Beyond airflow obstruction: acknowledging the diversity of abnormal spirometry patterns.

Restrictive spirometry patterns and PRISm may not be the same, potentially leading to missed detection of a considerable number of individuals with abnormal spirometry. It is essential to consider all spirometry indices carefully during interpretation. https://bit.ly/43pXzep.

Recurrent fearful isolated sleep paralysis - A distressing co-morbid condition of obstructive sleep apnea.

We present a case of recurrent fearful isolated sleep paralysis in a 52-year-old male of Indo-Caribbean ethnicity with obstructive sleep apnea (OSA). Recurrent sleep paralysis is a widely under-reported yet worrisome symptom of various sleep disorders. Although a benign condition in most cases, sleep paralysis in a minority of patients causes great distress. Some patients exhibit bedroom avoidance behavior, whereas others experience bedtime anxiety, making it difficult to fall asleep. This leads to poor sleep quality and sleep deprivation, which can greatly impact a person's overall health. As in our case, this led to a vicious "lack of sleep" cycle where a patient who had bedtime anxiety and could not fall asleep, owing to his recurrent isolated sleep paralysis, also had poor quality sleep secondary to his OSA. This increases morbidity and has many potential consequences, which may include cardiovascular events, cognitive decline, and motor vehicular accidents. Sometimes, simply addressing the underlying medical condition cures the recurrent sleep paralysis as in this case where continuous positive airway pressure for OSA cured the recurrent sleep paralysis. One of our goals is to raise awareness of recurrent sleep paralysis so that patients can seek medical help and would not have to live with the anguish of the condition. Coming forward will also assist medical researchers in furthering their understanding of sleep paralysis.

Risk factors for poor asthma control and impaired quality of life in a Caribbean population.

OBJECTIVE: Asthma, a major cause of disability and reduced quality of life, has a high global prevalence and burden of death. Despite the propitious guidelines, a substantial portion of asthmatics reportedly have poorly controlled disease. In the current study, we have examined risk factors for uncontrolled asthma in specialty clinics and its association with impaired quality of life. METHODS: A multicentre cross-sectional survey of asthma patients, 18 years and older, was conducted in Trinidad. Asthma Control Test (ACT) and the Juniper Mini Asthma Quality of Life Questionnaire (Mini AQLQ-J) were used to assess the disease control and quality of life, respectively. Data were analyzed using the Chi-square test and multivariable logistic regression controlling for gender. RESULTS: Of a total of 428 patients included, asthma was uncontrolled in 72.4% and asthma related quality of life was moderate to severely impaired in 86% of the studied population. In the multivariate regression models, poorly controlled asthma was associated with obesity (OR 2.25; 95% CI 1.30-3.39), late-onset asthma (OR 1.72; 95% CI 1.04-2.84), features of sleep apnea (OR 1.77; 95% CI 1.01-3.07) and depression (OR 2.01; 95% CI 1.04-3.86). Impaired quality of life was associated with Indo-Caribbean ethnicity (OR 3.19; 95% CI = 1.68-6.06). CONCLUSIONS: In this Caribbean population, uncontrolled asthma was independently associated with obesity, late-onset disease, and comorbidities of sleep apnea and depression. Poor asthma-related quality of life was independently associated with Indo-Caribbean ethnicity.

COVID-19 and ethnicity: Does reduced responsiveness to glucocorticoids explain the more aggressive nature of disease among minorities?

Marked ethnic variations in complications and mortality have been noted following infection with COVID-19, with Black, Asian, and minority ethnic groups (BAME) being particularly hard hit. We hypothesise that glucocorticoid resistance stemming from several intrinsic reasons such as chronic social stress and lower circulating levels of Vitamin D may contribute to the exaggerated inflammatory response, more severe disease and poorer outcomes observed in BAME.

Designing Futuristic Telemedicine Using Artificial Intelligence and Robotics in the COVID-19 Era.

