Cancer morbidity and mortality trends in Trinidad and Tobago (2008-2018).

PURPOSE: Cancer is a leading cause of death in the Caribbean, and the Republic of Trinidad and Tobago is no exception. Evidence suggests that cancer incidence and mortality may vary based on demographic factors across the different cancer types. This study aimed to investigate the incidence and mortality trends associated with cancer cases in Trinidad and Tobago for the period 2008-2018, across different age groups, gender, and ethnicity. METHODS: Data on 15,029 incident cancer cases were reported to the Dr. Elizabeth Quamina Cancer Registry between 2008 and 2018. The retrospective data were analyzed by sex, ancestry, and age, and were reported using Trinidad and Tobago population statistics for the period 2008-2018. RESULTS: The incidence of prostate and breast cancers was high among males and females, respectively. Among males, the highest cancer mortality was associated with prostate, lung, colon, blood, and pancreatic cancers, respectively. Among females, the highest cancer mortality was associated with breast, ovary, colon, blood, and pancreatic cancers. The frequency of occurrence of the top five cancer sites was the highest among Afro-Trinidadians followed by Indo-Trinidadians. Most females diagnosed with breast cancer were at a localized stage, while most males diagnosed with breast cancer were at a distant or regional stage. Most individuals diagnosed with blood cancer were at a distant stage. For lung and colon cancer, the stage of diagnosis for most males and females was either distant or unknown. Majority of males are diagnosed with prostate cancer at an unknown stage. CONCLUSIONS: The findings indicate highest cancer incidence and mortality occur among Afro-Trinidadians. The stage at diagnosis varies across cancer types and gender.

COVID-19 Vaccine Acceptance and Uptake among Healthcare Workers in Trinidad and Tobago.

Background: COVID-19 vaccine acceptance is important in ensuring the widespread vaccination of the population to achieve herd immunity. Establishing the acceptance of vaccines among healthcare workers, who play a vital role in an immunization program's success, is important. The aim of this study was to assess the influence of social trust and demographic factors on COVID-19 vaccine acceptance among healthcare workers. Methods: A cross-sectional survey utilizing an electronic questionnaire inquiring about COVID-19 vaccine uptake, preferences, and concerns was distributed via e-mail to 1,351 North Central Regional Health Authority (NCRHA) healthcare workers of the following categories: medical practitioners, nursing personnel, veterinary surgeons, medical interns, dental interns, paramedics, and pharmacists. These professions were selected as they were granted power to administer COVID-19 vaccines during the period of public emergency by the President of Trinidad and Tobago and were therefore likely to be NCRHA healthcare workers directly involved in vaccine administration services. Bivariate analysis using Chi-squared analysis of association was used to determine the association between the respondents' characteristics and the acceptance of the vaccine and the association between vaccine acceptance among healthcare workers and trust. The association between the acceptance of the COVID-19 vaccines and healthcare workers' characteristics and trust was established using multinomial logistic regression. Results: A total of 584 healthcare workers took part in the study, and 1.4% showed unwillingness to receive the COVID-19 vaccine. The study indicates that age, profession, trust in international public health organizations, and trust in other healthcare providers predict the uptake of COVID-19 vaccines among healthcare workers, with younger age groups and the nursing profession associated with an unwillingness to accept the vaccine. Gender of the healthcare workers does not predict vaccine acceptance. Conclusions and relevance: efforts towards enhanced vaccine acceptance among healthcare workers should take into consideration age, profession, and the trust in international organizations and other healthcare providers. Sensitization programs aimed at informing and creating awareness among healthcare workers about the COVID-19 vaccines should be age-specific as well as occupation-based.

A Short Course of Prednisolone in Patients With Moderate Covid 19 Respiratory Failure- Stop the Progression a Case Series.

Covid 19 positive patients requiring oxygen therapy to maintain saturations above 90% were given a trial of oral prednisolone between 15 and 30 mg until they were weaned to room air maintaining saturations >95%. This treatment resulted in the rapid resolution of worsening respiratory function of 4 Covid 19 positive patients within the High Dependency unit in a tertiary medical center. The cases are from the "first wave" in Trinidad, March 2020. The signs and symptoms of respiratory failure resolved after 72 hours of prednisolone treatment and none of these patients were escalated to non-invasive or invasive respiratory support. The patients were kept for a further 48 hours after the steroids were discontinued to monitor for relapse of symptoms, all patients were discharged home after quarantine. The initiation of a prednisolone steroid trial must be considered in Covid 19 positive patients needing supplementary oxygen therapy or developing worsening shortness of breath. Early Covid respiratory failure responds to a low dose for a short duration and prevents escalation to non-invasive/invasive respiratory support.

ChAdOx1 nCoV-19 Vaccine Side Effects among Healthcare Workers in Trinidad and Tobago.

Vaccine hesitancy due to safety concerns is a hindrance to the success of vaccination campaigns. In February 2021, Trinidad and Tobago commenced its National COVID-19 Vaccination Program. Healthcare workers were among the first group to receive the ChAdOx1 nCoV-19 (Oxford−AstraZeneca (Covishield, Serum Institute of India, Pune, India), the first COVID-19 vaccine available nationally. This study examined the safety of this vaccine in terms of the systemic and local adverse events following immunization reported by healthcare worker recipients. A cross-sectional study was conducted via a telephone questionnaire. Data concerning demographics, medical and COVID-19-related anamneses, and local and systemic side effects experienced within the first 48 h after receiving the first and second dose of this vaccine, respectively, were gathered. Among the 687 participants (male = 275; female = 412), prevalence of fever, body pain, chills, nausea, myalgia, headache, malaise, fatigue, and other systemic symptoms declined significantly 48 h after administration of the second dose compared to the first dose. Chi-square test and multiple logistic regression demonstrated the greater likelihood of younger recipients to report systemic symptoms compared to older recipients. Multiple logistic regression indicated that females were more likely to report headache, fatigue, and discomfort, and were less likely to report no symptoms, compared to males, after both doses. On average, recipients reported less local and systemic side effects 48 h after receiving the second dose compared to the first dose. The reported rate of occurrence of side effects was <50% for most adverse events, which is consistent with the manufacturer's claims that the vaccine is safe. This study adds data on the safety of this vaccine in a population that has not been previously studied. The findings can inform public health policy efforts to lower vaccine hesitancy based on safety concerns surrounding the ChAdOx1 nCoV-19 vaccine across various groups in society, including healthcare workers.

