Delays in adjuvant radiotherapy for primary breast cancer is harmful, especially in low-income countries.

Our retrospective cohort study of the effects of radiotherapy delay on the oncological outcome of breast cancer patients showed a prolonged radiotherapy waiting interval was associated with a statistically significant increase in the 3-year breast cancer-specific mortality. This research should stimulate setting up protocols geared towards minimizing delays.

A No-Cost, Bedside, Self-Traction Maneuver for Relief From Chronic Cervical Radiculopathy: A Case Report.

Cervical radiculopathy secondary to spondylosis is common in the elderly. Systematic reviews suggest that no single treatment modality represents the standard of care. A no-cost, bedside, self-traction intervention can be a useful adjunct to current options. A 60-year-old South Asian male presented with severe cervical radiculopathic pain in April 2019, proven by magnetic resonance imaging to be secondary to spondylosis. Since late 2019, he has been doing a daily self-traction procedure in which he lies prone with the anterior chest and abdomen flat on a bed, shoulders just off the mattress edge, and arms to the side. The position is maintained for 60 seconds, where the weight of the head provides traction. Overhead cervical traction has not been needed for the past three years, and the pain has been bearable. His Neck Disability Index has decreased from 25 to 2. This no-cost, minute-long daily maneuver has provided relief from chronic cervical neuropathic pain due to cervical spondylosis.

Parental Knowledge, Attitudes, and Perceptions Impacting Willingness to Vaccinate Against the Human Papillomavirus in Trinidad.

Background Cervical cancer remains a major cause of morbidity and mortality in young women in Trinidad and Tobago. This study aimed to determine the knowledge, attitudes, perceptions, and beliefs of Trinidadian parents toward human papillomavirus (HPV) vaccination. In addition, factors predictive of willingness to vaccinate were explored. Methodology In this cross-sectional study conducted between March and May 2019, a paper-based survey was self-administered to parents of children in the 5-12-year age group in seven geographically representative Trinidadian primary schools. Results Of the 420 questionnaires distributed, 160 were returned completed (38% response rate). General knowledge that HPV causes cervical cancer and genital warts and is spread by sexual contact was common among 81%, 71%, and 81% of parents, respectively. At least 40% of the respondents expressed uncertainty about the vaccine's long-lasting health problems and its effectiveness in preventing genital warts and cervical cancer. Half of the parents were unsure if the vaccine was harmful. The perceptions that vaccine safety data are fabricated, drug companies cover up the dangers of vaccines, vaccine efficacy data are often fabricated, people are deceived about vaccine efficacy and safety, and conspiracy beliefs were held by 15.5%, 26.1%, 13%, 21.7%, and 28.5% of parents, respectively. There was a negative correlation between knowledge and conspiracy belief scores (ρ = -0.30, p < 0.001). Overall, 45.3% of parents were willing to immunize their children against HPV. Being informed about HPV by a health professional (odds ratio (OR) = 2.9, 95% confidence interval (CI) 1.5-5.8), knowledge of the benefits (OR = 4.6, 95% CI = 2.2-9.6), and a health professional offering the option of vaccination (OR = 3.7, 95% CI = 1.7-8.0) were associated with significantly increased odds of parents willing to vaccinate their child. The agreement that vaccine safety data are often fabricated (OR = 0.31, 95% CI = 0.12-0.84), pharmaceutical companies cover up the dangers of vaccines (OR = 0.14, 95% CI = 0.06-0.37), waiting at the clinic being time-consuming (OR = 0.37, 95% CI = 0.15-0.89), and the beliefs that adolescents are too young to get a vaccine to prevent sexually transmitted disease (OR = 0.16, 95% CI = 0.11-0.83) were associated with a significantly decreased willingness to vaccinate. Conclusions While general knowledge about HPV was high, there remain several areas for parental education regarding the HPV vaccine. Misbeliefs need to be addressed and multilevel interventions are needed to improve HPV vaccine uptake in our setting.

COVID-19 Vaccine Hesitancy in Trinidad and Tobago: A Qualitative Study.

