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1.
Int J Nephrol Renovasc Dis ; 14: 173-192, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34135618

RESUMEN

Purpose: The determinants of quality of life for patients on renal replacement therapy vary across the world. The aim of this study is to determine the quality of life of patients on renal replacement therapy in Trinidad and Tobago and predictors thereof. Patients and Methods: This cross-sectional study took place over a 1-year period. Data were obtained from 530 out of 1383 patients meeting inclusion criteria (100 transplants, 80 peritoneal dialyses, 350 hemodialyses) using the survey instruments. Stratified random sampling with proportional allocation was used to select patients at hemodialysis centres. The Kidney Disease Quality of Life questionnaire (KDQOL-36), EuroQol and demographic questionnaires were administered via face-to-face interviews. SPSS24, STATA14 and MINITAB18 were used for descriptive and inferential data analysis. Results: Of the 530 patients, 52.5% were male, 37.5% were in the 56-65 years age group and 51.3% were of Indo-Trinbagonian descent. Hypertension (25.5%) and type 2 diabetes mellitus (62.0%) were reported as the main causes of kidney disease in the dialysis group. In the transplant category, chronic glomerulonephritis (45%) was the main aetiology of kidney disease. The KDQOL-36 domain scores and significantly associated variables included modality of renal replacement, Charlson's Comorbidity Index, ethnicity, income and employment status. Transplant patients had higher mean subcomponent Kidney Disease Quality of Life scores and performed better in the EuroQol than patients on dialysis. Patients on peritoneal dialysis had a better quality of life than hemodialysis patients. Among patients on hemodialysis, an arteriovenous fistula significantly impacted their quality of life. Conclusion: Renal transplant recipients enjoy the best quality of life and health state among patients on renal replacement therapy in Trinidad and Tobago. Increasing patients' access to renal transplantation or peritoneal dialysis will markedly improve health status for the number of years of renal replacement therapy.

2.
J Med Case Rep ; 15(1): 166, 2021 Mar 27.
Artículo en Inglés | MEDLINE | ID: mdl-33771229

RESUMEN

BACKGROUND: Traditional coronary artery disease risk factors are well established and help risk stratify most patients presenting with chest pain syndromes. Young patients (under age 30 years) without other risk factors are thought to be at very low risk of coronary artery disease and acute coronary syndromes. CASE PRESENTATION: We highlight the case of a 27-year-old Afro-Caribbean male who presented to hospital with chest pain and was discharged from the emergency room because he was thought to be low risk for ischemic heart disease. Laboratory investigations subsequently confirmed acute coronary syndrome. He was found to have an anomalous right coronary artery with a malignant origin running between the aorta and pulmonary artery eventually requiring surgical correction. Anomalous origins of the coronary arteries are rare causes of acute coronary syndromes, chest pain, and sudden cardiac death. CONCLUSION: Our patient could have easily had an adverse outcome as his diagnosis was missed by the initial treating physician. It is important to consider anomalous coronary artery origin in the evaluation of young symptomatic patients who may be otherwise low risk and not have traditional risk factors for ischemic heart disease.


Asunto(s)
Síndrome Coronario Agudo , Anomalías de los Vasos Coronarios , Infarto del Miocardio , Síndrome Coronario Agudo/etiología , Adulto , Dolor en el Pecho/etiología , Anomalías de los Vasos Coronarios/complicaciones , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Anomalías de los Vasos Coronarios/cirugía , Humanos , Masculino
3.
Radiol Case Rep ; 15(11): 2076-2079, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-32944104

RESUMEN

Uterine arteriovenous malformations are uncommon but pose the risk of potentially life-threatening hemorrhage. A 29-year-old pregnant female presented with vaginal spotting, after which ultrasound diagnosis of missed miscarriage was made and medical management undertaken. Vaginal spotting continued post-treatment which led to repeat pelvic ultrasound and subsequent magnetic resonance imaging which confirmed a uterine arteriovenous malformation masquerading as retained products of conception. Uterine instrumentation with dilatation and curettage could have been potentially devastating. The patient was successfully treated with uterine artery embolization.

