Capecitabine induced fingerprint changes.

WHAT IS KNOWN AND OBJECTIVE: Fingerprinting is recognized as an easily accessible means of personal identification; however, fingerprints can be damaged after administration of some chemotherapy agents that result in hand and foot syndrome (HFS). Fingerprint loss may also be due to reasons unrelated to HFS. This study evaluated the incidence of fingerprint changes in patients treated with capecitabine-containing chemotherapy regimens and its relations to various grades of HFS. METHODS: Seventy-one patients who received chemotherapy with or without capecitabine as part of their regimen were enrolled in the study. Fingerprints were collected once before the initiation of chemotherapy and once after the third course of chemotherapy. The fingerprints were examined by the Iranian Society of Forensic Physicians, for probable changes in the post-chemotherapy states. RESULTS AND DISCUSSION: Thirty-seven patients were enrolled in the capecitabine group and 34 in a comparison group. Fingerprint changes were observed in 25 (67.6%) of the 37 patients in the capecitabine group and none in the comparison group. There was no correlation between the occurrence or severity of HFS and fingerprint changes (P = 0.880). In capecitabine group, the total dose and course numbers of capecitabine were not significant in patients with and without fingerprint changes. WHAT IS NEW AND CONCLUSION: Based on our findings, we recommend notifying patients who are considered for capecitabine therapy about the risk of fingerprint changes before the initiation of treatment, as this may have legal implications.

Sleep, Well-Being, and Cognition in Medical Interns on a Float or Overnight Call Schedule.

Importance: Extended work hours and night shifts are essential in health care, but negatively affect physician sleep, well-being, and patient care. Alternative schedules with shorter work hours and/or reduced irregularity might mitigate these issues. Objective: To compare sleep, well-being, and cognition between interns working irregular, extended shifts (call schedule), and those working a more regular schedule with restricted hours (float schedule). Design, Setting, and Participants: In this observational longitudinal cohort study, interns in a Singapore-based teaching hospital were studied for 8 weeks from January 2022 to July 2023. Data were analyzed from July 2023 to July 2024. Exposure: Participants worked either regular approximately 10-hour workdays, interspersed with 24 hour or more overnight calls 4 to 5 times a month, or a float schedule, which included regular approximately 10-hour workdays, and 5 to 7 consecutive approximately 12-hour night shifts every 2 months. Exposure was based on departmental training and operational needs. Main Outcomes and Measures: Sleep was measured with wearable sleep trackers and an electronic diary. Day-to-day well-being and cognitive assessments were collected through a smartphone application. Assessments included the Sleep Regularity Index (SRI; determines the probability of an individual being in the same state [sleep or wake] at any 2 time points 24 hours apart, with 0 indicating highly random sleep patterns and 100 denoting perfect regularity) and Pittsburgh Sleep Quality Inventory (PSQI; scores ranges from 0 to 21, with higher scores indicating poorer sleep; a score greater than 5 suggests significant sleep difficulties). Results: Participants (mean [SD] age, 24.7 [1.1] years; 57 female participants [59.4%]; 41 on call schedule [42.7%]; 55 on float schedule [57.3%]) provided 4808 nights of sleep (84.2%) and 3390 days (59.3%) of well-being and cognition assessments. Participants on a float schedule had higher SRI scores (mean [SD] score, 69.4 [6.16]) and had better quality sleep (PSQI mean [SD] score, 5.4 [2.3]), than participants on call schedules (SRI mean [SD] score, 56.1 [11.3]; t91 = 6.81; mean difference, 13.3; 95% CI, 9.40 to 17.22; P < .001; PSQI mean [SD] score, 6.5 [2.3]; t79 = 2.16; 95% CI, 0.09 to 2.15; P = .03). Overnight call shifts, but not night float shifts, were associated with poorer mood (-13%; ß = -6.79; 95% CI, -9.32 to -4.27; P < .001), motivation (-21%; ß = -10.09; 95% CI, -12.55 to -7.63; P < .001), and sleepiness ratings (29%; ß = 15.96; 95% CI, 13.01 to 18.90; P < .001) and impaired vigilance (21 ms slower; ß = 20.68; 95% CI, 15.89 to 25.47; P < .001) compared with regular day shifts. Night shifts with naps were associated with better vigilance (16 ms faster; ß = -15.72; 95% CI, -28.27 to -3.17; P = .01) than nights without naps. Conclusions and relevance: In this cohort study, 24-hour call schedules were associated with poorer sleep, well-being, and cognition outcomes than float schedules. Naps during night shifts benefited vigilance in both schedules.

