Evaluating the risk of obstructive sleep apnea in type 2 diabetic patients, and its associations

OBJECTIVE: To assess the prevalence of high risk of Obstructive Sleep Apnoea (OSA) in Type 2 diabetics. To identify risk associations of OSA with obesity, sleep quality, daytime sleepiness and Acanthosis Nigricans. DESIGN AND METHODS: A cross sectional study was done in the diabetic wards of health facilities governed by three Regional Health Authorities in Trinidad. OSA risk was assessed by the Snoring, Tiredness, Observed Apnea, high blood Pressure (STOP) – Body mass index, Age, Neck circumference and Gender (BANG) questionnaire. Sleep quality and daytime sleepiness were also assessed by the Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale respectively. Bioimpedance analysis was also done using a stadiometer and standard bioimpedance scale. RESULTS: A total of 281 diabetic patients and 147 non-diabetic patients were interviewed throughout Trinidad. Females made up the majority of the sample, 67% of the diabetics and 66% of the non diabetics. The prevalence of OSA was found to be 73.2% in type 2 diabetics. Non diabetics had an OSA prevalence of 39.5%. Results from a binary regression showed that having diabetes increased the probability of “High Risk of OSA” by 93.1%. CONCLUSION: The prevalence of high risk of OSA in Trinidad was high in type 2 diabetic patients, and has strong correlations with obesity and Acanthosis Nigricans.

Penile Carcinoma in Northern Trinidad and Tobago.

OBJECTIVE: To determine the current incidence as well as general and ethnic trends of penile carcinoma in northern Trinidad and Tobago. METHODS: A retrospective analysis was conducted on all cases of penile carcinoma presenting in north and east Trinidad, as well as Tobago over an eight-year period. RESULTS: There were 19 cases from October 2003 to February 2012 with an age range of 42-96 years, mean of 59 years; peak age of presentation was 41-50 years and the number of cases presenting per year varied from one to four, with an average of three new cases yearly. Of 19 cases, 63% (12) originated from Port-of-Spain General Hospital (POSGH), 26% (5) from Sangre Grande (SGH) and 11% (2) from Tobago (TRH). There were 14 (74%) patients of African descent, three mixed and two of East Indian descent. There were four associated inflammatory lesions, five with ulcers, five verrucous lesions and two (10.5%) with human papillomavirus (HPV). One case presented with metastatic disease to the groin with erosion into the common femoral artery resulting in a blow-out of the vessel. The patient had the vessel oversewn and an extra-anatomic bypass done. He later had an above-knee amputation due to graft infection and failure. CONCLUSION: The incidence of penile carcinoma in north Trinidad and in Tobago is low and has halved in the past two decades. It stands at 0.6 cases per 100 000 males with the peak age group being 41-50 years, and with 95% of cases occurring between 41 and 80 years. There is a statistically significant association with active infection and being Afro-Caribbean. The decreasing incidence may be attributed to better hygiene, a higher rate of circumcision and low HPV rates in our population.

Giant accessory right-sided suprarenal spleen in thalassaemia.

An accessory spleen is defined as ectopic splenic tissue that develops due to failure of fusion of cells during embryonic development as they migrate from the midline to the left upper quadrant. While benign, complications may arise which include trauma, torsion, or infarction of the ectopic tissue. Additionally, patients who have had a splenectomy secondary to treatment for previous pathology such as a haematological malignancy or idiopathic thrombocytopenia purpura may experience persistent symptoms due to the accessory splenic tissue. The presence of an accessory spleen is therefore of significant diagnostic and therapeutic importance. To the best of the authors' knowledge, this case is the second and largest reported case of a giant right suprarenal accessory spleen and highlights the difficulty in differentiation of these masses from malignant adrenal tumours.

Rectus versus linea alba: a biomechanical study

The comparative differences in pullout suture strength between rectus muscle and sheath and linea alba were studied in cadaveric models. A suture simulating the rectus repair procedure and one using just linea alba were used. Forces were measured on a tensiometer. Mean rectus force was found to account for over 59 percent variability. Both force uniformly decrease towards the symphysis pubis. This suggests that the rectus, when used for incisional hernia repair, may contributed significantly to wound strength. Additionally, our findings may help to elucidate the observance that incisional hernias are commonly subumbilical and occur mostly in females.(AU)

Dengue haemorrhagic fever/dengue shock syndrome. An unwelcome arrival in Trinidad.

This is the first report of dengue haemorrhagic fever and dengue shock syndrome in Trinidad. Dengue infection was confirmed serologically or by viral isolation in five patients, aged 15 to 53 years, who presented with fever, thrombocytopenia and haemoconcentration. Three patients developed dengue shock syndrome, which was fatal; although there was no haemorrhagic tendency among these patients, bleeding occurred shortly before death in one of them. Two patients who had dengue haemorrhagic fever survived. The co-circulation of dengue virus serotypes 1, 2, and 4 in the Caribbean facilitates the development of dengue shock syndrome (DSS) or dengue haemorrhagic fever (DHF). Clinicians should therefore be aware of their clinical features, laboratory diagnosis and clinical management. Appropriate public health interventions and improved surveillance should be implemented to reduce the risk of DHF/DSS associated mortality in Trinidad and Tobago.

The incidence of prostate cancer-trends in two ethnic groups in Trinidad: a nine year study - abstract

Data on prostate cancer patients were obtained from the Pathology Department, General Hospital, San Fernando (before 1993) and, after 1993, prospectively collected for all admissions to that hospital for all patients with prostate cancer. Additonal data was collected from the hospital theatre registers and medical records. 365 prostate patients' data over the nine year period 1987-1995 were analysed for tends in the disease. In the population served by the hospital there are equal numbers of East Indians and Africans in the age range > 60 years. There was a rapid rise in the incidence of prostate cancer in males > 60 years starting in 1993, when PSA became widely available. This rise was maintained and seen mainly in the African population though there was a lesser rise among the East Indians. In most years, prostate cancer was more frequent in African than East Indian men. These data emphasize the value of PSA in detecting prostate cancer in both races but there is need for more education and systematic screening programmes to detect the asymptomatic male who can be offered curative therapy. The significantly higher frequency of prostate cancer in Africans (87.2 percent) than East Indians (12.8 percent) may be associated with differences with genetic and dietary factors and not with environment which is the same for both races. (AU))

Paracoccidioidomycosis in Trinidad.

Paracoccidioidomycosis is a systemic disease endemic to South America, but rarely recognised in other parts of the world. The patient we describe represents the first case of paracoccidioidomycosis observed in Trinidad.