Human papillomavirus genotypes and their prevalence in a cohort of women in Trinidad.

OBJECTIVE: Human papillomavirus (HPV) genotypes and their relative prevalences were determined in a cohort of 310 sexually active women in Trinidad, West Indies. METHODS: Cervical samples were collected with Ayre's spatulas and endocervical brushes. Samples were used for the conventional Papanicolaou test and for determining HPV genotypes by amplification of a section of the viral L1 gene, followed by DNA sequencing and probe hybridization. RESULTS: HPV infections were identified in 126 of 310 (40.6%) women. Of them, 83 (65.8%) were infected with high-risk HPV, 16 (12.7%) with low-risk HPV, and 27 (21.4%) with HPV types of unknown risk. HPV 52 (12.7%) was the most frequently occurring high-risk type, followed by HPV 66 (10.3%), HPV 16 (9.5%), and HPV 18 (8.6%). High-risk types HPV 16 and HPV 66 were each found in 3 (20.0%) and HPV 18 was found in 1 (6.6%) of the 15 women with abnormal cytology. CONCLUSIONS: Cervical HPV prevalence and heterogeneity of HPV genotypes are high in this Trinidad cohort. The relative importance of HPV genotypes in the development of cervical lesions needs further investigation in Trinidad in order to better understand the epidemiology of HPV infections as well as to determine the role of HPV testing in the screening, prevention, and control of cervical cancer. This pilot study provided important information on the prevalence of HPV genotypes, which will be used in future nationwide studies.

Overweight and Obesity in Children Are Associated with an Abundance of Firmicutes and Reduction of Bifidobacterium in Their Gastrointestinal Microbiota.

Background: Obesity in children continues to be a global epidemic. Given the recent focus on the potential role gut microbiota play in the development of obesity and the continuous rise of obesity in childhood worldwide, it has become necessary that the association between gut microbes and weight is explored in previously unexplored regions such as the Caribbean island of Trinidad. As such, our objective was to characterize the composition of the gut microbiota in children with obesity/overweight and children of normal weight to determine if there are any gut microbes associated with overweight and obesity. Methods: Fifty-one children provided stool samples and their BMIs were calculated and classified. 16S amplicons from stool samples were individually barcoded and sequenced in multiplex in the NextSeq 500 platform in a 150 bp paired-end modality and a complete gut microbiome profile was generated. Results: The relative abundance and diversity of the microbiota of the lean and children with obesity/overweight were analyzed against each other and showed that children with obesity/overweight recorded significantly more (p = 0.001) Firmicutes and significantly less Bifidobacterium (p = 0.039) than the children of normal weight. Children with obesity/overweight also recorded significantly (p = 0.009) reduced alpha diversity compared with the lean children. Conclusion: This study has shown associations of Firmicutes to obesity/overweight and Bifidobacterium species with healthy weight in children.

Comparison of prevalence and severity of asthma among adolescents in the Caribbean islands of Trinidad and Tobago: results of a nationwide cross-sectional survey.

BACKGROUND: Asthma is a growing problem in the Caribbean but the prevalence in most islands is unknown and possible inter-island variation in prevalence has not been determined. A nationwide cross-sectional survey was conducted to compare the prevalence of asthma symptoms among high school students in the two islands of the Republic of Trinidad and Tobago. METHODS: Questionnaire and video instruments based on those developed by the International Study of Asthma & Allergy in Childhood (ISAAC) were used to assess asthma prevalence among 6394 children (age range, 11-19 years; mean age, 14.08 yrs) in the second and third years of 35 randomly selected high schools in Trinidad and Tobago. This cross sectional survey was conducted between September and December 2002. RESULTS: A total of 4988 questionnaires were available for analysis (3519 in Trinidad and 1469 in Tobago). Among respondents from the two islands, there were no significant differences in the prevalence of ever wheezing (24.1% and 24.3% for Trinidad and Tobago, respectively, RR 0.99, 95% CI, 0.90-1.08); wheezing in the previous 12 months (13.1% & 13.4%, RR 0.98, 95% CI 0.84-1.15); a previous or current diagnosis of asthma (12.8% & 13.5%, RR 0.95, 95% CI 0.82-1.12) and night cough in the past 12 months (35.4% & 38.3%, RR 0.93, 95% CI 0.86-1.00). However, symptoms of severe asthma were significantly more common among students from Tobago and included having had more than one acute attack in the past year (13.4% & 15.8%, RR 0.85, 95% CI 0.73-1.00, p = 0.0004), night waking as a result of wheeze (7.4% & 10.9%, RR 0.68, 95% CI 0.56-0.83, p < 0.0001) and speech limitation in the past year (5.2% & 8.7%, RR 0.59, 95% CI 0.47-0.74, p < 0.001) Exercise-associated wheezing was also more frequent among Tobagonian adolescents (17.5% & 20.2%, RR 0.87, 95% CI 0.76 - 0.98, p = 0.04). CONCLUSION: Self-reported wheeze is common among adolescents in Trinidad and Tobago. Variation in symptoms was found between the two territories; high school students from Tobago, the less industrialized of the two islands, reported more symptoms of severe asthma and exercise-induced wheeze. Difference in the ethnic composition rather than socio-economic factors may be contributing to the observed differences in symptom prevalence.

