected complex neurogenetic disorders, living in resource limited r... more Millions of patients, with suspected complex neurogenetic disorders, living in resource limited regions around the world have no access to genetic testing despite the rapidly expanding availability and decreasing costs of genetic testing in first world nations. The barriers to increasing availability of genetic testing in resource limited nations are multifactorial but can be attributed, in large part, to a lack of awareness of the power of genetic testing to lead to a rapid, cost-effective, diagnosis that potentially will have profound clinical implications on treatment and patient outcomes. We report our experience with whole exome sequencing (WES) done for the first time in 5 patients of African descent with a suspected neurogenetic disorder living in a resource limited setting on the Eastern Caribbean island of Barbados. A diagnostic pathogenic mutation was found in 3 patients in the SCN1A, STXBP1 and SCN4A, who clinically were diagnosed with Dravet syndrome, Lennox-Gastaut synd...
BMC public health, Jan 22, 2018
We describe hospital-based management of acute ischaemic stroke patients in 2010-2013 in Barbados... more We describe hospital-based management of acute ischaemic stroke patients in 2010-2013 in Barbados, by comparing documented treatment given in the single tertiary public hospital with international guideline recommendations. Evidence-based stroke management guidelines were identified through a systematic literature search. Comparisons were made between these guidelines and documented diagnostic practice (all strokes) and prescribed medication (ischaemic stroke only), using a combination of key informant interviews and national stroke registry data for 2010-2013. Several published international guidelines for the acute management of ischaemic stroke recommended patient management in a dedicated stroke unit or nearest hospital specialised in stroke care. Further, patients should receive clinical diagnosis, CT brain scan, specialist evaluation by a multidisciplinary team and, if eligible, thrombolysis with alteplase within 3-3.5 h of symptom onset. Subsequent secondary prophylaxis, with...
Clinical Science, 1985
ABSTRACT
The American Journal of Tropical Medicine and Hygiene, 1996
Anterior horn cell degeneration has only occasionally been noted in patients with tropical spasti... more Anterior horn cell degeneration has only occasionally been noted in patients with tropical spastic paraparesis associated with human T lymphotropic virus type-1 (HTLV-1) infection. We report on three adult patients with HTLV-1-associated polymyositis who had clinical evidence of anterior horn cell degeneration. One patient had moderate proximal weakness and muscle wasting in all four limbs, while two had mild upper limb weakness with more profound proximal weakness and wasting in the lower limbs. In all three patients, electromyographic findings were compatible with motor unit loss and muscle biopsies showed mononuclear inflammatory cell infiltration; muscle biopsies in two patients showed features of denervation. Immunoglobulin G (IgG) antibodies to HTLV-1 were detected by enzyme-linked immunosorbent assay (ELISA) and confirmed by Western immunoblot in serum and cerebrospinal fluid in all three patients. In two, cell cultures were established from peripheral blood lymphocytes and HTLV-1 antigen was identified by immunofluorescence and the ELISA antigen-capture technique using an anti-p19 HTLV-1 mouse monoclonal antibody. The three cases illustrate the variety of neuromuscular disease, other than spastic paraparesis, that may occur in HTLV-1 infection. In some cases of HTLV-1-associated polymyositis, anterior horn cell degeneration may make a significant contribution to the muscle atrophy observed.
Clinical Physiology, 1985
Finger systolic-pressure (FSP) in response to local cooling has been evaluated as a diagnostic te... more Finger systolic-pressure (FSP) in response to local cooling has been evaluated as a diagnostic test in 28 females with primary Raynaud's phenomenon (PRP). The mean FSP (%) at 15 degrees C and 10 degrees C was significantly lower in the patients than in 28 age- and sex-matched controls but there was a large overlap in the individual responses. Diagnostic sensitivity of FSP (%) at 10 degrees C was only 57%. Increasing the sensitivity of the test lowered the specificity as the number of false positives rose. This also reduced the predictive value for a positive test. As a diagnostic test of PRP in individuals, the measurement of FSP appears to be of limited value, except in severe cases when complete vessel closure often occurs. Measurement of FSP will classify groups correctly and this objective physiological measure of Raynaud's phenomenon may have a place in group comparisons.
