Choice of Speciality among Medical Students at the Faculty of Medical Sciences, St. Augustine, UWI, Trinidad and Tobago, West Indies

The School of Medicine at the Faculty of Medical Sciences, University of the West Indies (FMS, UWI) graduates over 200 physicians yearly. Shortage of specialists exists; attributed by some, to the lack of opportunities. Challenges faced regarding medical specialization in Trinidad and Tobago (TT) are difficulties meeting the requirements of the available specialty programmes, lack of residency post and training in certain fields (1). Medical school is an opportune time to select a field as experience as a student and progression through the various years of medical school can influence choice (2,3). METHODOLOGY: A cross-sectional study was conducted by convenience sampling on 1278 medical students at the FMS, UWI using an online questionnaire. The distribution of specialist practitioners was abstracted from the online register of The Medical Board of Trinidad and Tobago.

Identification of undescribed medium-chain acylcarnitines present in urine of patients with propionic and methylmalonic acidemias.

In urine of patients with propionyl-CoA carboxylase deficiency or with methylmalonic acidemia, carnitine esters of 2-methyl-branched fatty acids of all chain lengths between 4 and 9 atoms of carbon were identified during the acute phase of the diseases. The chemical structure of these compounds was obtained by gas chromatography-mass spectrometry analysis of their fatty acid moieties in their free and picolinyl ester forms. We suggest mechanisms for the biosynthesis of these branched fatty acids, and their accumulation in urine during episodes of caloric imbalance.

Identification of new medium-chain acylcarnitines present in urine of a patient with medium-chain acyl-CoA dehydrogenase deficiency.

Previously undescribed medium-chain acylcarnitines were identified in a urine sample from a patient with medium-chain acyl-CoA dehydrogenase deficiency. These are the 4-methylvaleryl, 4- and 5-methylhexanoyl, 6-methylheptanoyl-, 6-methyloctanoyl-, 4,5-dimethylhexanoyl- and 4,7-decadienoylcarnitines. Their chemical structures were obtained by gas chromatographymass spectrometry analysis of their fatty acid moieties as picolinyl esters.

Identification of new medium-chain acylcarnitines present in normal human urine.

Analysis of urinary medium-chain acylcarnitines extracted on C18 cartridges and gas chromatography mass spectrometry of their fatty acid moieties as picolinyl esters allowed the determination of the chemical structure of previously unidentified acylcarnitines in normal human urine. These are the 2,6-dimethylheptanoyl-, the 2,6-dimethyl-5-heptenoyl-, and the trans- and cis-3,4-methylene heptanoylcarnitines, also named 3-cyclopropane octanoylcarnitines. Assessment of the structure of these cyclopropane derivatives was obtained by 1H and 13C nuclear magnetic resonance spectroscopy. In addition, other acylcarnitines were tentatively identified.

Fast-atom bombardment mass spectrometry and low energy collision-induced tandem mass spectrometry of tauroconjugated bile acid anions.

Fragmentation of negative ions produced by fast-atom bombardment (FAB) from 14 tauroconjugated bile acids and some of their deuterated analogs has been studied by mass spectrometry and by collision-induced dissociation (CED) tandem mass spectrometry at low energy.Low energy collision-induced dissociation of the deprotonated molecules [M - H](-) of these tauroconjugated bile acids leads to both charge-driven and charge-remote fragmentations (CRF). The former yields neutral loss from the side chain with charge migration during the fragmentation process. These fragments dominate the CID spectra, but are absent from the FAB spectra. Their relative abundances are dependent on the number and the positions of the hydroxyl groups in the steroid nucleus and thus permit distinction among some positional isomers.The CRF fragments correspond to cleavages in the side chain up to fragmentations across the steroid rings with charge retention on the sulfonate group. These CRF fragments, which also are useful for structural identification, are less intense in CID than in FAB spectra. It appears that these charge-remote fragments are favored by unsaturation in the steroid rings, either as keto groups or as endocyclic double bonds. Tandem mass spectrometry combined with the use of deuterated analogs demonstrates that the structures of the survivor pseudomolecular ions and of the CRF fragments are not rearranged.

Bile acids and conjugates identified in metabolic disorders by fast atom bombardment and tandem mass spectrometry.

From a study of the collision-activated fragmentation of bile acids, a qualitative analytical method based on negative ion fast atom bombardment tandem mass spectrometry has been developed. The times for sample preparation and analyses are short. Both free and conjugated bile acids are detected as they occur in biological fluids, without derivatization. For identifying bile acids and conjugates, the method offers better specificity and sensitivity than does the fast atom bombardment mass spectrometric technique alone. Specific scan modes have been developed for the selective detection of taurine conjugates, delta 4-unsaturated taurine conjugates, delta 4-3-keto free acids and their glycine conjugates, free acids and glycine conjugates bearing a hydroxyl group at the C-12 position, sulfates of glycine and taurine conjugates, and a C29 dicarboxylic bile acid, specific for generalized peroxisomal disorders. Applications of this technique demonstrate its potential usefulness, principally in the diagnosis of several peroxisomal disorders.

Study of reactions induced by hydroxylamine treatment of esters of organic acids and of 3-ketoacids: application to the study of urines from patients under valproate therapy.

Hydroxylamine used at alkaline pH as oximating agent in the search for organic aciduria by gas chromatography/mass spectrometry (GC/MS) induces other chemical reactions. Esters are partially transformed in their corresponding hydroxamic acids. GC/MS characteristics of the trimethylsilylated derivatives of the hydroxamic acids arising from alpha-unsaturated esters are here reported. Their mass spectral fragmentation helps in the recognition of peaks arising from the glucuronides of 2-ene- and probably 2,3'-diene-valproic acid. By heating in the injection port of the gas chromatograph, part of some trimethylsilylated hydroxamic acids are transformed to the corresponding isocyanates by a Lossen-like rearrangement. In addition to the corresponding hydroxamic acids, hydroxylamine treatment of alpha-unsaturated esters forms 2-isoxazolidin-3-ones by intramolecular Michael addition. GC/MS characteristics of the trimethylsilylated derivatives of these compounds are reported. Submitted to hydroxylamine, 3-ketoacids forms 2-isoxazolin-5-ones by cyclization of the oximes after acidification. This explains the existence of two GC peaks observed from urine extracts of patients under valproate therapy, which correspond to two tautomers of 2-isoxazolin-5-one originating from the oximes of the 3-keto-valproic acid.

The hydroxamate of valproic acid, a compound produced by oximation of urine from patients under valproic therapy.

A previously unreported substance, detected by gas chromatography after oximation of urine from patients receiving valproic acid, was isolated and analysed by mass spectrometry and nuclear magnetic resonance spectroscopy. It was identified as the hydroxamate of valproic acid.