Effect of N-acetyl-L-cysteine on Cytokine Production by Human Peripheral Blood Mononuclear Cells.

OBJECTIVES: This study investigates the in vitro effect of the antioxidant drug, N-acetyl-L-cysteine (NAC), on cytokine production by peripheral blood mononuclear cells (PBMC). METHODS: PBMC were isolated by Ficoll-Hypaque, and stimulated with anti-CD3 antibodies, phytohaemagglutinin (PHA), lipopolysaccharide (LPS) for 24 hours in the presence or absence of 5 mM NAC. The cytokines produced were measured by enzyme-linked immunosorbent assay (ELISA). RESULTS: Treatment with NAC significantly up-regulates the secretion of IL-1ß, IL-5 (interleukin) and IFN-γ (interferon) and down regulates IL-10 production, after anti-CD3 or PHA (p<0.05), but not after LPS stimulation. NAC also significantly increased total IL-12 secretion after anti-CD3 (but not PHA or LPS) stimulation and IL-12p40 after anti-CD3, PHA, and LPS stimulation (p <0.05). CONCLUSION: These results indicate that NAC up-regulated the production of pro-inflammatory cytokines, and down regulated anti-inflammatory cytokine production by PBMC, in a process which may be associated with increased levels of glutathione (GSH). Further work is required to determine whether this increase or decrease in cytokine production is due to direct effect of NAC.

Saharan dust clouds and human health in the English-speaking Caribbean: what we know and don't know.

Dust clouds travel across the Atlantic to the Americas and the Caribbean Islands. This long-range transport of dust leads to clouds that are enriched with small particles less than 10 microm aerodynamic diameter (PM10) which can reach human airways. The dust clouds also bring pollen, microbes, insects and chemicals, all of which could potentially have a negative impact on human health. This has led to a small number of retrospective studies being conducted on the islands of Barbados and Trinidad to look at possible associations between dust cover and acute asthma admissions to Emergency Rooms. The results have been conflicting. This review examines these studies, offers possible explanations for the differences in results, and suggests that there is a need for a prospective Caribbean-wide study to assess fully any relationship between African dust clouds and human respiratory and cardiovascular diseases.

Human papillomavirus genotypes and their prevalence in a cohort of women in Trinidad / Genotipos del papilomavirus humano y su prevalencia en una cohorte de mujeres en Trinidad