Comparison of pneumatic dilation with pneumatic dilation plus botulinum toxin for treatment of achalasia.

Among the therapeutic options for achalasia are pneumatic dilatation (PD), an appropriate long-term therapy, and botulinum toxin injection (BT) that is a relatively short-term therapy. This study aimed to compare therapeutic effect of repetitive pneumatic dilation with a combined method (botulinum toxin injection and pneumatic dilation) in a group of achalasia patients who are low responder to two initial pneumatic dilations. Thirty-four patients with documented primary achalasia that had low response to two times PD (<50% decrease in symptom score and barium height at 5 minute in timed esophagogram after 3 month of late PD) were randomized to receive pneumatic dilation (n=18) or botulinum toxin injection and pneumatic dilation by four weeks interval (n=16), PD and BT+PD groups respectively. Symptom scores were evaluated before and at 1, 6 and 12 months after treatment. Clinical remission was defined as a decrease in symptom score > or = 50% of baseline. There were no significant differences between the two groups in gender, age and achalasia type. Remission rate of patients in BT-PD group in comparison with PD group were 87.5% vs. 67.1% (P = 0.7), 87.5% vs. 61.1% (P = 0.59) and 87.5% vs. 55.5% (P = 0.53) at 1, 6 and 12 months respectively .There were no major complications in either group. The mean symptom score decreased by 62.71% in the BT-PD group (P < 0.002) and 50.77% in the PD group (P < 0.01) at the end of the first year. Despite a better response rate in BT+PD group, a difference was not statistically significant. A difference may be meaningful if a large numbers of patients are included in the study.

Evaluation of asthma control using patient based measures and peak expiratory flow rate.

OBJECTIVE: Asthma control has not been formally evaluated in the Caribbean. This study evaluated disease control on The Asthma Control Test (ACT), The Royal College of Physicians "Three questions" for Assessing Asthma Control (RCP), peak expiratory flow rate (PEFR) and patients' self-assessment of control. SUBJECTS AND METHODS: Asthma control was examined in a cross-section of 205 asthmatics above 16 years of age using the ACT, RCP and on the PEFR % predicted. Scores below 20 and equal to or above 1 on the ACT and RCP respectively, and PEFR below 80% predicted indicated uncontrolled asthma. Patients stated whether they perceived their asthma was controlled or uncontrolled. RESULTS: Overall there were more females (63.9%, p < 0.001) than males (36.1%). Males aged between 17-30 years predominated (60.8%, p < 0.001) with gender reversal beyond 30 years of age (33.2%, p < 0.002) years. Self-assessed control was higher (69.3%, p < 0.001) than control evaluated by the ACT and RCP tests, which were comparable (p > 0.05). Fewer patients (13.2%) achieved control on PEFR > 80% predicted than on the ACT (22.4%) and RCP (18%). The Kappa statistic indicated good reproducibility of the RCP and ACT and concordance between the PEFR and RCP (0.63) and the PEFR and ACT (0.56). Higher education was associated with control on the ACT (p < 0.0005) and RCP (p < 0.002) but not on PEFR or self-assessment (p > 0.05). CONCLUSION: Approximately 80% of study asthmatics were uncontrolled, and patients tended to overestimate their disease control. The ACT and RCP instruments were comparable with the PEFR. Efforts to study their validity and formal evaluation of asthma control in Trinidad are recommended.

Laser therapy for an obstructing primary tracheal lymphoma in a patient with AIDS.

A patient with AIDS presented with progressive dyspnea leading to respiratory failure with near complete airway obstruction due to primary tracheal lymphoma. Laser therapy was used locally to debulk the tumour, which facilitated extubation and led to definitive treatment with chemotherapy. Alternatives for local airway control are discussed.