4.
Open Heart ; 6(1): e000841, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30997117

RESUMEN

Objectives: This novel, pilot study aimed to assess the estimated prevalence of high on-treatment platelet reactivity (HPR) in Trinidad and Tobago. Methods: Patients (n=40) who were awaiting elective percutaneous coronary intervention on maintenance dual antiplatelet therapy (DAPT) with aspirin 81 mg daily and clopidogrel 75 mg or loaded at least 48 hours prior were recruited. Platelet reactivity with the VerifyNow P2Y12 assay (Accriva Diagnostics, San Diego, California, USA) was assessed prior to cardiac catheterisation. Results: 60.7% (17/28) of the South Asian (Indo-Trinidadians) patients had HPR, whereas 14.3% (1/7) of Africans and 40% (2/5) of mixed ethnicity had HPR. There was a significant association between HPR (P2Y12 reaction units >208) and ethnicity with South Asians (Indo-Trinidadians) (OR 5.4; 95% CI 1.18 to 24.66, p=0.029). Conclusions: This pilot study serves to introduce the preliminary observation that the estimated prevalence of HPR is considerably higher within the heterogeneous population in Trinidad at 50% as compared with predominantly Caucasian studies. Furthermore, the HPR is significantly higher in South Asians (Indo-Trinidadians) (>60% of patients) which has severe clinical repercussions considering the cardiovascular disease pandemic. Clopidogrel may not be a satisfactory or optimal antiplatelet agent in this subgroup, and therefore, another more potent antiplatelet such as ticagrelor should be used instead. Further large-scale studies are imperative to confirm these findings. (Funded by the University of the West Indies, St. Augustine; POINT ClinicalTrials.gov number, NCT03667066.).

6.
Conn Med ; 76(2): 81-3, 2012 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-22670357

RESUMEN

Twiddler's syndrome is a rare cause of pacemaker dysfunction characterized by coiling of the lead around the rotated generator. It is even less common for implantable cardioverter-defibrillator (ICD) devices. We describe a 44-year-old woman who underwent successful implantation of an ICD and three months later presented with left arm twitching. Chest radiograph demonstrated the unusual dislodgement of the atrial lead only and rotation of the ICD generator. The diagnosis of Twiddler's syndrome with solitary atrial lead rotation was thus established. The ICD pacing mode was switched to VVI, which resulted in cessation of muscle contractions. She later underwent atrial lead revision, untwisting and reanchoring of the ICD generator without any complications.


Asunto(s)
Desfibriladores Implantables , Cuerpos Extraños/diagnóstico por imagen , Migración de Cuerpo Extraño/diagnóstico por imagen , Adulto , Falla de Equipo , Femenino , Humanos , Radiografía Torácica , Reoperación , Resultado del Tratamiento
7.
Cardiovasc Revasc Med ; 12(6): 399-402, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-21855421

RESUMEN

Atherosclerotic renal artery disease is a common disease entity that may be identified in patients with difficult-to-control hypertension and/or chronic kidney disease but is probably underdiagnosed. Current evidence from both observational and randomized studies offers mixed results regarding the support for renal artery revascularization. There is lack of equipoise with regard to the efficacy of renal artery revascularization among the interventional and renal communities, as well as disagreements on the appropriate endpoints to measure in clinical trials, which have led to selection bias confounding the scant available data. We report a patient who does not fit any clinical trial inclusion criteria with acute on chronic kidney injury and new-onset heart failure whose symptoms and renal function improved significantly after renal artery intervention.


