Challenges for eGFR equations in the developing world.

The populations in countries that have the highest number of individuals with chronic kidney disease (CKD) are the low and middle-income countries which are ethnically diverse. The regional and international data highlighting the need for continuous monitoring of renal function warrants that such countries use equations that give the best estimates of glomerular filtration rate for their settings. While chronic disease conditions such as diabetes and hypertension are the main conditions associated with CKD in adult populations and complicated urinary tract infections and congenital anomalies in the kidney and the urinary tract in the young, the management of patients with CKD at any age can be impacted by medical and non-biological factors. This communication seeks to posit issues that may be germane to consider when using the CKD-EPI 2021 equations in the adult and young adult populations. These equations, by excluding the race factor, have put the spotlight on the relevance of the cultural and economic context concerning the management of renal patents. The social determinants of health, how an individual defines their gender, the cultural acceptance of such or the lack thereof, factors influencing the choice of the test, communication, and technology among others may all affect renal care. These issues together may have a greater impact on renal patient care and outcome than racial disparity. While the racial divide may have been a driver for differential treatment in developed nations with different ethnic groups they may be less so when compared with more homogenous populations.

Health status risk factors and quality of life in 75-84-year-old individuals assessed for dementia using the short 10/66 dementia diagnostic schedule.

BACKGROUND: Trinidad is an island that not only has a population at high vascular risk but also one that is in epidemiological transition with high dementia prevalence. The aim of the study was to investigate modifiable risk factors associated with dementia in middle-old (75-84 years) individuals. METHODS: As part of a large national community survey of dementia prevalence in Trinidad, 811 people aged 75-84 years were evaluated for dementia using the 10/66 short algorithm. Demographic data collected included information on age, gender, ethnicity, religion, education, occupation, living accommodation, smoking, alcohol consumption, self-reported medical conditions, impairments and ability to do instrumental activities of daily living (IADL). Data were analysed using multivariable logistic regression models. RESULTS: Of the 811 participants, nearly 55% were female. The mean age was 78.8 (SD = 2.8) years and dementia was present in 198 (24.4%). Having less than ten years of education, being an agricultural worker, skilled labourer or housewife and having more than four co-morbidities were significantly associated with dementia. The odds ratio for dementia for those having self-reported stroke was 4.93 (95% CI [2.64-9.23]) and for diabetes was 1.76 (95% CI [1.17-2.65]) adjusting for age, age2, gender, ethnicity, religion, education and occupation. Impairment in eyesight, hearing, climbing stairs, and walking were also more common in the group with dementia. Ability to perform IADLs was linked with dementia. Individuals with dementia were more likely to be unable to perform any of the eight IADLs. Those who did not exercise at all (OR 6.95, 95% CI [2.02-23.90]) and those who did low exercise (OR 1.83, 95% CI [1.07-3.13]) compared to those who did moderate to high exercise were also more likely to have dementia. CONCLUSION: In the middle-old population in Trinidad having diabetes and stroke, low IADL score, and no exercise were more common in people with dementia.

Assessment of treatment goals attained by patients according to guidelines for diabetes management in primary care centres in North Trinidad.

BACKGROUND: the scientific literature is deficient in studies looking at the achievement of primary care diabetes treatment targets as stipulated by best practice guidelines in the Caribbean. AIMS: assessment of treatment goals attained by patients according to the Caribbean Health Research Council (CHRC)/Pan-American Health Organization (PAHO) guidelines for diabetes management in primary care centres in North Trinidad. The primary interest of this study was the extent to which stated intermediate outcome measures were achieved. Secondarily, process measures and adherence to specific recommendations on pharmacotherapy were evaluated. METHODS: this was a cross-sectional study where 225 patients with diabetes from five primary care centres were interviewed in October and November 2007. Data collected included age, sex, ethnicity, religious background, educational level and duration, diabetes type and duration since diagnosis, the presence of hypertension, current blood pressure, level of physical activity and current medications. Last documented serum cholesterol and HbA1c within the past year were obtained from patient records. Anthropometric measurements recorded were weight, height and waist and hip circumferences. RESULTS: of patients with available values, 49.3% achieved the target total cholesterol of less than 200 mg/dL while 56.6% had an HbA1C level of less than 6.5%. Only 47.7% attained a blood pressure target of less than or equal to 130/80 mmHg. 25.2% had a Body Mass Index (BMI) of less than 25 kg/m(2). For waist circumference measurements, 40.8% of males and 2.1% of females were within recommended limits. Only 13.5% had 20 minutes or more of at least moderate exercise daily. No patient met all recommended target values for these six parameters. CONCLUSIONS: there is poor achievement of treatment goals as set by best practice diabetes management guidelines. Results from this study may serve to inform primary care strategy revisions aimed at more widespread achievement of control targets which would ultimately abate the burden of illness in this population.