Background After three years of COVID-19, the WHO declared that the pandemic was no longer a global health emergency. Vaccination remains part of the management strategy, given the current phase of the pandemic. This study explored the reasons for COVID-19 vaccine hesitancy in Trinidad and Tobago (TT). Methodology A qualitative study of persons 18 years and over from the eastern, northwest, northcentral, and southwestern geographical areas of TT, who are unvaccinated and hesitant, was done by convenience sampling. Formal in-depth virtual interviews were done on a one-to-one basis using a semi-structured questionnaire. The interviews were recorded and transcribed using the principles of reflexive thematic analysis of participants' responses.  Results From 25 participants' responses, the main themes for being vaccine-hesitant were fear, inefficacy, information inadequacy, perceived susceptibility, mistrust, herbal alternatives, and religious hesitations. Additionally, their motivations for receiving the vaccine in the future were surrounded by themes of necessity, perceived susceptibility, health benchmark, and assurance. Conclusion and recommendations This qualitative investigation identified traditional factors contributing to COVID-19 vaccine hesitancy and unique determinants such as herbal use and religious beliefs within the TT context. These insights could inform future research and facilitate the development of tailored strategies to address persistent vaccine hesitancy for COVID-19.

Differential Mental Health Impact of COVID-19 Lockdowns on Persons with Non-Communicable Diseases in Trinidad and Tobago.

Persons with chronic non-communicable diseases (NCDs) were identified as particularly at risk of severe morbidity and mortality during the COVID-19 pandemic. Little is written about the impact of COVID-19 on this sub-population in the Caribbean, where the prevalence of NCDs is disproportionately high. This study aimed to ascertain COVID-related concerns, and the mental health impact of the pandemic among persons with and without NCDs in Trinidad and Tobago, during the acute period of COVID-19 lockdowns early in the pandemic. An anonymous online survey collected cross-sectional data from a convenience sample nationwide. Of 1287 respondents, 219 self-identified as having an NCD. Findings suggest that the pandemic was experienced unequally by persons with NCDs, who were more likely to be concerned about health and wellbeing and to report health inequalities-unemployment, social isolation and negative effects of government restrictions. Compared to those without NCDs, they were more likely to increase use of marijuana during the lockdown period, and to report severe anxiety/depression that can result in exacerbation of NCDs. Interventions for persons with NCDs must address the mental health consequences of any pandemic, including increased drug use, and also address social inequalities to reduce sustained post-pandemic mental health impact and negative health outcomes.

Correlation of RETINAL Artery Diameter with Coronary Artery Disease: The RETINA CAD Pilot Study-Are the Eyes the Windows to the Heart?

INTRODUCTION: This study aimed to determine whether there was any correlation between coronary artery disease (CAD) and retinal artery diameter at an academic tertiary medical center in Trinidad and Tobago. METHODS: This prospective study evaluated patients (n = 77) with recent invasive coronary angiography (CAG) and the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score who subsequently underwent optical coherence tomography-angiography (OCT-A) at the Eric Williams Medical Sciences Complex (EWMSC) from January 2021 to March 2021. Routine medical history and cardiovascular medications were also recorded. Spearman's rank correlation coefficient and Mann-Whitney U-tests were used to compare correlations and medians between groups. RESULTS: The average patient age was 57.8 years old, with the majority being male [n = 55 (71.4%)] and of South Asian ethnicity [n = 53 (68.8%)]. Retinal artery diameter was negatively correlated with the SYNTAX score (-0.332 for the right eye, p = 0.003 and -0.237 for the left eye, p = 0.038). A statistically significant relationship was also demonstrated in females and diabetic patients. There were no serious adverse events (SAEs). CONCLUSION: A significantly negative correlation was observed between retinal artery diameter and SYNTAX score. This study alludes to the practical use of optical coherence tomography-angiography (OCT-A) as a noninvasive diagnostic modality for patients with cardiovascular disease (CVD). Further large-scale, multicentric studies are required to confirm these exploratory findings. TRIAL REGISTRATION NUMBER: NCT04233619.

A cross-sectional survey of prospective healthcare professionals' knowledge, attitudes and perceptions of medical Cannabis.

