Knowledge and Perception of Physicians regarding Telemedicine Technology in Trinidad and Tobago

Telemedicine is an unexplored practice that has received advocacy due to technological advancement and social distancing regulations imposed due to Covid-19. According to the W.H.O1 50% of its member states have implemented a national telemedicine policy, stimulating the question "Why hasn't Trinidad and Tobago introduced a structured and stable telemedical service?" To investigate this, we target experienced physicians to understand the benefits and limitations of adapting telemedical technology into the current medical model. Utilization of Telemedicine in developing countries, like Trinidad and Tobago, is very promising as it can improve healthcare accessibility and elevate the quality of care for potential patients in rural areas

Experience with a gonadotrophin-releasing hormone agonist prior to myomectomy--comparison of twice- vs thrice-monthly doses and a control group.

The aim of this randomised prospective study was to investigate the impact of preoperative gonadotrophin-releasing hormone agonist (GnRHa) compared with a control group with myomectomy. A total of 36 women (n = 36, group 1) with fibroids were randomised to receive either two monthly doses (n = 18/36, group 1a) or three monthly doses of goserelin (n = 18/36, group 1b) prior to myomectomy. The 32 women who received no treatment (group 2) comprised the controls. All patients had similar demographic features. There were no significant differences among the three groups with respect to: (1) mean intraoperative blood loss; (2) preoperative and postoperative blood transfusion or (3) length of hospital stay. The only advantage of administering GnRHa prior to myomectomy for symptomatic fibroids in our population was a higher haemoglobin level prior to surgery among the women who received three doses of the drug.

HIV-1 Antiretroviral Drug Resistance in Pregnant Women in Jamaica: A Preliminary Report.

This preliminary report sought to provide insight into the genetic diversity of human immunodeficiency virus drug resistance (HIVDR) in Jamaica. This was done by investigating the genetic diversity associated with drug resistance in pregnant women living with HIV attending antenatal clinics in Kingston, Jamaica. Blood samples were collected and viral RNA were extracted and analysed. The protease and reverse transcriptase (Pro-RT) genes were amplified using the nested polymerase chain reaction (PCR) method. Polymerase chain reaction amplicons were obtained for nine of 16 patients (56%), of which five (55%) were antiretroviral (ARV) drug naïve and four (45%) were treatment experienced. Three minor protease resistant-conferring mutations (A71AT, A71V, A71T) and five mutations conferring high to low-level resistance (K219EK, T69S, K103S, G190A and K103N) were detected in the RT region. More than 50% of the resistance mutations found were detected in ARV drug naïve individuals, implying that viruses are being transmitted with the ARV resistance. These preliminary results will inform the health practitioners of the level of drug resistance that is being transmitted as well as strengthen the need to initiate a national baseline survey on HIVDR in Jamaica.

A national survey of home-based care kits for palliative HIV/AIDS care in South Africa.

The objective of this study was to assess home-based care (HBC) kits and programs in South Africa to evaluate the feasibility of scaling up kit production and distribution. South African HBC organizations received structured questionnaires; key informant interviews and a literature review were completed to assess systems for production, distribution and supply of HBC kits. Meetings with stakeholders were held in two Provinces to share and analyze the study findings. The study team distributed questionnaires to 466 organizations and conducted interviews with representatives from 45 organizations, the Provincial Department of Health (DoH) and manufacturers of kits. All identifiable HBC organizations in South Africa were included in the survey. As a result 215 HBC organizations returned questionnaires; including non-governmental organizations (56%), community-based organizations (32%) and organizations affiliated with government health departments. Two types of kits were available: a home kit and a professional kit. The demand for HBC kits exceeded availability, kit contents and availability varied considerably and the supply chain was irregular. Kit production and distribution systems were fragmented. Replenishment of kit items was problematic. End-users are mostly caregivers who have not received adequate training on their use. The study shows that substantial work has been done by HBC organizations in South Africa to respond to the need for palliative care supplies within resource constraints. The growing demand for kits exceeds the supply. There is a need to improve the supply chain management of HBC kits, strengthen referral systems and links between community-based organizations and government departments, expand training opportunities for care givers, and develop monitoring and evaluation systems.

A new combined DTP-HBV-Hib vaccine--strategy for incorporation of Hib vaccination into childhood immunisation programmes.