The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) in Persian Speaking Patients with Knee Osteoarthritis.

BACKGROUND: Osteoarthritis of the knee is the most common chronic joint disease that involves middle aged and elderly persons. There are different clinical instruments to quantify the health status of patients with knee osteoarthritis and one example is the WOMAC score that has been translated and adapted into different languages. The purpose of this study was cultural adaptation, validation and reliability testing of the Persian version of the WOMAC index in Iranians with knee osteoarthritis. METHODS: We translated the original WOMAC questionnaire into Persian by the forward and backward technique, and then its psychometric study was done on 169 native Persian speaking patients with knee degenerative joint disease. Mean age of patients was 53.9 years. The SF-36 and KOOS were used to assess construct validity. RESULTS: Reliability testing resulted in a Cronbach's alpha of 0.917, showing the internal consistency of the questionnaire to be a reliable tool. Inter-correlation matrix among different scales of the Persian WOMAC index yielded a highly significant correlation between all subscales including stiffness, pain, and physical function. In terms of validity, Pearson`s correlation coefficient was significant between three domains of the WOMAC with PF, RP, BP, GH, VT, and PCS dimensions of the SF-36 health survey (P<0.005) and KOOS (P<0.0001) . CONCLUSIONS: The Persian WOMAC index is a valid and reliable patient- reported clinical instrument for knee osteoarthritis.

Exenteration: the nursing approach.

Knowledge of the operative procedure is essential to patient teaching. Knowledge of the stages of grieving and the recognition that it is an essential component to healing will help the nurse support the patient during the grieving process. Show the patient empathy and understanding by active listening and demonstrating caring.

Evaluation of asthma control using patient based measures and peak expiratory flow rate / Evaluación del control del asma usando medidas basadas en el paciente y tasas de flujo expiratorio máximo

OBJECTIVE: Asthma control has not been formally evaluated in the Caribbean. This study evaluated disease control on The Asthma Control Test (ACT), The Royal College of Physicians "Three questions" for Assessing Asthma Control (RCP), peak expiratory flow rate (PEFR) and patients'self-assessment of control. SUBJECTS AND METHODS: Asthma control was examined in a cross-section of 205 asthmatics above 16 years of age using the ACT, RCP and on the PEFR % predicted. Scores below 20 and equal to or above 1 on the ACT and RCP respectively, and PEFR below 80% predicted indicated uncontrolled asthma. Patients stated whether they perceived their asthma was controlled or uncontrolled. RESULTS: Overall there were more females (63.9%, p < 0.001) than males (36.1%). Males aged between 17-30 years predominated (60.8%, p < 0.001) with gender reversal beyond 30 years of age (33.2%, p < 0.002) years. Self-assessed control was higher (69.3%, p < 0.001) than control evaluated by the ACT and RCP tests, which were comparable (p > 0.05). Fewer patients (13.2%) achieved control on PEFR > 80% predicted than on the ACT (22.4%) and RCP (18%). The Kappa statistic indicated good reproducibility of the RCP and ACT and concordance between the PEFR and RCP (0.63) and the PEFR and ACT (0.56). Higher education was associated with control on the ACT (p < 0.0005) and RCP (p < 0.002) but not on PEFR or self-assessment (p > 0.05). CONCLUSION: Approximately 80% of study asthmatics were uncontrolled, and patients tended to overestimate their disease control. The ACT and RCP instruments were comparable with the PEFR. Efforts to study their validity and formal evaluation of asthma control in Trinidad are recommended.