West Indian Med J, Jul 1, 1994
West Indian Med J, Apr 1, 1995
West Indian Med J, Apr 1, 1990
West Indian Med J, Jul 1, 1991
Practical Neurology, 2004
Barbados lies in the eastern Caribbean. It is a small coral-capped island (430 km2) that was bypa... more Barbados lies in the eastern Caribbean. It is a small coral-capped island (430 km2) that was bypassed by Christopher Columbus during his four voyages between 1492 and 1502. It is thought that later Portuguese explorers, noticing the many trees on the island with long pendulous aerial roots, vaguely resembling bearded men, gave the island its name – barbado is Portuguese
Journal of human virology
It has been shown that > 90% of mothers of HTLV-I-infected children were themselves carriers o... more It has been shown that > 90% of mothers of HTLV-I-infected children were themselves carriers of HTLV-I. This study was designed to determine the HTLV-I serostatus of mothers of patients with adult T-cell leukemia (ATL) and HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP), and to assess the association of age of exposure and disease outcome. In a cross-sectional study of the HTLV-I serostatus of mothers of HTLV-I-seropositive patients with ATL and HAM/TSP, 36 living mothers of patients with ATL and 15 mothers of patients with TSP/HAM were traced and enrolled. Five of the 15 (33%) mothers of patients with HAM/TSP and 35 of the 36 (97.2%) mothers of patients with ATL were HTLV-I-seropositive. All patients were breast-fed and none received blood transfusions. This study confirms that infection with HTLV-I in early childhood can lead to ATL in later life, and that HAM/TSP can also result from early infection but more commonly results from infection acquired in adult...
The West Indian medical journal, 1981
Stroke, 2008
Background and Purpose— Risk of stroke is higher in black Caribbeans in the United Kingdom compar... more Background and Purpose— Risk of stroke is higher in black Caribbeans in the United Kingdom compared with black Caribbeans in their country of origin. We investigated if these differences were caused by variations in prior-to-stroke risk factors. Summary of Report— Data were collected from the South London Stroke Register (SLSR) and the Barbados Register of Strokes (BROS). Differences in prevalence and management of stroke risk factors were adjusted for age, sex, living conditions prestroke, stroke subtype, and socioeconomic status by multivariable logistic regression. Patients in BROS were on average older (mean difference 4 years) and more likely to have a nonmanual occupation. They were less likely to have a prestroke diagnosis of myocardial infarction (OR, 0.39; 95% CI, 0.19 to 0.77) or diabetes (OR, 0.65; 95% CI, 0.46 to 0.92) and were less likely to report smoking (OR, 0.31; 95% CI, 0.19 to 0.49). They were also more likely to receive appropriate prestroke antihypertensive (OR,...
Stroke, 2006
Background and Purpose— There are variations in mortality rates for stroke in black communities, ... more Background and Purpose— There are variations in mortality rates for stroke in black communities, but the factors associated with survival remain unclear. Methods— The authors studied population-based stroke registers with follow up in South London (270 participants, 1995 to 2002) and Barbados (578 participants, 2001 to 2003). Differences in sociodemographic factors, stroke risk factors and their management, case severity, and acute management between London and Barbados were studied. Survival analysis used Kaplan-Meier curves, log-rank test, and Cox proportional hazards model with stratification. Results— There were 1411 person-years of follow-up. Patients in Barbados had poorer survival (log-rank test P =0.037), particularly those with a prestroke Barthel index scores between 15 and 20 (1-year survival, 56.4% versus 74.3%; P <0.001). This disadvantage remained significant (hazard ratio [HR], 1.99; 95% CI, 1.23 to 3.21, P =0.005) after adjustment for age and year of stroke and st...
Stroke, 2006
Background and Purpose— The incidence of stroke in black populations is a public health issue, bu... more Background and Purpose— The incidence of stroke in black populations is a public health issue, but how risk varies between black communities is unclear. Methods— Population-based registers in South London (SLSR) and Barbados (Barbados Register of Strokes [BROS]). Stroke incidence estimated by age group, gender and stroke subtype from January 1995 to December 2002 (SLSR), and October 2001 to September 2003 (BROS). Incidence rate ratios [IRR] estimated adjusting for age and sex. Results— Two hundred and seventy-one cases registered in SLSR and 628 cases in BROS. Average age of stroke was 66.1 years (SD 13.7) in SLSR and 71.5 years (SD 14.9) in BROS ( P <0.001). The incidence rate/1000 population in SLSR was 1.61 (European adjusted; 95% CI, 1.41 to 1.81) and 1.08 (world adjusted; 95% CI, 0.95 to 1.21). For Barbados incidence rates were 1.29 (European adjusted; 95% CI, 1.19 to1.39) and 0.85 (world adjusted; 95% CI, 0.78 to 0.92). Overall IRR for SLSR: BROS adjusted for age and sex wa...