Background: Compounds isolated from Cannabis possess many beneficial effects creating a renewed worldwide interest in its therapeutic potential. With increased legalization for medicinal use globally, healthcare professionals must be familiar with the drug's uses and potential adverse effects. Objective: To determine prospective healthcare providers' knowledge, attitude and perception to medical Cannabis. Method: A self-administered online questionnaire comprising 21 questions to assess the knowledge, attitude and perception of medical Cannabis was distributed via google forms among students at the Faculty of Medical Sciences, the University of the West Indies, St Augustine Campus. Chi-square analysis was used to detect significant associations between demographics and measured variables. A p-value <0.05 was considered significant. Results: Popular perceived therapeutic benefits of Cannabis were chronic pain (91.2%), anxiety (84.2%) and seizures (71.1%), and identification of the risks associated with the use of Cannabis was low. Users of Cannabis were able to identify indications and symptoms that can be treated with Cannabis but were less aware of the adverse effects of the drug than non-users (p < 0.001). More than three-quarters (87.3%) believed they could identify therapeutic uses and adverse effects but only 14.2% were ready to answer queries from patients. The main source of Cannabis information was the internet and information was lacking in the medical school curriculum. Conclusion: The majority of students could not identify the drug's indications and adverse effects. There is a need to improve training for all prospective medical personnel to cater for the change in legislation status.

Positive influences of the COVID-19 pandemic on community dwelling adults in Trinidad and Tobago: a cross sectional study.

BACKGROUND: Since the onset of the coronavirus (COVID-19) pandemic its negative effects have been highlighted globally. There is little literature that examines the positive impact on daily living. AIMS: To examine the positive influences of government-imposed COVID-19 public health restrictions on adults throughout Trinidad and Tobago (TT) and their associated factors. METHOD: A cross-sectional study, using an adapted pretested online survey instrument, was conducted amongst non-institutionalised, community-dwelling adults using convenience sampling. RESULTS: Of 1287 completed and weighted responses, the mean age (S.D.) was 39.2 (14.6) years, 49% were males, and 61% completed secondary level education. The top 5 positive experiences were more time spent with family (80%), more down-time (78%), learning new skills (68%), more time for hobbies (66%), self-care (57%), more time spent with friends (55%) and eating healthier (50%). The importance of religion, working from home, and an increase in marijuana use emerged as positive correlates for certain positive experiences, while participants with chronic illness, and a positive anxiety or depression screen, were negatively associated with most positive experiences. CONCLUSIONS: Despite the negative consequences of the COVID19 pandemic, several positives were highlighted in this study. These findings have implications for social policies toward building resilience within the community.

Comparison of cardiac CT angiography coronary artery dimensions and ethnicity in Trinidad: the CADET pilot study.

BACKGROUND: This study aimed to determine if there were any significant differences in coronary artery (CA) dimensions at prespecified segments during cardiac CT angiography (CCTA) compared with ethnicity at an academic tertiary medical centre in Trinidad and Tobago. METHODS: Patients (n=170) who underwent CCTA from July 2016 to June 2021 at the Eric Williams Medical Sciences Complex were selected based on predefined selection criteria. The size of the left main and proximal, mid and distal diameters of the left anterior descending, left circumflex and right coronary artery (RCA) were measured using quantitative coronary angiography, syngo.CT Coronary Analysis (Siemens Healthineers AG, Erlangen, Germany). Routine medical history, cardiovascular medications and anthropometric data were also recorded. Comparisons were performed using an independent sample t-test and analysis of variance for continuous variables. RESULTS: One hundred and seventy participants were enrolled in this study. There were no statistically significant associations between gender and CA dimensions; however, there were significant associations between South Asian and Caribbean black ethnicities for almost all CA dimensions except for the distal RCA segment. These findings were replicated when the analysis was adjusted for body surface area with the addition of the mid-RCA segment, which was bordering near-significance (p value 0.051). CONCLUSIONS: Significantly smaller CA dimensions were observed in South Asian patients compared with Caribbean black patients undergoing CCTA. This pilot study could be clinically significant for Trinidadian patients at risk of developing coronary artery disease. TRIAL REGISTRATION NUMBER: NCT04774861.

Eight years of antibiotic consumption at a primary care outpatient facility in Trinidad and Tobago 2011-18: a synopsis of consumption trends.