OBJETIVO: El control del asma no ha sido evaluado formalmente en el Caribe. El estudio evaluó el control de la enfermedad utilizando el Test de Control del Asma (TCA), las "tres preguntas" del Colegio Real de Médicos para evaluar el control del asma (CRM), y la tasa de flujo expiratorio máximo (FEM) así como la autoevaluación del control por parte de los pacientes. SUJETOS Y MÉTODOS: El control del asma fue examinado en una sección transversal de 205 asmáticos de más de 16 años de edad, mediante el TCA, el CRM, y la predicción del FEM%. Las puntuaciones por debajo de 20 e iguales o por encima de 1 en el TCA y el CRM respectivamente, por debajo del 80% de predicción de la FEM, indicaban asma no controlada. Los pacientes informaban si percibían su asma como controlada o no controlada. RESULTADOS: En general hubo más (p < 0.001) mujeres (63.9%) que hombres (36.1%). Los hombres predominaron (p < 0.001) entre los 17 - 30 años (60.8%) con reversión del género (p < 0.002) pasados los 30 (33.2%) años. El control autoevaluado (69.3%) fue mayor (p < 0.001) que el control evaluado por las pruebas TCA y CRM, que fueron comparables (p > 0.05). Menos pacientes (13.2%) lograron un control con FEM > 80% de predicción que con TCA (22.4%) y CRM (18%). La estadística Kappa indicó una buena reproductibilidad de CRM y TCA, así como concordancia entre FEM y CRM (0.63) y FEM y TCA (0.56). Un nivel de educación más alto estuvo asociado con el control en TCA (p < 0.0005) y CRM (p < 0.002) pero no en FEM o autoevaluación (p > 0.05). CONCLUSIÓN: Aproximadamente el 80% de los asmáticos fueron no controlados, y los pacientes sobrestiman su control de la enfermedad. Los instrumentos TCA y CRM fueron comparables con la FEM. Se recomienda hacer esfuerzos por estudiar la validez de estos, así como la evaluación formal del control del asma en Trinidad.

Microbial load and the prevalence of Escherichia coli, Salmonella spp. and Listeria spp. in Ready-to-Eat products in Trinidad.

This study was designed to determine the prevalence and microbial load of Listeria spp., Escherichia coli O157 and Salmonella spp. in ready-to-eat products in supermarkets across Trinidad. The microbial load was assessed using the total aerobic plate count (TAPC) per g/ml of foods and prevalence of Escherichia coli O157 and Salmonella spp. determined using conventional methods. For Listeria monocytogenes, immunomagnetic separation (IMS), TECRA (enzymelinked immunosorbent assay, ELISA) and conventional methods were used. The log10 mean ñ sd TAPC per g or ml was highest for vegetables (11.0ñ11.6), and lowest for seafood (5.2ñ5.7) (p < 0.05). The prevalence of L. monocytogenes was 1.7 per cent. Sixteen (4.5 per cent) of 153 samples yielded E. coli but all samples were negative for Salmonella spp. and E. coli O157. The high microbial load and isolation of L. monocytogenes and E. coli from popular RTE foods could pose a health risk to consumers in the country.

Tuberculosis – patients’ knowledge, attitudes and practices regarding their illness

OBJECTIVE: To determine tuberculosis (TB) patients’ knowledge, attitudes and practices with respect to their illness. DESIGN AND METHODS: A cross sectional study was conducted. 208 tuberculosis patients > 18 years of age who were currently receiving treatment were included. The study sample was selected from two major regional chest clinics in Trinidad. A pilot tested questionnaire was interviewer administered to each patient. RESULTS: Out of the 208 patients interviewed (response rate 65.0%), 129 were male, and 79 were female. The majority of patients had either secondary or tertiary level of education (54.8%), whereas only 43.8% had either primary level of education or none at all. Analysis revealed that TB knowledge was affected by a patient’s level of education, where persons with secondary/tertiary levels of education had a greater knowledge about TB (p<0.005). The majority (78.4%) of patients believed that they were not stigmatized; however, 191 (91.8%) patients urged for increased public awareness about TB in order to change perceptions toward the disease. The majority of patients were compliant towards their management advice, as well as taking their prescribed medications, however non- compliance was noted to be more likely in the under 50 year age group (9.8%), rather than the over 50 year age group (1.1%). CONCLUSION: Patients with at least secondary level education had better knowledge about tuberculosis than those with primary level education. Patients indicated the need for more public awareness about TB. Compliance with management (medication and attendance at clinics) was good among the majority of the patients.