Building artificial intelligence and machine learning models : a primer for emergency physicians.

There has been a rise in the number of studies relating to the role of artificial intelligence (AI) in healthcare. Its potential in Emergency Medicine (EM) has been explored in recent years with operational, predictive, diagnostic and prognostic emergency department (ED) implementations being developed. For EM researchers building models de novo, collaborative working with data scientists is invaluable throughout the process. Synergism and understanding between domain (EM) and data experts increases the likelihood of realising a successful real-world model. Our linked manuscript provided a conceptual framework (including a glossary of AI terms) to support clinicians in interpreting AI research. The aim of this paper is to supplement that framework by exploring the key issues for clinicians and researchers to consider in the process of developing an AI model.

Laboratory predictors for COVID-19 Intensive Care Unit admissions in Trinidad and Tobago.

Understanding symptoms associated with COVID-19 cases requiring intensive care unit(ICU) attention is important in management of the life-threatening cases of the disease. This study aimed to determine laboratory indicators of ICU admission for COVID-19 patients. For this retrospective chart review study, data from 116 patients(ICU, n = 18, Non-ICU, n = 98) with confirmed SARS-CoV-2, managed at two hospitals in Trinidad and Tobago, from March 12th to April 12th 2020, were analyzed. The median age of non-ICU patients was 59.0(IQR = 23.5) years; ICU patients had a median age of 62.5(IR = 17.5). From univariate analysis, laboratory indicators significantly associated with ICU admission included WBC(P = 0.037), lymphocyte(P = 0.016), LDH(P = 0.002), AST(P = 0.005) and CRP(P = 0.0001). However, multivariate analysis including WBC, neutrophil, lymphocyte, PLT, AST, LDH, ALT and CRP indicated that only AST was associated with high odds of ICU admission(OR 0.002, 95% CI 0.000-0.004, P = 0.017). Statistically significant AUC were obtained for neutrophil(AUC = 0.704, P = 0.007), CRP (AUC = 0.81, p = 0.00) and LDH(AUC = 0.766, P = 0.00) and AST (AUC = 0.729, P = 0.003). The findings indicate that neutrophils, AST and LDH's ROC curves are good tests, CRP curve is a very good test, but lymphocyte curve is a poor test, in determining COVID-19 patients for ICU admission. Neutrophil, AST, LDH and CRP are suitable predictors of COVID-19 patients that should receive intensive unit care. The study provides significant insights into laboratory parameters that can be used to predict COVID-19 severity and important considerations for healthcare providers in making evidence-based decisions regarding COVID-19 patient management, especially in the context of limited ICU facilities. This study was not funded.

Epidemiology and Management Trends of Patients With Sepsis and Septic Shock in the Intensive Care Unit: A Prospective Trial in the Caribbean.

Objectives To investigate the epidemiology, management, and predictors of mortality in severe sepsis and septic shock in the intensive care units (ICUs) of Trinidad, Trinidad & Tobago. Methods A prospective observational study in four ICUs over a one-year period (August 2017-August 2018) was conducted. Physiologic variables, treatment data, and outcomes were collected on admission to ICU and daily until 28 days. The 28-day mortality and ICU mortality were recorded. Subgroup analysis was performed based on survival, and predictors of mortality were determined through logistic regression. Results Outcome data were available for 163 patients. The 28-day mortality rates for sepsis and septic shock were 42% and 47%, respectively. ICU mortality rate for sepsis was 34%. The most common suspected source of infection was pneumonia (33%). Acute kidney injury (AKI) was common and present in 71% of patients, with renal replacement therapy only being used in 30% of cases. Mechanical ventilation was required in 84% of cases. Moderate-to-severe acute respiratory distress syndrome (ARDS) (OR: 4; 95% CI: 1.9-8.8; p < 0.001) and the development of AKI (all stages) (OR: 10; 95% CI: 3.9-30.2; p < 0.001) were found to be predictive of mortality. Incidence of mechanical ventilation, moderate-to-severe ARDS, stage 3 AKI, septic shock, and failure to achieve a mean arterial pressure of > 60 mmHg within the first 24 hours of admission were higher in patients who did not survive (p < 0.05). Conclusions Sepsis and septic shock are associated with a high 28-day mortality. Organ dysfunction with renal and pulmonary involvement was an important factor in predicting a higher mortality.

A benign cancer with malicious paraneoplastic syndromes.

A 70-year-old retired general practitioner with known follicular lymphoma presented with ptosis, dysphagia and progressive weakness in his upper and lower limbs. Despite having positive antibodies for myasthenia gravis he did not respond to conventional treatment with pyridostigmine, immunoglobulins and steroids. After 1 week on a general ward, he required intensive care for non-invasive ventilation. On the intensive care unit, he developed a secondary paraneoplastic syndrome in the form of a syndrome of inappropriate antidiuretic hormone secretion and required a tracheostomy for ventilatory support. After 1 week of invasive ventilation and remaining fully conscious throughout, he declined further treatment and passed away.