OBJECTIVES: To explore antibiotic consumption and surveillance patterns in Trinidad and Tobago. METHODS: A retrospective observational study was conducted. Stock requisition and logbooks from a District Health Facility in Trinidad were examined for the period 2011-18. Daily Defined Doses (DDDs) for each antibiotic were computed and extrapolated to represent the antibiotic consumption per 1000 residents within the population. RESULTS: The mean consumption across the years was 2.917 DDD per 1000 residents per day. The most consumed antibiotics were cefuroxime, amoxicillin/clavulanic acid, and azithromycin, with mean DDDs of 0.879, 0.695 and 0.373 respectively. The least consumed antibiotics were cefaclor and clarithromycin, with DDDs of 0.0006 and 0.0005, respectively. CONCLUSIONS: Trinidad and Tobago is not mentioned in the WHO surveillance report on antibiotic consumption. Our most recent (2018) estimate of total antibiotic consumption was 3.224 DDD per 1000 habitants per day. This figure is an underestimate, as data was derived solely from the public sector. Notwithstanding, this data is novel and can provide a baseline for future comparison and development of national surveillance programmes.

The Effect of Dapagliflozin on Platelet Function Testing Profiles in Diabetic Patients: The EDGE Pilot Study.

INTRODUCTION: This prospective pharmacodynamic (PD) study assessed the effect of the sodium-glucose co-transporter-2 inhibitor (SGLT2i), dapagliflozin, on platelet reactivity. METHODS: Patients with stable coronary artery disease (CAD) and type 2 diabetes mellitus (T2DM) (n = 27) who were on maintenance dual antiplatelet therapy (DAPT) of aspirin 81 mg daily, and clopidogrel 75 mg daily were recruited. Platelet function was evaluated with the VerifyNow™ P2Y12 assay (Werfen, Bedford, MA, USA) and assessed prior to initiation of and after 10 days of treatment with dapagliflozin 10 mg once-daily dose regimen. Results were compared with a paired t test. RESULTS: Treatment with dapagliflozin significantly decreased P2Y12 reaction units (PRU) by 20%, (95% confidence interval (CI) 8.5-32.6%, p value 0.002). The mean difference in PRU was 36.70 (95% CI 16.66-56.75). No patients experienced any serious adverse events (SAEs). CONCLUSIONS: Significantly diminished platelet reactivity was observed on dapagliflozin as compared to without dapagliflozin. This dedicated pharmacodynamic study could be potentially informative and applicable for Trinidadian stable CAD patients with T2DM on DAPT. Further studies are required to confirm these exploratory findings. CLINICAL TRIAL REGISTRATION: EDGE ClinicalTrials.gov number NCT04400760.

2020 family medicine postgraduate examinations at The University of the West Indies: successes and challenges in the time of COVID-19 pandemic.

Little has been published regarding postgraduate assessments during the COVID-19 pandemic. There is an urgent need to graduate well-trained specialists including family physicians who play a key role in patient care. The successes and challenges encountered in mounting qualifying 2020 Family Medicine examinations during the COVID-19 pandemic at the University of the West Indies are described in this paper. Human resource, planning, use of technology and virtual environments are discussed, which enabled successful examinations at this multicampus regional site.

The Effect of Empagliflozin on Platelet Function Profiles in Patients with Stable Coronary Artery Disease in Trinidad: The EFFECT Pilot Study.

INTRODUCTION: This prospective pharmacodynamic (PD) study aimed to assess the effect of the sodium-glucose cotransporter 2 inhibitor (SGLT2i) empagliflozin on platelet reactivity. METHODS: Patients with stable coronary artery disease (CAD) and type 2 diabetes mellitus (T2DM) (n = 20) who were actively treated with dual antiplatelet therapy (DAPT) of aspirin 81 mg daily and clopidogrel 75 mg daily were recruited. Platelet function was measured with the VerifyNow™ P2Y12 assay (Instrumentation Laboratory, Massachusetts, USA) and assessed before the initiation of and after 10 days of treatment with empagliflozin 25 mg once daily maintenance dose regimen. Results were compared with a paired t test. RESULTS: The mean P2Y12 reaction units (PRU) on empagliflozin was significantly less than without empagliflozin at baseline (187.35, 95% confidence interval (CI) 155.38-219.32 vs. 217.25, CI 180.60-253.90; p < 0.030). The mean difference in PRU was 29.90 (95% CI 3.17-56.63). No patients experienced any serious adverse events (SAEs). CONCLUSIONS: Significantly attenuated platelet reactivity was observed on empagliflozin as compared to without empagliflozin. This dedicated pharmacodynamic study could be clinically pertinent for Trinidadian patients with stable CAD and T2DM on DAPT. Further studies are required to confirm these exploratory findings. (Funded by the University of the West Indies, St. Augustine; EFFECT). CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov number NCT04342819.