The socio-economic determinants of multimorbidity among the elderly population in Trinidad and Tobago.

OBJECTIVE: To estimate the prevalence of multimorbidity and investigate the socioeconomic factors that are associated with multimorbidity among persons 70 years and older in Trinidad and Tobago. DESIGN AND METHODS: The data were obtained from a nationally representative comprehensive cross-sectional survey conducted in 2014 among elderly persons in the targeted age group. The prevalence of multimorbidity among the elderly population was estimated. A logit model was utilized to determine the socioeconomic characteristics that are associated with multimorbidity in the elderly. RESULTS: The results of the study show that multimorbidity in the elderly population is strongly associated with age, ethnicity, lower education, smoking history, no physical activity and being female. An interesting finding is that elderly persons in the richest quintile are in general, more prone to multimorbidity. CONCLUSION: The findings suggest that interventions to reduce multimorbidity among the elderly population must encourage greater levels of physical activity, provide education on the risk factors of multimorbidity, and discourage smoking.

High Prevalence of Diabetes Mellitus in a Cohort of Patients with Chronic Obstructive Pulmonary Disease in Trinidad, West Indies.

OBJECTIVES: Both chronic obstructive pulmonary disease (COPD) and diabetes mellitus (DM) are highly prevalent in Trinidad, West Indies. Our objective was to evaluate the prevalence of DM in a cohort of Trinidadian patients with COPD and investigate the possible impact of diabetes on COPD using standard outcome measures, that is, lung function, exacerbations, quality of life and depression questionnaires, as well as mortality. MATERIALS AND METHODS: This was a cross-sectional follow-up study utilizing a cohort of 105 patients from chest clinics in the three major general hospitals in Trinidad. RESULTS: Diabetes was diagnosed based on a glycated hemoglobin (HbA1c) level of ≥6.5% (or a prior self-reported history), and for pre-diabetes, of 5.7%-6.4%. Of 105 patients, 40% fulfilled the criteria for diabetes and 40% for pre-diabetes. Of those diagnosed with diabetes, 38% obtained this diagnosis de novo. A history of intravenous corticosteroid use was associated with higher HbA1c levels (p=0.043) upon diagnosis. The percentage of predicted forced vital capacity was negatively related to HbA1c (p=0.033), but those with diabetes also had a greater body mass index (p=0.001). After a 1-year follow-up, mortality was significantly greater among patients with diabetes (p=0.026). Patients with at least one exacerbation in the past year or poorer lung function parameters had worse quality of life (p≤0.040) and depression (p≤0.018) scores. Notably, 31.4% of the total cohort exhibited clinically significant depression scores. CONCLUSION: This study revealed that a high proportion of COPD patients in tertiary care had diabetes or pre-diabetes.

Dementia prevalence in a population at high vascular risk: the Trinidad national survey of ageing and cognition.

OBJECTIVE: To investigate the dementia prevalence in a country with high levels of cardiovascular risk factors DESIGN AND METHODS: Older people in Trinidad are recognised to have particularly high levels of cardiovascular risk factors. We carried out a survey in a nationally representative sample of people aged ≥70 years using household enumeration. Dementia status was ascertained using standardised interviews and algorithms from the 10/66 schedule and age-specific prevalence were compared with identically defined output from the 10/66 surveys of 16 536 residents in eight other low-income and middle-income countries. RESULTS: Of 1832 participants (77.0% response rate), dementia was present in 442 (23.4%). Prevalences were 12.0% in persons aged 70-74 years, 23.5% at 75-79, 25.8% at 80-84, 41.3% at 85-89 and 54.0% in those aged ≥90 years. Prevalence ratios compared with averages from 10/66 surveys in these age groups were 2.2, 2.6, 1.6, 1.7 and 1.6, respectively, and were 2.7, 2.8, 1.7, 1.4 and 0.8, respectively, compared with previously published consensus estimates for the Latin American region. Dementia was significantly associated with reported stroke and diabetes in logistic regression models adjusted for sociodemographic status and other vascular risk factors (OR (95% CI) 4.40 (2.70 to 7.19) and 1.56 (1.20 to 2.03), respectively). Projected national numbers of people with dementia (18 206) were 70%-100% higher than those estimated using most recent regional consensus prevalences. CONCLUSION: In a nation with high levels of vascular risk, dementia prevalence is higher than expected, particularly at the lower end of the 70+ age range. International prevalence projections may need to take into account risk status as well as age structures.