Journal of Neurology, Neurosurgery & Psychiatry, 1992
The clinical features of seven patients with non-ketotic hyperglycaemia who developed focal seizu... more The clinical features of seven patients with non-ketotic hyperglycaemia who developed focal seizures are presented. All patients were alert except one who was mildly confused. Glucose values varied from 17-8 to 55-1 mmol/l, while calculated osmolarity values were elevated in all cases to a mild or moderate extent (299-1 to 346 5 mmol/l). In three cases diabetes mellitus was a new diagnosis. Four patients had recurrent episodes of focal seizures when glycaemic control was lost. Movement induced or kinesigenic seizures were seen in three cases and epilepsia partialis continua in one case. Seizures associated with hyperglycaemia are resistant to anticonvulsant treatment and respond best to insulin and rehydration. Focal seizures in adults may indicate diabetes mellitus. The link between focal seizures and hyperglycaemia was first reported in 1965' yet in one well known textbook of epilepsy, hyperglycaemia-associated seizures are not mentioned at all.2 The phenomenon may not be rare; in a review of 158 cases of non-ketotic hyperglycaemia 19% had focal motor seizures.3 We report seven patients, including three previously undiagnosed diabetics, who presented with focal seizures and non-ketotic hyperglycaemia. We suggest that once clinicians are made aware of the association between focal seizures and hyperglycaemia, as happened early in 1989 at this hospital, further cases are readily identified and managed more appropriately. Patients and methods Six of the patients were seen by at least one of the authors and five (cases 1, 2, 3, 4, 5) were diagnosed in 1989. We also carried out a search of discharge diagnoses from this hospital for
Journal of Neurology, Neurosurgery & Psychiatry, 1987
The Pan African Medical Journal, 2021
Millions of patients, with suspected complex neurogenetic disorders, living in resource limited r... more Millions of patients, with suspected complex neurogenetic disorders, living in resource limited regions around the world have no access to genetic testing despite the rapidly expanding availability and decreasing costs of genetic testing in first world nations. The barriers to increasing availability of genetic testing in resource limited nations are multifactorial but can be attributed, in large part, to a lack of awareness of the power of genetic testing to lead to a rapid, cost-effective, diagnosis that potentially will have profound clinical implications on treatment and patient outcomes. We report our experience with whole exome sequencing (WES) done for the first time in 5 patients of African descent with a suspected neurogenetic disorder living in a resource limited setting on the Eastern Caribbean island of Barbados. A diagnostic pathogenic mutation was found in 3 patients in the SCN1A, STXBP1 and SCN4A, who clinically were diagnosed with Dravet syndrome, Lennox-Gastaut synd...
BMC public health, Jan 22, 2018
We describe hospital-based management of acute ischaemic stroke patients in 2010-2013 in Barbados... more We describe hospital-based management of acute ischaemic stroke patients in 2010-2013 in Barbados, by comparing documented treatment given in the single tertiary public hospital with international guideline recommendations. Evidence-based stroke management guidelines were identified through a systematic literature search. Comparisons were made between these guidelines and documented diagnostic practice (all strokes) and prescribed medication (ischaemic stroke only), using a combination of key informant interviews and national stroke registry data for 2010-2013. Several published international guidelines for the acute management of ischaemic stroke recommended patient management in a dedicated stroke unit or nearest hospital specialised in stroke care. Further, patients should receive clinical diagnosis, CT brain scan, specialist evaluation by a multidisciplinary team and, if eligible, thrombolysis with alteplase within 3-3.5 h of symptom onset. Subsequent secondary prophylaxis, with...
