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2.
Med Hypotheses ; 144: 110220, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33254527

RESUMEN

Marked ethnic variations in complications and mortality have been noted following infection with COVID-19, with Black, Asian, and minority ethnic groups (BAME) being particularly hard hit. We hypothesise that glucocorticoid resistance stemming from several intrinsic reasons such as chronic social stress and lower circulating levels of Vitamin D may contribute to the exaggerated inflammatory response, more severe disease and poorer outcomes observed in BAME.


Asunto(s)
COVID-19/tratamiento farmacológico , Glucocorticoides/uso terapéutico , Grupos Minoritarios , Grupo de Ascendencia Continental Africana , Antiinflamatorios/uso terapéutico , Grupo de Ascendencia Continental Asiática , COVID-19/complicaciones , COVID-19/epidemiología , Resistencia a Medicamentos , Grupos Étnicos , Humanos , Modelos Biológicos , Pandemias , SARS-CoV-2 , Índice de Severidad de la Enfermedad , Estrés Psicológico/complicaciones
3.
Front Public Health ; 8: 556720, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33178656

RESUMEN

Coronavirus disease 2019 (COVID-19) has accelerated the adoption of telemedicine globally. The current consortium critically examines the telemedicine frameworks, identifies gaps in its implementation and investigates the changes in telemedicine framework/s during COVID-19 across the globe. Streamlining of global public health preparedness framework that is interoperable and allow for collaboration and sharing of resources, in which telemedicine is an integral part of the public health response during outbreaks such as COVID-19, should be pursued. With adequate reinforcement, telemedicine has the potential to act as the "safety-net" of our public health response to an outbreak. Our focus on telemedicine must shift to the developing and under-developing nations, which carry a disproportionate burden of vulnerable communities who are at risk due to COVID-19.


Asunto(s)
COVID-19 , Telemedicina , Humanos , Pandemias/prevención & control , Salud Pública , SARS-CoV-2
4.
Front Public Health ; 8: 556789, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33224912

RESUMEN

Technological innovations such as artificial intelligence and robotics may be of potential use in telemedicine and in building capacity to respond to future pandemics beyond the current COVID-19 era. Our international consortium of interdisciplinary experts in clinical medicine, health policy, and telemedicine have identified gaps in uptake and implementation of telemedicine or telehealth across geographics and medical specialties. This paper discusses various artificial intelligence and robotics-assisted telemedicine or telehealth applications during COVID-19 and presents an alternative artificial intelligence assisted telemedicine framework to accelerate the rapid deployment of telemedicine and improve access to quality and cost-effective healthcare. We postulate that the artificial intelligence assisted telemedicine framework would be indispensable in creating futuristic and resilient health systems that can support communities amidst pandemics.


Asunto(s)
COVID-19 , Telemedicina , Inteligencia Artificial , Humanos , Pandemias , SARS-CoV-2
5.
Front Public Health ; 8: 410, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33014958

RESUMEN

Technology has acted as a great enabler of patient continuity through remote consultation, ongoing monitoring, and patient education using telephone and videoconferencing in the coronavirus disease 2019 (COVID-19) era. The devastating impact of COVID-19 is bound to prevail beyond its current reign. The vulnerable sections of our community, including the elderly, those from lower socioeconomic backgrounds, those with multiple comorbidities, and immunocompromised patients, endure a relatively higher burden of a pandemic such as COVID-19. The rapid adoption of different technologies across countries, driven by the need to provide continued medical care in the era of social distancing, has catalyzed the penetration of telemedicine. Limiting the exposure of patients, healthcare workers, and systems is critical in controlling the viral spread. Telemedicine offers an opportunity to improve health systems delivery, access, and efficiency. This article critically examines the current telemedicine landscape and challenges in its adoption, toward remote/tele-delivery of care, across various medical specialties. The current consortium provides a roadmap and/or framework, along with recommendations, for telemedicine uptake and implementation in clinical practice during and beyond COVID-19.