Comparisons between different elements of reported burden and common mental disorder in caregivers of ethnically diverse people with dementia in Trinidad.

OBJECTIVE: Culture plays a significant role in determining family responsibilities and possibly influences the caregiver burden associated with providing care for a relative with dementia. This study was carried out to determine the elements of caregiver burden in Trinidadians regarding which interventions will provide the most benefit. METHODS: Seventy-five caregivers of patients diagnosed with dementia participated in this investigation. Demographic data were recorded for each caregiver and patient. Caregiver burden was assessed using the Zarit Burden Interview (ZBI), and the General Health Questionnaire (GHQ) was used as a measure of psychiatric morbidity. Statistical analyses were performed using Stata and SPSS software. Associations between individual ZBI items and GHQ-28 scores in caregivers were analyzed in logistic regression models; the above-median GHQ-28 scores were used a binary dependent variable, and individual ZBI item scores were entered as 5-point ordinal independent variables. RESULTS: The caregiver sample was composed of 61 females and 14 males. Caregiver burden was significantly associated with the participant being male; there was heterogeneity by ethnic group, and a higher burden on female caregivers was detected at borderline levels of significance. Upon examining the associations between different ZBI items and the above-median GHQ-28 scores in caregivers, the strongest associations were found with domains reflecting the caregiver's health having suffered, the caregiver not having sufficient time for him/herself, the caregiver's social life suffering, and the caregiver admitting to feeling stressed due to caregiving and meeting other responsibilities. CONCLUSIONS: In this sample, with a majority of female caregivers, the factors of the person with dementia being male and belonging to a minority ethnic group were associated with a greater degree of caregiver burden. The information obtained through the association of individual ZBI items and above-median GHQ-28 scores is a helpful guide for profiling Trinidadian caregiver burden.

Potential biomarkers for dementia in Trinidad and Tobago.

Biomarkers that could possibly discriminate between healthy controls and patients with dementias of the Alzheimer's type (AD) and vascular dementia (VaD) were investigated. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition TR (DSM IV TR) was used to diagnose for dementia in Trinidad. Healthy seniors greater than 60 years old were controls. All participants were administered the Mini-Mental State Examination (MMSE) and had blood analyzed for levels of C-reactive protein (CRP), total homocysteine (tHcy) and microglial antibodies (MgAb). Plasma tHcy was determined on the Abbot AxSym, serum CRP concentrations were measured using the Tina-Quant sCRP (Latex) high sensitive immunoturbidimetric assay and serum MgAb were examined on frozen rat brain sections. The study was carried out on 29 patients that fulfilled the inclusion criteria and 46 controls. Of the patients 65.5% had AD and 34.5% had VaD. Significant differences were found between the mean MMSE scores of the different types of dementias and controls. MgAb presence as well as tHcy were able to distinguish between controls and dementia of the AD and VaD type, respectively. The MMSE is a good discriminative tool for dementias. Serum MgAbs are a possible biomarker for Alzheimer disease pathology and tHcy is elevated in patients with vascular dementia.

B-type natriuretic peptide in pediatrics.

OBJECTIVES: There has been growing interest in the use of serum B-type natriuretic peptide (BNP) and the N-terminal segment of its pro-hormone (NT-proBNP) as biomarkers for cardiac disease. The aim of this review is to summarize the current state of knowledge regarding BNP and NT-proBNP measurement in the pediatric population. DESIGN AND METHODS: A computerized literature search on the National Library of Medicine was done and all articles including BNP and pediatrics were selected and discussed. RESULTS: The data from several studies suggest that the measurement of BNP may be useful in diagnosing and managing pediatric heart failure, congenital heart disease, cardiac transplantation and patients on chemotherapy. There are difficulties in establishing appropriate reference ranges in children. CONCLUSION: There is insufficient evidence for the routine use of BNP or NT-proBNP. Further research to clearly define the clinical utility in the pediatric age group is eagerly anticipated.

Measurement of neutrophil gelatinase-associated lipocalin (NGAL) in patients with non-communicable diseases: any additional benefit?