Technological innovations such as artificial intelligence and robotics may be of potential use in telemedicine and in building capacity to respond to future pandemics beyond the current COVID-19 era. Our international consortium of interdisciplinary experts in clinical medicine, health policy, and telemedicine have identified gaps in uptake and implementation of telemedicine or telehealth across geographics and medical specialties. This paper discusses various artificial intelligence and robotics-assisted telemedicine or telehealth applications during COVID-19 and presents an alternative artificial intelligence assisted telemedicine framework to accelerate the rapid deployment of telemedicine and improve access to quality and cost-effective healthcare. We postulate that the artificial intelligence assisted telemedicine framework would be indispensable in creating futuristic and resilient health systems that can support communities amidst pandemics.

Telemedicine Across the Globe-Position Paper From the COVID-19 Pandemic Health System Resilience PROGRAM (REPROGRAM) International Consortium (Part 1).

Coronavirus disease 2019 (COVID-19) has accelerated the adoption of telemedicine globally. The current consortium critically examines the telemedicine frameworks, identifies gaps in its implementation and investigates the changes in telemedicine framework/s during COVID-19 across the globe. Streamlining of global public health preparedness framework that is interoperable and allow for collaboration and sharing of resources, in which telemedicine is an integral part of the public health response during outbreaks such as COVID-19, should be pursued. With adequate reinforcement, telemedicine has the potential to act as the "safety-net" of our public health response to an outbreak. Our focus on telemedicine must shift to the developing and under-developing nations, which carry a disproportionate burden of vulnerable communities who are at risk due to COVID-19.

Telemedicine as the New Outpatient Clinic Gone Digital: Position Paper From the Pandemic Health System REsilience PROGRAM (REPROGRAM) International Consortium (Part 2).

Technology has acted as a great enabler of patient continuity through remote consultation, ongoing monitoring, and patient education using telephone and videoconferencing in the coronavirus disease 2019 (COVID-19) era. The devastating impact of COVID-19 is bound to prevail beyond its current reign. The vulnerable sections of our community, including the elderly, those from lower socioeconomic backgrounds, those with multiple comorbidities, and immunocompromised patients, endure a relatively higher burden of a pandemic such as COVID-19. The rapid adoption of different technologies across countries, driven by the need to provide continued medical care in the era of social distancing, has catalyzed the penetration of telemedicine. Limiting the exposure of patients, healthcare workers, and systems is critical in controlling the viral spread. Telemedicine offers an opportunity to improve health systems delivery, access, and efficiency. This article critically examines the current telemedicine landscape and challenges in its adoption, toward remote/tele-delivery of care, across various medical specialties. The current consortium provides a roadmap and/or framework, along with recommendations, for telemedicine uptake and implementation in clinical practice during and beyond COVID-19.

The impact of air pollution on the incidence and mortality of COVID-19.

Air pollution is the most significant environmental risk factor for all-cause mortality, and it has caused substantial disability-adjusted life-years and economic loss. Air pollution intensified the mortality during past pandemics, Spanish flu in 1918 and SARS-CoV-1 in 2003. It increases host susceptibility and virulence of respiratory infections and reduces viral clearance. Thus, a question arises whether there will be any impact of air pollution on the current pandemic coronavirus disease 2019 (COVID-19)? Thus far, history and science are directing towards an immense potential impact of air pollution on the COVID-19 pandemic. Some of the devastated countries with the current pandemic are those with a poor air quality index. Further epidemiological and ecological studies are necessary to confirm this association. Also, countries must mobilize funding for mitigation of air pollution to benefit environmental health and ameliorate its potential effects on pandemics of the future.

Tuberculosis Skin Test Screening in the National Tuberculosis Program of Trinidad and Tobago.