OBJECTIVES: To evaluate the immunogenicity and reactogenicity of a pentavalent vaccine prepared by extemporaneously mixing diphtheria-tetanus pertussis-hepatitis B vaccine (DTP-HBV) and lyophilised Haemophilus influenzae type B (Hib)-tetanus conjugate vaccines in the same syringe, compared with the same vaccines given as separate, concomitant administrations. DESIGN: Open, randomised comparative study. SETTING: Durban, South Africa. SUBJECTS: A total of 120 healthy male and female infants were enrolled in the trial and randomised into two groups; group 1 received the combined administration (DTP-HBV-Hib), and group 2 received separate administrations of DTP-HBV and Hib vaccines. Vaccines were given as a three-dose primary vaccination course at 2, 4 and 6 months [corrected] of age. OUTCOME MEASURES: Antibody levels were measured using standard techniques and local and general solicited symptoms were recorded using diary cards. RESULTS: All subjects had seroprotective titres against diphtheria and tetanus; and antipolyribose-ribitol phosphate (PRP) titres > or = 0.15 microgram/ml 1 month after the final dose. A vaccine response (defined as post-vaccination titres > or = 15 ELISA (EL).U/ml in initially seronegative subjects; and as post-vaccination titres > or = pre-vaccination titres in initially seropositive subjects) against the pertussis component was seen in 83% and 85% of subjects in the groups receiving combined and separate administration. No differences were seen in any of the geometric mean titres (GMTs) between the two administrations either 2 months after the second dose or 1 month after the final dose. There was no observed increase in reactogenicity in the group receiving the mixed administration. CONCLUSIONS: The results demonstrate that combined DTP-HBV-Hib vaccine is well tolerated and immunogenic.

Reactogenicity and immunogenicity of a single dose of a typhoid Vi polysaccharide vaccine in adolescents.

BACKGROUND: The current study evaluated the reactogenicity and immunogenicity of Typherix, a recently developed Vi polysaccharide typhoid vaccine, in adolescents. METHODS: This phase II, open, single-group study was conducted at a single centre in South Africa. Healthy adolescents, aged between 11 and 18 years received a single 0.5ml dose of typhoid Vi polysaccharide vaccine 25 microg via intramuscular injection in the left deltoid. Safety and reactogenicity were assessed from solicited and unsolicited symptoms and signs reported during the 5-day and 28-day postvaccination follow-up periods. Seroconversion rates were calculated at 28 days after vaccination. RESULTS: A total of 100 adolescents received the vaccine. Seropositivity to Vi antigen was measured in 95 subjects and showed a rate of 98.9% [geometric mean titre (GMT) of 1966 enzyme-linked immunosorbent assay (ELISA) units/ml] at day 28. Of 99 subjects included in the reactogenicity analysis, 46.5% reported clinical symptoms, 40.4% general symptoms, and 18.2% local symptoms or signs. Solicited symptoms were reported in 46.5% of subjects. Local solicited symptoms involved mainly soreness. General solicited symptoms were most frequently headache (19% of subjects) and general aches (13%). All solicited symptoms were mild or moderate except for two reports of fever >39 degrees C. Unsolicited symptoms (all moderate) were recorded in 8.1% of subjects, and were most frequently of an upper respiratory tract nature and viral-like syndrome. No serious adverse events were reported. CONCLUSIONS: The typhoid Vi polysaccharide vaccine Typherix proved to be well tolerated and immunogenic when administered to adolescents.

Immunogenicity and safety of a live attenuated varicella vaccine in healthy Indian children aged 9-24 months.

OBJECTIVES: To investigate the safety of live attenuated varicella vaccine (Oka strain) and the optimal virus titre/dose required for immunogenicity in healthy South African children. DESIGN: Double-blind randomised clinical study using two different lots of varicella vaccine, each at two different titres. Subjects were randomly allocated to groups 1, 2, 3 and 4 to receive vaccine containing a mean virus titre of 10(4,5), 10(3,1), 10(3,9) and 10(2,7) PFUs per dose respectively. Clinical signs and symptoms were followed up for 42 days post-vaccination. Specific varicella antibodies were measured by an indirect immunofluorescence method in sera obtained on day 0 and day 42. SETTING: City Health Clinic, Chatsworth, Durban. PARTICIPANTS: A total of 200 healthy 9-24-month-old children were vaccinated, of whom 189 (44,5%) completed the study. MAIN OUTCOME MEASURES: Pre- and post-vaccination varicella antibody levels. Adverse events following varicella vaccination. RESULTS: The vaccine was safe and well tolerated. No local symptoms were reported. Skin reactions were specifically solicited in this study: 21 reactions were reported in 8.5% (17/200) of children. Vesicles were reported in 2 vaccines (< or = 10 vesicles in both cases). One serious adverse event was reported: hospitalisation for bronchopneumonia on day 16 post-vaccination which resolved without sequelae. Around day 42 post-vaccination (range 35-63 days) all the 176 initially seronegative subjects had seroconverted for varicella antibodies. Post-vaccination geometric mean titres (GMTs) were 104.1, 66.2, 69.5 and 77.0 for groups 1-4 respectively. Six subjects who were initially seropositive maintained or increased their titres post-vaccination; 3 of the 6 showed a booster response (a > or = 4-fold increase from the pre-vaccination titre). CONCLUSIONS: Varicella vaccine was found to be safe, immunogenic and well tolerated. No difference in seroconversion rates or GMTs, either between groups receiving the two vaccine lots or between groups receiving the different titres of each lot, was shown.