Clinical Science, 1985
ABSTRACT
The American Journal of Tropical Medicine and Hygiene, 1996
Anterior horn cell degeneration has only occasionally been noted in patients with tropical spasti... more Anterior horn cell degeneration has only occasionally been noted in patients with tropical spastic paraparesis associated with human T lymphotropic virus type-1 (HTLV-1) infection. We report on three adult patients with HTLV-1-associated polymyositis who had clinical evidence of anterior horn cell degeneration. One patient had moderate proximal weakness and muscle wasting in all four limbs, while two had mild upper limb weakness with more profound proximal weakness and wasting in the lower limbs. In all three patients, electromyographic findings were compatible with motor unit loss and muscle biopsies showed mononuclear inflammatory cell infiltration; muscle biopsies in two patients showed features of denervation. Immunoglobulin G (IgG) antibodies to HTLV-1 were detected by enzyme-linked immunosorbent assay (ELISA) and confirmed by Western immunoblot in serum and cerebrospinal fluid in all three patients. In two, cell cultures were established from peripheral blood lymphocytes and HTLV-1 antigen was identified by immunofluorescence and the ELISA antigen-capture technique using an anti-p19 HTLV-1 mouse monoclonal antibody. The three cases illustrate the variety of neuromuscular disease, other than spastic paraparesis, that may occur in HTLV-1 infection. In some cases of HTLV-1-associated polymyositis, anterior horn cell degeneration may make a significant contribution to the muscle atrophy observed.
Clinical Physiology, 1985
Finger systolic-pressure (FSP) in response to local cooling has been evaluated as a diagnostic te... more Finger systolic-pressure (FSP) in response to local cooling has been evaluated as a diagnostic test in 28 females with primary Raynaud's phenomenon (PRP). The mean FSP (%) at 15 degrees C and 10 degrees C was significantly lower in the patients than in 28 age- and sex-matched controls but there was a large overlap in the individual responses. Diagnostic sensitivity of FSP (%) at 10 degrees C was only 57%. Increasing the sensitivity of the test lowered the specificity as the number of false positives rose. This also reduced the predictive value for a positive test. As a diagnostic test of PRP in individuals, the measurement of FSP appears to be of limited value, except in severe cases when complete vessel closure often occurs. Measurement of FSP will classify groups correctly and this objective physiological measure of Raynaud's phenomenon may have a place in group comparisons.
West Indian Med J, Jul 1, 1994
West Indian Med J, Apr 1, 1995
West Indian Med J, Apr 1, 1990
West Indian Med J, Jul 1, 1991
Practical Neurology, 2004
Barbados lies in the eastern Caribbean. It is a small coral-capped island (430 km2) that was bypa... more Barbados lies in the eastern Caribbean. It is a small coral-capped island (430 km2) that was bypassed by Christopher Columbus during his four voyages between 1492 and 1502. It is thought that later Portuguese explorers, noticing the many trees on the island with long pendulous aerial roots, vaguely resembling bearded men, gave the island its name – barbado is Portuguese
Journal of human virology
It has been shown that > 90% of mothers of HTLV-I-infected children were themselves carriers o... more It has been shown that > 90% of mothers of HTLV-I-infected children were themselves carriers of HTLV-I. This study was designed to determine the HTLV-I serostatus of mothers of patients with adult T-cell leukemia (ATL) and HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP), and to assess the association of age of exposure and disease outcome. In a cross-sectional study of the HTLV-I serostatus of mothers of HTLV-I-seropositive patients with ATL and HAM/TSP, 36 living mothers of patients with ATL and 15 mothers of patients with TSP/HAM were traced and enrolled. Five of the 15 (33%) mothers of patients with HAM/TSP and 35 of the 36 (97.2%) mothers of patients with ATL were HTLV-I-seropositive. All patients were breast-fed and none received blood transfusions. This study confirms that infection with HTLV-I in early childhood can lead to ATL in later life, and that HAM/TSP can also result from early infection but more commonly results from infection acquired in adult...
The West Indian medical journal, 1981
Stroke, 2008
Background and Purpose— Risk of stroke is higher in black Caribbeans in the United Kingdom compar... more Background and Purpose— Risk of stroke is higher in black Caribbeans in the United Kingdom compared with black Caribbeans in their country of origin. We investigated if these differences were caused by variations in prior-to-stroke risk factors. Summary of Report— Data were collected from the South London Stroke Register (SLSR) and the Barbados Register of Strokes (BROS). Differences in prevalence and management of stroke risk factors were adjusted for age, sex, living conditions prestroke, stroke subtype, and socioeconomic status by multivariable logistic regression. Patients in BROS were on average older (mean difference 4 years) and more likely to have a nonmanual occupation. They were less likely to have a prestroke diagnosis of myocardial infarction (OR, 0.39; 95% CI, 0.19 to 0.77) or diabetes (OR, 0.65; 95% CI, 0.46 to 0.92) and were less likely to report smoking (OR, 0.31; 95% CI, 0.19 to 0.49). They were also more likely to receive appropriate prestroke antihypertensive (OR,...