Diagnostic accuracy of salivary gland ultrasound in Sjögren's syndrome: A systematic review and meta-analysis.

BACKGROUND: To systematically review the diagnostic accuracy of salivary gland ultrasound in primary Sjögren's syndrome (pSS). METHODS: PubMed, Embase, CINAHL, Cochrane Central and Scopus and ClinicalTrials.gov were searched to identify diagnostic or validation studies in patients with pSS meeting the diagnostic criteria. A diagnostic test meta-analysis was performed using a bivariate model to calculate the pooled sensitivity, specificity, positive/negative likelihood ratios, and the diagnostic odds ratio. Meta-regression analyses were done for several pSS covariates. RESULTS: Sixty-five studies met our criteria for the qualitative review. Fifty-four studies with a total of 6087 patients were included in the meta-analysis. Pooled sensitivity for salivary gland ultrasound was 80% [95% confidence interval (CI): 77-83%; I 2 = 78%], and specificity was 90% (95% CI: 87-92%; I 2 = 76%). The pooled positive and negative likelihood ratios were 8 (95% CI: 6.4-10) and 0.22 (95% CI: 0.19-0.25), respectively. The corresponding pooled diagnostic odds ratio (DOR) was 37 (95% CI: 28-48). Separate meta-regression models resulted in similar diagnostic estimates: (a) adjusted for mean age: sensitivity 81% (95% CI:77-84%; I 2 = 99%) and specificity 90% (95% CI: 87-93%; I2 = 99%); (b) adjusted for mean disease duration, sensitivity 79% (95% CI:72-84%; I 2 = 99%), and specificity 90% (89-94%; I 2 = 99%). The diagnostic estimates were robust to sensitivity analyses by quality criteria, pSS diagnostic criteria and ultrasound scoring systems. CONCLUSION: Salivary gland ultrasound is a valuable modality for the diagnosis of Sjögren's syndrome. It is plausible that salivary gland ultrasound can be used as an important criterion for the diagnosis of pSS.

Screening for depressive symptoms in cardiovascular patients at a tertiary centre in Trinidad and Tobago: investigation of correlates in the SAD CAT study.

BACKGROUND: This study aimed to screen cardiovascular patients for depressive symptoms at a tertiary centre in Trinidad and Tobago; and to determine any significant associations amongst patients' demographics, comorbidities, and cardiovascular medications with depressive symptoms. METHODS: In this observational, cross-sectional study, patients (n = 1203) were randomly selected from the cardiology outpatient clinics at the Eric Williams Medical Sciences Complex. After meeting selection criteria, informed consent was obtained, and patients were administered a case report form, which included the Patient Health Questionnaire-9 (PHQ-9). Descriptive analyses included frequency, percentage and summary statistics. Inferential analyses included 95% confidence intervals (CIs), independent sample t-test, Fisher's exact test, Chi-square test, and multivariate logistic regression. RESULTS: The study had a 96% respondent rate, whereby the average age was 62 years old. Slightly less than half were male, and 52.5% were female. Over 90 % of the sample had cardiovascular disease (CVD). One-quarter of the sample had a PHQ-9 score of ≥10, with almost one-fifth having no depressive symptoms. Females, lower levels of education and income were all found to be statistically significant at risk for depressive symptoms (all p-values < 0.001). Comorbidities associated with depressive symptoms included hypertension, prior cerebrovascular events, chronic kidney disease, and chronic obstructive pulmonary disease with odds ratios (ORs) and 95% confidence intervals (CIs) of OR 1.988 (CI 1.414-2.797), OR 1.847 (CI 1.251-2.728), OR 1.872 (CI 1.207-2.902) and OR 1.703 (CI 1.009-2.876) respectively. Only the cardiovascular medication of ticagrelor was found to be significantly associated with depressive symptoms (p-value < 0.001). CONCLUSIONS: Twenty-five percent of screened cardiovascular patients displayed significant depressive symptoms with a PHQ-9 ≥ 10. This study also highlights the importance of implementing a multidisciplinary approach to managing cardiovascular disease and screening for depressive symptoms in this subpopulation. Further studies are required to validate these findings. TRIAL REGISTRATION: ClinicalTrials.gov number, NCT03863262 . This trial was retrospectively registered on 20th February 2019.

Physician related barriers towards insulin therapy at primary care centres in Trinidad: a cross-sectional study.