Subclinical pertussis in incompletely vaccinated and unvaccinated infants.

Incidental to a phase II study of acellular and whole-cell pertussis vaccines involving 342 infants who were clinically observed from birth until the age of 9 months, subclinical pertussis was retrospectively diagnosed in 10 infants on the basis of serological evidence. IgG and IgA to filamentous haemagglutinin (FHA), pertussis toxin (PT) and agglutinogens 2 and 3 (AGG2, 3) were assayed by enzyme-linked immunosorbent assay (ELISA) in serum obtained at birth and at 2, 4, 6 and 9 months of age. All 10 infants had > or = 4-fold rises in at least two different pertussis IgG antibodies. Nine of the 10 infants had > or = 4-fold increases in all three IgG antibodies measured. One infant had > or = 4-fold increases in IgG-FHA and IgG-AGG2,3 but not IgG-PT. Seven infants had raised IgA antibodies to PT and FHA and 4 infants had raised IgA antibodies to AGG2,3. Subclinical infection provoked differing degrees of antibody production in response to multiple antigens. Subclinical infection was detected in both unvaccinated infants (4) and in infants who had been vaccinated from 2 months of age with either acellular (4) or whole-cell vaccines (2). Subjects were 8 months of age or younger and only 1 had completed primary vaccination. Other infections of infancy were commonly detected; 4 infants had upper respiratory disease about the time of subclinical pertussis. None had a household member with symptomatic pertussis. Likelihood of subclinical infection was related to significantly lower levels of maternally acquired pertussis IgG-AGG2,3 antibodies but not associated with infants' nutritional status.

Does whole-cell pertussis vaccine protect black South African infants? Assessment of post-vaccination events and antibody responses to pertussis toxin, filamentous haemagglutinin and agglutinogens 2 and 3.

The whole-cell pertussis vaccine currently used in South Africa has not been adequately evaluated for post-vaccination events and immunogenicity. A trial of this vaccine combined with diphtheria and tetanus toxoids (DTP) was undertaken in 115 black babies who received primary vaccination at 2, 4 and 6 months of age. Serological IgG responses to the major antigens of Bordetella pertussis, filamentous haemagglutinin (FHA), pertussis toxin (PT) and fimbriae (agglutinogens 2 and 3 (AGG 2 + 3), were evaluated by enzyme-linked immunosorbent assay in sera obtained at birth, and before vaccination at 2, 4 and 6 months and at 9 months. Surprisingly, after 3 doses of DTP, responses to PT and FHA were found merely to restore levels of IgG to PT and FHA to those found in cord blood. In contrast with the positive increases in these antibodies found in other series of whole-cell vaccination, the anti-PT seroconversion rate was only 19% and the anti-FHA rate only 24%. High levels of anti-AGG 2 + 3 were produced with 67.2% seroconversion. The frequency and nature of post-vaccination events were recorded. Incidences of all reactions to the vaccine were low (7.6%). Fever (3.2%) and excessive crying (2.4%) were the most frequently occurring minor events. The rate of neurological post-vaccination events (without sequelae) during the brief follow-up period was 2 hypotonic-hyporesponsive episodes (8.03/1,000 doses) and 1 convulsion (4.02/1,000 doses). Significant pertussis antibody levels were found in maternal and cord sera with levels in the latter frequently being higher.(ABSTRACT TRUNCATED AT 250 WORDS)

Chloride levels in meningitis.

The blood/cerebrospinal fluid bromide ratio is sensitive and specific in the diagnosis of tuberculous meningitis (TBM). Blood/CSF chloride (Cl-) ratios were not found to be useful in differentiating between TBM and viral and acute bacterial meningitis in 59 black children. In a study of 148 children with bacterial or viral meningitis or TBM, the majority (112) had CSF Cl- levels below the lower limit of normal. Accordingly, CSF and blood Cl- levels and the blood/CSF Cl- ratio were not found to be useful in differentiating between TBM, acute bacterial meningitis and viral meningitis.