Asunto(s)
Instituciones de Atención Ambulatoria , COVID-19/prevención & control , Telemedicina/tendencias , Personal de Salud , Humanos , Pandemias , Distanciamiento Físico , Comunicación por Videocoferencia
6.
Artículo en Inglés | MEDLINE | ID: mdl-32879902

RESUMEN

Air pollution is the most significant environmental risk factor for all-cause mortality, and it has caused substantial disability-adjusted life-years and economic loss. Air pollution intensified the mortality during past pandemics, Spanish flu in 1918 and SARS-CoV-1 in 2003. It increases host susceptibility and virulence of respiratory infections and reduces viral clearance. Thus, a question arises whether there will be any impact of air pollution on the current pandemic coronavirus disease 2019 (COVID-19)? Thus far, history and science are directing towards an immense potential impact of air pollution on the COVID-19 pandemic. Some of the devastated countries with the current pandemic are those with a poor air quality index. Further epidemiological and ecological studies are necessary to confirm this association. Also, countries must mobilize funding for mitigation of air pollution to benefit environmental health and ameliorate its potential effects on pandemics of the future.


Asunto(s)
Contaminación del Aire/efectos adversos , COVID-19/epidemiología , Pandemias/estadística & datos numéricos , COVID-19/mortalidad , Humanos , Incidencia
8.
Healthcare (Basel) ; 8(3)2020 Jul 27.
Artículo en Inglés | MEDLINE | ID: mdl-32727008

RESUMEN

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.

9.
J Asthma ; : 1-9, 2020 Jun 16.
Artículo en Inglés | MEDLINE | ID: mdl-32493146

RESUMEN

OBJECTIVE: Asthma, a major cause of disability and reduced quality of life, has a high global prevalence and burden of death. Despite the propitious guidelines, a substantial portion of asthmatics reportedly have poorly controlled disease. In the current study, we have examined risk factors for uncontrolled asthma in specialty clinics and its association with impaired quality of life. METHODS: A multicentre cross-sectional survey of asthma patients, 18 years and older, was conducted in Trinidad. Asthma Control Test (ACT) and the Juniper Mini Asthma Quality of Life Questionnaire (Mini AQLQ-J) were used to assess the disease control and quality of life, respectively. Data were analyzed using the Chi-square test and multivariable logistic regression controlling for gender. RESULTS: Of a total of 428 patients included, asthma was uncontrolled in 72.4% and asthma related quality of life was moderate to severely impaired in 86% of the studied population. In the multivariate regression models, poorly controlled asthma was associated with obesity (OR 2.25; 95% CI 1.30-3.39), late-onset asthma (OR 1.72; 95% CI 1.04-2.84), features of sleep apnea (OR 1.77; 95% CI 1.01-3.07) and depression (OR 2.01; 95% CI 1.04-3.86). Impaired quality of life was associated with Indo-Caribbean ethnicity (OR 3.19; 95% CI = 1.68-6.06). CONCLUSIONS: In this Caribbean population, uncontrolled asthma was independently associated with obesity, late-onset disease, and comorbidities of sleep apnea and depression. Poor asthma-related quality of life was independently associated with Indo-Caribbean ethnicity.

10.
Respirology ; 25(8): 802-803, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32533588
11.
Emerg Infect Dis ; 26(3): 624-625, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31922950

RESUMEN

An estimated one quarter of persons worldwide are infected with Mycobacterium tuberculosis. In 2018, the World Health Organization issued revised guidance on BCG vaccine for high-risk groups. The World Health Organization should consider guiding countries on a case-by-case basis in developing appropriate BCG policies to deliver equitable healthcare and protect public health.