AIM: Chronic kidney disease (CKD) is one of the major complication from non-communicable diseases (NCD), such as diabetes or hypertension. We aimed to determine if routine measurement of neutrophil gelatinase-associated lipocalin (NGAL) in NCD patients could provide additional benefit for diagnosing kidney disease. METHODS: Fasting serum NGAL, urea, creatinine, uric acid and albumin were measured in 298 NCD patients. Estimated glomerular filtration rate (e-GFR) was calculated using the CKD-EPI equation. Multiple linear regression modeling was used for analysis. RESULTS: CKD patients have the highest levels of NGAL than the other NCD patients (p < 0.001). Although NGAL was significantly related to e-GFR, creatinine, urea and albumin in CKD-patients (p < 0.001) and not in the other NCD patients (p > 0.05), only serum creatinine predicted NGAL levels in CKD-patients (p < 0.001). CONCLUSION: NGAL level is best associated with serum creatinine only in patients with CKD and NGAL measurement may not be cost effective as a routine kidney function test in NCD patients in under-resourced economies.

Trinidad and Tobago: A decade of dementia research.

In 2003, academic staff members at The University of the West Indies Faculty of Medical Sciences St Augustine Trinidad and Tobago combined their expertise to make strides in Alzheimer's and Dementia research in Trinidad and Tobago. Dr. Nelleen Baboolal, Dr. Gershwin Davis and Professor Amanda McRae began developing a project that has produced significant results by examining not only the epidemiology of dementia, but the associated risk factors; caregiver burden and ultimately establishing biomarkers for the disease. This review is an account of our results from a decade of dementia research and how they are contributing toward mitigating the dementia tsunami in Trinidad and Tobago.

Em 2003, os membros da equipe acadêmica da Faculdade de Ciências Médicas St Augustine, da Universidade de West Indies, Trinidad e Tobago, combinaram seus conhecimentos para promover avanços nas pesquisas sobre doença de Alzheimer e demência em Trinidad e Tobago. Dr. Nelleen Baboolal, Dr. Gershwin Davis e Professora Amanda McRae começaram a desenvolver um projeto que tem produzido resultados significativos através da análise não só da epidemiologia da demência, mas também dos fatores de risco associados, sobrecarga do cuidador e, ultimamente, estabelecendo biomarcadores para a doença. Esta avaliação representa um relato de nossos resultados de uma década de pesquisa demência e como eles estão contribuindo para mitigar o tsunami de demência em Trinidad e Tobago.

Trinidad and Tobago: A decade of dementia research / Trinidad e Tobago: uma década de pesquisa dementia

In 2003, academic staff members at The University of the West Indies Faculty of Medical Sciences St Augustine Trinidad and Tobago combined their expertise to make strides in Alzheimers and Dementia research in Trinidad and Tobago. Dr. Nelleen Baboolal, Dr. Gershwin Davis and Professor Amanda McRae began developing a project that has produced significant results by examining not only the epidemiology of dementia, but the associated risk factors; caregiver burden and ultimately establishing biomarkers for the disease. This review is an account of our results from a decade of dementia research and how they are contributing toward mitigating the dementia tsunami in Trinidad and Tobago.

Em 2003, os membros da equipe acadêmica da Faculdade de Ciências Médicas St Augustine, da Universidade de West Indies, Trinidad e Tobago, combinaram seus conhecimentos para promover avanços nas pesquisas sobre doença de Alzheimer e demência em Trinidad e Tobago. Dr. Nelleen Baboolal, Dr. Gershwin Davis e Professora Amanda McRae começaram a desenvolver um projeto que tem produzido resultados significativos através da análise não só da epidemiologia da demência, mas também dos fatores de risco associados, sobrecarga do cuidador e, ultimamente, estabelecendo biomarcadores para a doença. Esta avaliação representa um relato de nossos resultados de uma década de pesquisa demência e como eles estão contribuindo para mitigar o tsunami de demência em Trinidad e Tobago.

Sialic acid, homocysteine and CRP: potential markers for dementia.

To investigate whether sialic acid could discriminate between healthy age matched controls and patients with dementias of the Alzheimer's type (AD), and pure vascular dementia (VaD). 27 patients and 51 controls were administered the Mini-Mental State Examination (MMSE) and had blood analyzed for levels of total sialic acid, total homocysteine (tHcy), and C-reactive protein (CRP). Significant differences were found between the mean MMSE scores for patients with dementia compared with controls. Sialic acid levels were significantly higher in patients with AD compared with controls and homocysteine levels were higher in VaD. Sialic acid levels discriminated between patients with dementia of the Alzheimer's type and healthy controls only. The MMSE could discriminate between controls and patients with dementia but not between the subtypes and homocysteine was significant for patients with VaD.