OBJECTIVE: Human papillomavirus (HPV) genotypes and their relative prevalences were determined in a cohort of 310 sexually active women in Trinidad, West Indies. METHODS: Cervical samples were collected with Ayre's spatulas and endocervical brushes. Samples were used for the conventional Papanicolaou test and for determining HPV genotypes by amplification of a section of the viral L1 gene, followed by DNA sequencing and probe hybridization. RESULTS: HPV infections were identified in 126 of 310 (40.6 percent) women. Of them, 83 (65.8 percent) were infected with high-risk HPV, 16 (12.7 percent) with low-risk HPV, and 27 (21.4 percent) with HPV types of unknown risk. HPV 52 (12.7 percent) was the most frequently occurring high-risk type, followed by HPV 66 (10.3 percent), HPV 16 (9.5 percent), and HPV 18 (8.6 percent). High-risk types HPV 16 and HPV 66 were each found in 3 (20.0 percent) and HPV 18 was found in 1 (6.6 percent) of the 15 women with abnormal cytology. CONCLUSIONS: Cervical HPV prevalence and heterogeneity of HPV genotypes are high in this Trinidad cohort. The relative importance of HPV genotypes in the development of cervical lesions needs further investigation in Trinidad in order to better understand the epidemiology of HPV infections as well as to determine the role of HPV testing in the screening, prevention, and control of cervical cancer. This pilot study provided important information on the prevalence of HPV genotypes, which will be used in future nationwide studies.

OBJETIVO: Se determinaron los genotipos del papilomavirus humano (PVH) y su prevalencia relativa en una cohorte de 310 mujeres sexualmente activas de Trinidad, en la zona de las Indias Occidentales. MÉTODOS: Se tomaron muestras del cuello uterino con espátula de Ayre y cepillo endocervical. Las muestras se usaron para llevar a cabo la prueba convencional de Papanicolaou y para determinar los genotipos de PVH mediante la amplificación de una sección del gen vírico L1, seguida de secuenciación del ADN e hibridación con sonda. RESULTADOS: Se encontró una infección por PVH en 126 de las 310 mujeres (40,6 por ciento). De ellas, 83 (65,8 por ciento) estaban infectadas con PVH de alto riesgo, 16 (12,7 por ciento) con PVH de bajo riesgo, y 27 (21,4 por ciento) con tipos de PVH de riesgo desconocido. De los PVH de alto riesgo, el más frecuente fue el PVH 52 (12,7 por ciento), seguido por el PVH 66 (10,3 por ciento), el PVH 16 (9,5 por ciento) y el PVH 18 (8,6 por ciento). Entre las 15 mujeres con citología anormal se encontraron los PVH de alto riesgo 16 y 66 en 3 (20,0 por ciento) mujeres cada uno, y el PVH 18 en 1 (6,6 por ciento). CONCLUSIONES: Tanto la prevalencia de PVH en el cuello uterino como la heterogeneidad de los genotipos de PVH son elevadas en esta cohorte de Trinidad. La importancia relativa de los genotipos de PVH en la aparición de las lesiones cervicales requiere de mayor investigación en Trinidad para conocer más a fondo las características epidemiológicas de las infecciones por PVH, así como para determinar el papel del estudio de los PVH en la detección sistemática, la prevención y el control del cáncer del cuello uterino. Este estudio piloto suministró información importante sobre la prevalencia de los genotipos de PVH, que se usará en futuros estudios que se lleven a cabo en todo el país.

Smoking at home is strongly associated with symptoms of asthma and rhinitis in children of primary school age in Trinidad and Tobago.

OBJECTIVE: To compare, in the twin-island republic of Trinidad and Tobago, the prevalence of symptoms of asthma and rhinitis among children of primary school age who are exposed to household environmental tobacco smoke with the prevalence of these symptoms in their colleagues without this exposure. METHODS: Between September and December 2002, questionnaires based on the instrument developed for the International Study of Asthma and Allergies in Childhood (ISAAC) were distributed, via the children in their schools, to parents of 6,611 Year 2 pupils (typically 6 years old) or Year 3 pupils (typically 7 years old) in 106 randomly selected schools in Trinidad and Tobago (5,511 pupils on Trinidad and 1,100 pupils on Tobago). We added to the standard ISAAC questionnaires two questions, one on household smoking and one on the ethnicity of the children. RESULTS: A total of 3 170 completed questionnaires were suitable for further analysis (2,618 from Trinidad and 552 from Tobago). On Trinidad 782 of the children (29.9%) lived in homes where one or both parents smoked, and 513 (19.6%) had other relatives in the household who smoked. On Tobago 94 of the pupils (17.0%) had parents who smoked, and 84 (15.4%) came from homes where other residents smoked. Parental smoking was significantly associated with wheezing (odds ratio (OR): 1.43; 95% confidence interval (CI): 1.11-1.83), exercise-induced wheezing (OR: 2.12; 95% CI: 1.59-2.82), nocturnal coughing (OR: 1.64; 95% CI: 1.37-1.97), and symptoms of rhinitis (OR: 1.35; 95% CI: 1.10-1.65) in the last 12 months as well as a history of hay fever/sinus problems (OR: 1.39; 95% CI: 1.11-1.74). Smoking in the home by adult residents other than parents was also significantly associated with all of these symptoms as well as a history of asthma (OR: 1.49; 95% CI: 1.13-1.97). In terms of ethnic differences, parental smoking was most prevalent in the homes of South Asian students, while smoking by other adults in the home occurred most commonly in the households of pupils of mixed race. CONCLUSIONS: Even in Trinidad and Tobago, which is a tropical environment where more time is spent outdoors and homes have more open ventilation than in temperate climates, environmental tobacco smoke exposure is closely associated with an increased prevalence of symptoms of asthma and rhinitis in primary-school-aged children.