Asunto(s)
Angioplastia , Obstrucción de la Arteria Renal/terapia , Enfermedad Aguda , Lesión Renal Aguda/etiología , Lesión Renal Aguda/terapia , Anciano , Angioplastia/instrumentación , Presión Sanguínea , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/terapia , Humanos , Hipertensión Renovascular/etiología , Hipertensión Renovascular/terapia , Masculino , Selección de Paciente , Radiografía , Obstrucción de la Arteria Renal/complicaciones , Obstrucción de la Arteria Renal/diagnóstico por imagen , Obstrucción de la Arteria Renal/fisiopatología , Stents , Resultado del Tratamiento
8.
Clin Cardiol ; 32(12): E48-54, 2009 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-20014189

RESUMEN

BACKGROUND: Endocarditis complicating central venous catheter blood stream infection (CVC-BSI) is a serious complication and is being seen with increasing frequency. METHODS: All patients discharged from our institution with International Classification of Disease (ICD-9) codes of endocarditis and CVC-BSI were identified. The medical records of those meeting our inclusion criteria were reviewed. RESULTS: From October 1, 1998 until December 31, 2006, 24 patients were identified with inpatient mortality of 20.8%. Nine cases were nosocomial and 15 were non-nosocomial. The most common comorbidities were diabetes mellitus (45.8%), chronic kidney disease (58.4%), prior valvular abnormalities (37.5%), and multiple prior hospitalizations (65.2%). There were 13 external lines, 9 tunneled lines, and 2 implantable ports. Responsible microorganisms included Staphylococcus aureus in 54.6%, coagulase-negative staphylococci in 37.5%, Candida species (spp.) in 16.6%, and enterococci in 12.5%. Five cases were polymicrobial. The line tip was within the right atrium (RA) in 37.5%, the superior vena cava (SVC)-RA junction in 20.8%, the SVC in 33.3%, and the pulmonary artery in 4.2% of patients. Sites of endocardial involvement were the aortic valve in 6 patients, mitral valve in 7 patients, tricuspid valve in 6 patients, right atrial wall in 11 patients, and pacemaker wire in 2 patients. Isolated right-sided involvement occurred in 50% of cases, isolated left-sided in 33.4%, and bilateral involvement in 16.6%. Transesophageal echocardiography (TEE) was necessary for diagnosis in 10 cases (41.6%). CONCLUSIONS: Endocarditis complicating CVC-BSI more often involves right-sided structures, with catheter tips in or near the right atrium, frequently requires TEE for diagnosis, and has significant inpatient mortality.


Asunto(s)
Bacteriemia/etiología , Infecciones Relacionadas con Catéteres/complicaciones , Cateterismo Venoso Central/efectos adversos , Endocarditis Bacteriana/complicaciones , Antibacterianos/uso terapéutico , Infecciones Relacionadas con Catéteres/terapia , Comorbilidad , Infección Hospitalaria/complicaciones , Ecocardiografía Transesofágica , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/terapia , Femenino , Atrios Cardíacos/diagnóstico por imagen , Atrios Cardíacos/microbiología , Válvulas Cardíacas/diagnóstico por imagen , Válvulas Cardíacas/microbiología , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
10.
Clin Cardiol ; 30(4): 156-60, 2007 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-17443648

RESUMEN

Noncompaction of the ventricular myocardium is a rare form of cardiomyopathy that has been described since the early 1990s. However, noncompaction remains frequently overlooked, in part due to the limited awareness of its unique clinical and imaging characteristics. Contemporary diagnosis has been facilitated by the introduction of specific morphologic criteria by echocardiography and cardiac magnetic resonance. Management issues revolve around the management of heart failure, arrhythmias, and thromboembolic events in order to prevent the significant morbidity and even mortality that has been associated with this entity. Finally, the genetics of noncompaction have been diverse and an issue of clinical importance as it relates to screening of first-degree relatives of affected patients. Two recent cases are presented and many of the contemporary issues in diagnosis and management, based on an extensive review of the literature, are addressed.


Asunto(s)
Cardiomiopatías/diagnóstico , Cardiomiopatías/terapia , Taquicardia Ventricular/terapia , Antagonistas Adrenérgicos beta/uso terapéutico , Adulto , Cardiomiopatías/complicaciones , Desfibriladores Implantables , Ecocardiografía , Femenino , Humanos , Imagen por Resonancia Cinemagnética , Masculino , Persona de Mediana Edad , Taquicardia Ventricular/etiología , Disfunción Ventricular Izquierda/terapia
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