Plasma homocysteine is elevated in COPD patients and is related to COPD severity.

BACKGROUND: Although recent studies have found that total plasma homocysteine (tHCY) and chronic obstructive pulmonary disease (COPD) are both risk factors for cardiac disease, there have been few studies of plasma homocysteine levels in COPD patients. We tested the hypothesis that total plasma homocysteine (tHCY) would be elevated in patients diagnosed with COPD compared with controls. METHODS: We studied 29 COPD outpatients and 25 asymptomatic subjects (controls) over age 55 years with measurement of forced expiratory volume in one second (FEV1), forced vital capacity (FVC), St. Georges Respiratory Questionnaire (SGRQ) score, tHCY and serum C-reactive protein (sCRP). RESULTS: There was no difference between controls vs. COPD patients in mean age or gender but mean (SD) FEV1 was 2.25 (0.77) vs. 1.43 (0.60) L; FEV1% predicted 76.1 (17.2) vs. 49.1 (16.3) p < 0.001 in both cases. Median (IQR) tHCY was 8.22 (6.63, 9.55) in controls vs. 10.96 (7.56, 13.60) micromol/l for COPD, p = 0.006 and sCRP 0.89 (0.47, 2.55) vs. 2.05 (0.86, 6.19) mg/l, p = 0.023. tHCY(log) was also higher in (r, p) smokers (0.448, 0.001), patients with low FEV1% (-0.397, 0.003), males (0.475, < 0.001), but high SGRQ Total score (0.289, 0.034), and high sCRP (0.316, 0.038). tHCY(log) was independently related to (regression coefficient, p) sCRP(log) (0.087, 0.024), male gender (0.345, < 0.001) and presence of COPD (0.194, 0.031). Median (IQR) tHCY GOLD Stage I and II 8.05 (7.28, 11.04), GOLD Stage III and IV: 11.83 (9.30, 18.30); p = 0.023. CONCLUSIONS: Plasma homocysteine is significantly elevated in COPD patients relative to age and sex-matched controls and is related to serum CRP and COPD severity.

Plasma homocysteine is elevated in COPD patients and is related to COPD severity.

BACKGROUND: Although recent studies have found that total plasma homocysteine (tHCY) and chronic obstructive pulmonary disease (COPD) are both risk factors for cardiac disease, there have been few studies of plasma homocysteine levels in COPD patients. We tested the hypothesis that total plasma homocysteine (tHCY) would be elevated in patients diagnosed with COPD compared with controls. METHODS: We studied 29 COPD outpatients and 25 asymptomatic subjects (controls) over age 55 years with measurement of forced expiratory volume in one second (FEV1), forced vital capacity (FVC), St. Georges Respiratory Questionnaire (SGRQ) score, tHCY and serum C-reactive protein (sCRP). RESULTS: There was no difference between controls vs. COPD patients in mean age or gender but mean (SD) FEV1 was 2.25 (0.77) vs. 1.43 (0.60) L; FEV1 per cent predicted 76.1 (17.2) vs. 49.1 (16.3) p < 0.001 in both cases. Median (IQR) tHCY was 8.22 (6.63, 9.55) in controls vs. 10.96 (7.56, 13.60) micromol/l for COPD, p = 0.006 and sCRP 0.89 (0.47, 2.55) vs. 2.05 (0.86, 6.19) mg/l, p = 0.023. tHCY(log) was also higher in (r, p) smokers (0.448, 0.001), patients with low FEV1 per cent (-0.397, 0.003), males (0.475, < 0.001), but high SGRQ Total score (0.289, 0.034), and high sCRP (0.316, 0.038). tHCY(log) was independently related to (regression coefficient, p) sCRP(log) (0.087, 0.024), male gender (0.345, < 0.001) and presence of COPD (0.194, 0.031). Median (IQR) tHCY GOLD Stage I and II 8.05 (7.28, 11.04), GOLD Stage III and IV: 11.83 (9.30, 18.30); p = 0.023. CONCLUSIONS: Plasma homocysteine is significantly elevated in COPD patients relative to age and sex-matched controls and is related to serum CRP and COPD severity.