Comparison of prevalence and severity of asthma among adolescents in the Caribbean islands of Trinidad and Tobago: results of a nationwide cross-sectional survey

BACKGROUND: A nationwide cross-sectional survey was conducted to compare the prevalence of asthma symptoms among high school students in the two islands of the Republic of Trinidad and Tobago. METHODS: Questionnaire and video instruments based on those developed by the International Study of Asthma & Allergy in Childhood (ISAAC) were used to assess asthma prevalence among 6394 children (age range, 11–19 years; mean age, 14.08 yrs) in the second and third years of 35 randomly selected high schools in Trinidad and Tobago. RESULTS: A total of 4988 questionnaires were available for analysis (3519 in Trinidad and 1469 in Tobago); wheezing in the previous 12 months (13.1 per cent & 13.4 per cent, RR 0.98, 95 per cent CI 0.84–1.15); a previous or current diagnosis of asthma (12.8 per cent & 13.5 per cent, RR 0.95, 95 per cent CI 0.82–1.12) and night cough in the past 12 months (35.4 per cent & 38.3 per cent, RR0.93, 95 per cent CI 0.86–1.00). However, symptoms of severe asthma were significantly more common among students from Tobago and included having had more than one acute attack in the past year (13.4 per cent & 15.8 per cent, RR 0.85, 95 per cent CI 0.73–1.00, p = 0.0004), night waking as a result of wheeze (7.4 per cent & 10.9 per cent, RR 0.68, 95 per cent CI 0.56–0.83, p < 0.0001) and speech limitation in the past year (5.2 per cent & 8.7 per cent, RR 0.59, 95 per cent CI 0.47–0.74, p < 0.001) Exercise-associated wheezing was also more frequent among Tobagonian adolescents (17.5 per cent & 20.2 per cent, RR 0.87, 95 per cent CI 0.76 – 0.98, p = 0.04). CONCLUSION: Self-reported wheeze is common among adolescents in Trinidad and Tobago. Variation in symptoms was found between the two territories; high school students from Tobago, the less industrialized of the two islands, reported more symptoms of severe asthma and exercise-induced wheeze.

Smoking at home is strongly associated with symptoms of asthma and rhinitis in children of primary school age in Trinidad and Tobago