Stroke, 2006
Background and Purpose— There are variations in mortality rates for stroke in black communities, ... more Background and Purpose— There are variations in mortality rates for stroke in black communities, but the factors associated with survival remain unclear. Methods— The authors studied population-based stroke registers with follow up in South London (270 participants, 1995 to 2002) and Barbados (578 participants, 2001 to 2003). Differences in sociodemographic factors, stroke risk factors and their management, case severity, and acute management between London and Barbados were studied. Survival analysis used Kaplan-Meier curves, log-rank test, and Cox proportional hazards model with stratification. Results— There were 1411 person-years of follow-up. Patients in Barbados had poorer survival (log-rank test P =0.037), particularly those with a prestroke Barthel index scores between 15 and 20 (1-year survival, 56.4% versus 74.3%; P <0.001). This disadvantage remained significant (hazard ratio [HR], 1.99; 95% CI, 1.23 to 3.21, P =0.005) after adjustment for age and year of stroke and st...
Stroke, 2006
Background and Purpose— The incidence of stroke in black populations is a public health issue, bu... more Background and Purpose— The incidence of stroke in black populations is a public health issue, but how risk varies between black communities is unclear. Methods— Population-based registers in South London (SLSR) and Barbados (Barbados Register of Strokes [BROS]). Stroke incidence estimated by age group, gender and stroke subtype from January 1995 to December 2002 (SLSR), and October 2001 to September 2003 (BROS). Incidence rate ratios [IRR] estimated adjusting for age and sex. Results— Two hundred and seventy-one cases registered in SLSR and 628 cases in BROS. Average age of stroke was 66.1 years (SD 13.7) in SLSR and 71.5 years (SD 14.9) in BROS ( P <0.001). The incidence rate/1000 population in SLSR was 1.61 (European adjusted; 95% CI, 1.41 to 1.81) and 1.08 (world adjusted; 95% CI, 0.95 to 1.21). For Barbados incidence rates were 1.29 (European adjusted; 95% CI, 1.19 to1.39) and 0.85 (world adjusted; 95% CI, 0.78 to 0.92). Overall IRR for SLSR: BROS adjusted for age and sex wa...
Journal of Neurology, Neurosurgery & Psychiatry, 1992
The clinical features of seven patients with non-ketotic hyperglycaemia who developed focal seizu... more The clinical features of seven patients with non-ketotic hyperglycaemia who developed focal seizures are presented. All patients were alert except one who was mildly confused. Glucose values varied from 17-8 to 55-1 mmol/l, while calculated osmolarity values were elevated in all cases to a mild or moderate extent (299-1 to 346 5 mmol/l). In three cases diabetes mellitus was a new diagnosis. Four patients had recurrent episodes of focal seizures when glycaemic control was lost. Movement induced or kinesigenic seizures were seen in three cases and epilepsia partialis continua in one case. Seizures associated with hyperglycaemia are resistant to anticonvulsant treatment and respond best to insulin and rehydration. Focal seizures in adults may indicate diabetes mellitus. The link between focal seizures and hyperglycaemia was first reported in 1965' yet in one well known textbook of epilepsy, hyperglycaemia-associated seizures are not mentioned at all.2 The phenomenon may not be rare; in a review of 158 cases of non-ketotic hyperglycaemia 19% had focal motor seizures.3 We report seven patients, including three previously undiagnosed diabetics, who presented with focal seizures and non-ketotic hyperglycaemia. We suggest that once clinicians are made aware of the association between focal seizures and hyperglycaemia, as happened early in 1989 at this hospital, further cases are readily identified and managed more appropriately. Patients and methods Six of the patients were seen by at least one of the authors and five (cases 1, 2, 3, 4, 5) were diagnosed in 1989. We also carried out a search of discharge diagnoses from this hospital for
Journal of Neurology, Neurosurgery & Psychiatry, 1987