Globally, a quarter of the population is infected with tuberculosis (TB), caused by Mycobacterium tuberculosis. About 5-10% of latent TB infections (LTBI) progress to active disease during the lifetime. Prevention of TB and treating LTBI is a critical component of the World Health Organization's (WHO) End TB Strategy. This study aims to examine the screening practices for prevention and treatment employed by the National Tuberculosis Program of Trinidad and Tobago in comparison to the WHO's standard guidelines. A cross-sectional retrospective study was conducted from the TB registers (2018-2019) for persons aged 18 years and above with recorded tuberculin skin test reactions (TST). Bivariate comparisons for categorical variables were made using Chi-square or Fisher's exact test. Binary logistic regression was used for exploring predictors of TST positivity with adjustment for demographic confounders in multivariable models. Of the total 1972 eligible entries studied, 384 (19.4%) individuals were tested positive with TST. TB contact screening (aOR 2.49; 95% CI 1.65, 3.75) and Bacillus Calmette-Guerin (BCG) vaccination status (aOR 1.66; 95% CI, 1.24 to 2.22) were associated with a positive TST reaction, whereas, preplacement screening failed to show such association when compared to those screened as suspect cases. The findings suggest that TB contact screening and positive BCG vaccination status are associated with TST positivity independent of age and gender.

COPD: Gaps in the GOLD Recommendations and Related Imperative Research Needs.

The GOLD 2020 updates added more lucidity on the treatment of COPD. However, few diagnostic dilemmas still exist. Research is needed on the use of the CAT score in assessing symptoms for the diagnosis of COPD. Further work-up is needed on diagnostic instability of spirometry, and diagnostic role of the lower limit of normal (LLN) criteria, slow vital capacity (FEV1/VC), forced inspiratory vital capacity (FEV1/FIVC), and rapid FEV1 decline. Incorporating parameters of lung hyperinflation and exercise capacity in the COPD diagnostic criteria might add value in its diagnosis and management. GOLD's approach towards routine CT imaging needs to be reviewed. Establishing a "pre-COPD" stage can be helpful in the early diagnosis and intervention to reduce the rapid lung function decline among at-risk individuals. The use of mMRC score as a surrogate to assess the overall severity of COPD related symptoms should be reviewed. The therapeutic guidance role of sputum eosinophils should be studied in patients with intermediate and low blood eosinophil counts.

Need for BCG Vaccination to Prevent TB in High-Incidence Countries and Populations.

An estimated one quarter of persons worldwide are infected with Mycobacterium tuberculosis. In 2018, the World Health Organization issued revised guidance on BCG vaccine for high-risk groups. The World Health Organization should consider guiding countries on a case-by-case basis in developing appropriate BCG policies to deliver equitable healthcare and protect public health.

A Case Report of Foreign Body Embolization.

Prostate brachytherapy (BT) seed embolization to the lung is a rare complication, with <1% of all seeds migrating post-implantation. Here, we present the case of a 63-year-old male who presented with a history of chest pain and intermittent dyspnea at rest for the last four months.

Best practices to impart clinical skills during preclinical years of medical curriculum.

Globally, health is regarded as a booming industry with greater stress being laid on high quality, accountability, and transparency. Traditional medical curricula rely primarily on clerkships during the clinical period of study to train clinical skills, while the preclinical period is mainly used to teach the basic sciences. In recent years, the early introduction of clinical skills training has received increased attention. This review aims to identify and summarize teaching approaches of clinical skills for medical students during preclinical years, namely, (1) framing objectives (2) learning activities, and (3) evaluation strategies. Although the clinical tutor's role is to ensure that students receive effective preclinical skills through different modes of learning (lectures, presentations, and problem-based learning), the role of advanced technologies, namely, simulation-based learning platforms and gamification are found to be very successful. To improve the communication skills, there is strong evidence in support of role plays, and similarly, for enhancing observation skills, an introduction of fine arts in clinical skills training was found to be very useful. Medical schools worldwide should give high priority to conduct faculty development programs on various aspects of training and teaching modalities, evaluation strategies, and improving the evaluation of various clinical skills. Students should be provided with sufficient learning opportunities including a well-equipped clinical skills laboratory and individual attention, and constructive feedback should be given to students for building their confidence level during their learning process.