OBJETIVO: Comparar, en las dos islas que integran la república de Trinidad y Tabago, la prevalencia de síntomas de asma y de rinitis en escolares de primaria expuestos al humo de tabaco en el ambiente domiciliario con la prevalencia de los mismos síntomas en coetáneos sin la exposición. MÉTODOS: Entre septiembre y diciembre de 2002, se distribuyeron cuestionarios basados en el instrumento elaborado para el Estudio Internacional de Asma y Alergias en la Niñez (ISAAC, por International Study of Asthma and Allergies in Childhood). La distribución la efectuaron los escolares de 106 escuelas escogidas aleatoriamente en Trinidad y Tabago (5 511 escolares en Trinidad y 1 100 en Tabago) entre los padres de 6 611 escolares de segundo o tercer grado (por lo general de 6 y 7 años de edad, respectivamente). Añadimos dos preguntas al cuestionario ISAAC, una de ellas sobre el tabaquismo en el domicilio y la otra sobre el origen étnico de los niños. RESULTADOS: Un total de 3 170 cuestionarios llenados se prestaron a análisis (2 618 de Trinidad y 552 de Tabago). En Trinidad 782 (29,9%) de los niños vivían en hogares donde uno de los padres o ambos padres fumaban, y 513 (19,6%) tenían otros parientes en el domicilio que fumaban. En Tabago 94 de los niños (17,0%) tenían padres que fumaban y 84 (15,4%) venían de hogares donde otros residentes fumaban. El tabaquismo en los padres mostró una asociación significativa con la presencia de sibilancias (razón de posibilidades [RP]: 1,43; intervalo de confianza de 95% [IC95%]: 1,11û 1,83), sibilancias provocadas por el ejercicio (RP: 2,12; IC95%: 1,59û2,82), tos nocturna (RP: 1,64; IC95%: 1,37û1,97) y síntomas de rinitis (RP: 1,35; IC95%: 1,10û1,65) en los 12 meses más recientes, así como antecedentes de fiebre del heno o problemas sinusales (RP: 1,39; IC95%: 1,11û1,74). La presencia en el domicilio de parientes fumadores distintos de los padres también mostró una asociación significativa con todos estos síntomas y con antecedentes de asma (RP: 1,49; IC95%: 1,13û1,97). En cuanto a diferencias por razones étnicas, el tabaquismo de los padres fue más frecuente en los hogares de escolares del sur del Asia, mientras que el tabaquismo de otros adultos en el domicilio se observó con más frecuencia en los hogares de escolares de raza mixta...

Asthma in the English-speaking Caribbean

The prevalence of asthma in the Caribbean is high and seems to be increasing. Asthma research in this region has been biased towards the paediatric population and there is little published on adult disease. There is a high prevalence of other allergic diseases in the patients studied, with skin reactivity to at least one allergen in 50 - 81 percent of subjects. Reactivity to house dust mite, especially Dermatophagoides pteronyssinus, occurred most commonly and sensitivity to this mite correlated with high levels of mite proteins in mattress and bedroom dust. Asthmatic admissions to hospitals are highest in the last qaurter of the year by fall to their lowest levesl in April. Admission rates are influenced by climatic variables wuch as relative humidity and wind speed. In some territories current management of asthma remains reliant on the use of oral bronchodilators with underutilisation of inhaled beta-agonists and corticosteriod preparations

Blood utilization for elective general surgery at the Port-of-Spain General Hospital

A study of 7 commonly performed elective general surgical procedures shows that blood is only rarely used in most operations that traditionally require group and cross-matching of two units for surgery. This is expensive, takes much time and could contribute to shortage of already limited blood stores. It is recommended that a transfusion committee be established to set up guidelines for blood utilisation (AU)

A retrospective analysis of invasive streptococcuss pneumoniae infections in Trinidad

A retrospective analysis of culture-positive cases of S pneumoniae from normally sterile body fluids is reported. Over 40 percent of patients were 5 years old or less while 28 percent of patients were 50 years old or more. Meningitis (44 percent) was the commonest clinical presentation followed closely by pneumonia (31 percent). The commonest predisposing disorder was human immunodeficiency virus infection though there were no identifiable risk factors in the majority of patients. Mortality from invasive pneumococcal disease was significantly higher in elderly patients compared with other age groups (p=0.0003). In this study, all S pneumoniae isolates, for which there were antibiotic sensitivity data, were penicillin and/or amoxycillin sensitive.(Au)

A retrospective analysis of invasive Streptococus pneumoniae infection in Trinidad

A retrospective analysis of culture-positive cases of S. pneumoniae infection is reported. Over 40 percent of patients were > 5 years old while patients > 50 years accounted for 28 percent of cases. Meningitis (44 percent) was the most common clinical presentation followed closely by pneumonia (31 percent). Many patients, however, were described as having sepsis and/or bacteraemia with an identifiable focus of infection. The commonest underlying predisposing condition was HIV infection though there were no identifiable risk factors in the majority of patients. Mortality from invasive pneumococcal disease was epecially high in elderly patients. In this study, all S. pneumoniae isolates for which there were antibiotic sensitivity data were penicillin and/or amoxycillin sensitive.(AU)