BACKGROUND: Physician related factors with respect to insulin therapy can contribute to diabetes mellitus (DM) mismanagement. Patient related factors have been previously explored in a Trinidad survey. The main objective of this study was to explore primary care physicians' (PCPs) related barriers towards insulin therapy. METHODS: A cross-sectional study on a convenience sample of PCPs in the public primary care system was done using an online survey. RESULTS: Of the 170 PCPs contacted, 75 (44%) responded. There were 47 females (62.7%) and 28 males (37.3%) with a mean age of 35.9 yrs. Nearly 40% of physicians admitted that the education given to patients was inadequate to allow initiation of insulin therapy. Half the respondents admitted to insufficient consultation times and inadequate appointment frequency to allow for intensification of insulin therapy. Forty percent of PCPs admitted that HbA1c results were unavailable to guide their management decisions. Only 6.7% of physicians said they had access to rapid acting insulin, while 5.3% said they had access to insulin pens. CONCLUSION: PCPs in Trinidad treating diabetes at the public primary care clinics face several barriers in administering proper insulin therapy. Addressing these factors can improve glycemic control in this population.

The Effect of Low-Dose Ticagrelor on Platelet Function Profiles in Patients With Stable Coronary Artery Disease in Trinidad: The TWIST Pilot Study.

INTRODUCTION: This prospective, pharmacodynamic study aimed to explore the potential applicability of a low-dose ticagrelor regimen in a heterogeneous Trinidadian subpopulation. METHODS: Patients with stable coronary artery disease (n = 25) who were actively treated with dual antiplatelet therapy of aspirin 81 mg daily and clopidogrel 75 mg daily were recruited. Platelet function was measured with the VerifyNow P2Y12 assay (Accriva Diagnostics, San Diego, CA, USA) and assessed before initiation of and after 14 days of treatment with a low-dose ticagrelor 45 mg twice daily maintenance dose regimen. Results were compared with a paired t test. RESULTS: The mean P2Y12 reaction units (PRU) score on ticagrelor was significantly less compared to that of clopidogrel (50.4, 95% confidence interval (CI) 29-73.9; vs. 149.6, 95% CI 129.4-169.9; p value < 0.001). Of the patients, 4% experienced Medical Research Council class 1 dyspnea, and Bleeding Academic Research Consortium class 1 bleeding on the ticagrelor regimen (one patient each). CONCLUSIONS: Significantly attenuated platelet reactivity was seen on the low ticagrelor maintenance dose as compared to clopidogrel. This dedicated pharmacodynamic study could be applicable and informative for Trinidadian stable coronary artery disease patients. Further studies are required to confirm these exploratory findings.(Funded by the University of the West Indies, St. Augustine). TRIAL REGISTRATION: ClinicalTrials.gov number NCT04206176.

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.

A Protocol for the Study of Polymorphisms and Response to Metformin in Patients with Type 2 Diabetes in Trinidad.

Background: Metformin is the drug of first choice in people newly diagnosed with type 2 diabetes. Most patients respond to metformin monotherapy, but many others remain uncontrolled even at maximal doses. Although non-adherence is a major contributor to non-response, genetic polymorphisms of organic cation transporters play an important role in clinical response. We hypothesize that genetic variants are partly responsible for non-response. Objective: This study aims to determine the allele and genotype frequencies of three single nucleotide polymorphisms (SNPs; ATM rs11212617, SLC22A1 rs594709 and SLC47A1 rs2289669) most commonly associated with failure to respond to metformin. Setting: Ten primary health care facilities in the North Central Regional Health Authority region of Trinidad. Patients: The study population will include 216 patients with diabetes adherent to metformin monotherapy for at least three months. Methods: Following a 12-hour overnight fast, blood samples will be taken to measure fasting insulin and HbA1c. DNA would be isolated and PCR will be used to determine the allele and genotype frequencies of these three SNPs in adherent diabetic patients. DNA samples will be stored for future sequencing of these three genes to determine whether other, possibly novel, mutations are associated with poor metformin response in Trinidad. Clinical Significance: This study will highlight the prevalence of these polymorphisms in our population. Should an association be found between the polymorphisms tested and glycemic control in adherent patients on metformin monotherapy, this will have implications for further research on medication initiation in newly diagnosed patients with diabetes in Trinidad.