Allergic rhinitis and skin prick testing in Trinidad

This study investigated a group of 17 patients in Trinidad who were diagnosed as having allergic rhinitis following the criteria set out by the International Rhinitis Management Working Group: the presence of two or more of these symptoms (sneezing, blockage, running nose - including drainage of mucus down the back of the throat) for more than one hour a day for more than two weeks. These patients had skin prick testing performed with a panel of common allergens. Of the 17 patients tested, 76.4 percent reacted to Dermatophagoides pteronyssinus and 52.9 percent reacted to house dust. In conclusion, it appears that Dermatophagoides pteronyssinus is a common allergen involved in allergic rhinitis in Trinidad.(AU)

Is routine cross-matching of blood necessary in elective surgery? - abstract

Requests for two units of blood for major elective surgery are still routine practice at the Port-of-Spain General Hospital. This is necessarily associated with increased cost and work load in the blood bank and may even further accentuate the chronic shortage of blood. This study was undertaken to determine whether routine cross-matching of blood is necessary in elective surgery. The operative room notes of 358 consecutive patients undergoing 7 common elective operations (cholecystectomy, thyroidectomy, mastectomy, prostatectomy, pyelolithotomy, nephrectomy and elective gut resection) were reviewed. The blood consumption and transfusion index were calculated using the method outlined by Mintz et al (JAMA, 239: 623-5, 1978). When the transfusion index was less than 0.5, routine pre-operative cross-matching was regarded as unnecessary. Though there was wide variation in the transfusion index in the procedures studied (from 0.03 in thyroidectomy to 0.45 in elective gut resection), in no case did the index exceed 0.5. Routine cross-matching of blood appears to be unnecessary for the procedures studied. However, because 82 percent of blood given to the blood bank is donated for elective procedures, it is necessary to continue requesting blood from the relatives and friends of patients undergoing elective surgery. Inadequate storage and delay in the return of unused blood further accentuates the shortage of blood. We therefore recommend that the practice of routine cross-matching of blood for these elective operations be abandoned (AU)

A retrospective analysis of invasive streptococcuss pneumoniae infections in Trinidad

A retrospective analysis of culture-positive cases of S pneumoniae from normally sterile body fluids is reported. Over 40 percent of patients were 5 years old or less while 28 percent of patients were 50 years old or more. Meningitis (44 percent) was the commonest clinical presentation followed closely by pneumonia (31 percent). The commonest predisposing disorder was human immunodeficiency virus infection though there were no identifiable risk factors in the majority of patients. Mortality from invasive pneumococcal disease was significantly higher in elderly patients compared with other age groups (p=0.0003). In this study, all S pneumoniae isolates, for which there were antibiotic sensitivity data, were penicillin and/or amoxycillin sensitive.

Nitric oxide levels in children with febrile illnesses - Poster abstract

OBJECTIVE: To determine nitric oxide (NO) levels in children with febrile illness and to investigate its prognostic value in early dengue virus infections. DESIGN AND METHOD: A pilot case control study was conducted from September 1998 to March 1999 at the Eric Williams Medical Sciences Complex, Priority Care Facility (PCF), in Trinidad. Serum NO concentrations were measured in children <12 years presenting with febrile illnesses in the absence of clinically significant bacterial infection. RESULTS: Of 59 blood samples collected, there were 22 from individuals diagnoses as virally induced gastroenteritis (VGE), with 31 non-specific viral illnesses (VI), and 6 viral infections associated with upper-respiratory tract infection (URTI-VI). The mean (NO) in all cases was above normal (11.9 uM SD 5.9) 81.17 uM in VGE, 41.30 uM in VI and 57.83 uM in URTI-VI. Krushkal-Wallis test revealed that there was a significant difference (p = 0.007) between all three means and that the mean (NO) for VGE was significantly higher (p = 0.003) than that of VI. CONCLUSIONS: The degree of elevation of NO varies between viral illnesses in children and its potential as a rapid prognostic marker warrants further investigation.(AU)