Asunto(s)
Vacuna BCG/inmunología , Mycobacterium tuberculosis/inmunología , Tuberculosis Pulmonar/epidemiología , Vacunación , Países en Desarrollo , Humanos , Incidencia , Tuberculosis Pulmonar/etiología , Tuberculosis Pulmonar/prevención & control , Organización Mundial de la Salud
12.
COPD ; 17(1): 1-3, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31902259

RESUMEN

The GOLD 2020 updates added more lucidity on the treatment of COPD. However, few diagnostic dilemmas still exist. Research is needed on the use of the CAT score in assessing symptoms for the diagnosis of COPD. Further work-up is needed on diagnostic instability of spirometry, and diagnostic role of the lower limit of normal (LLN) criteria, slow vital capacity (FEV1/VC), forced inspiratory vital capacity (FEV1/FIVC), and rapid FEV1 decline. Incorporating parameters of lung hyperinflation and exercise capacity in the COPD diagnostic criteria might add value in its diagnosis and management. GOLD's approach towards routine CT imaging needs to be reviewed. Establishing a "pre-COPD" stage can be helpful in the early diagnosis and intervention to reduce the rapid lung function decline among at-risk individuals. The use of mMRC score as a surrogate to assess the overall severity of COPD related symptoms should be reviewed. The therapeutic guidance role of sputum eosinophils should be studied in patients with intermediate and low blood eosinophil counts.

13.
Artículo en Inglés | MedCarib | ID: biblio-1284261

RESUMEN

This study aims to evaluate the effect or lack thereof, of glucocorticoids on Black, Asian, and Minority ethnic groups (BAME) when compared to white populations in the setting of COVID-19 treatment


Asunto(s)
Humanos , Masculino , Femenino , Grupos Étnicos , COVID-19
15.
Cureus ; 11(6): e4917, 2019 Jun 17.
Artículo en Inglés | MEDLINE | ID: mdl-31423393

RESUMEN

Prostate brachytherapy (BT) seed embolization to the lung is a rare complication, with <1% of all seeds migrating post-implantation. Here, we present the case of a 63-year-old male who presented with a history of chest pain and intermittent dyspnea at rest for the last four months.

17.
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.).

18.
J Educ Health Promot ; 8: 57, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31008124

RESUMEN

Globally, health is regarded as a booming industry with greater stress being laid on high quality, accountability, and transparency. Traditional medical curricula rely primarily on clerkships during the clinical period of study to train clinical skills, while the preclinical period is mainly used to teach the basic sciences. In recent years, the early introduction of clinical skills training has received increased attention. This review aims to identify and summarize teaching approaches of clinical skills for medical students during preclinical years, namely, (1) framing objectives (2) learning activities, and (3) evaluation strategies. Although the clinical tutor's role is to ensure that students receive effective preclinical skills through different modes of learning (lectures, presentations, and problem-based learning), the role of advanced technologies, namely, simulation-based learning platforms and gamification are found to be very successful. To improve the communication skills, there is strong evidence in support of role plays, and similarly, for enhancing observation skills, an introduction of fine arts in clinical skills training was found to be very useful. Medical schools worldwide should give high priority to conduct faculty development programs on various aspects of training and teaching modalities, evaluation strategies, and improving the evaluation of various clinical skills. Students should be provided with sufficient learning opportunities including a well-equipped clinical skills laboratory and individual attention, and constructive feedback should be given to students for building their confidence level during their learning process.

19.
BMC Pulm Med ; 19(1): 62, 2019 Mar 14.
Artículo en Inglés | MEDLINE | ID: mdl-30866890

RESUMEN

BACKGROUND: Relationships between low forced vital capacity (FVC), and morbidity have previously been studied but there are no data available for the Caribbean population. This study assessed the association of low FVC with risk factors, health variables and socioeconomic status in a community-based study of the Trinidad and Tobago population. METHODS: A cross-sectional survey was conducted using the Burden of Obstructive Lung Disease (BOLD) study protocol. Participants aged 40 years and above were selected using a two-stage stratified cluster sampling. Generalized linear models were used to examine associations between FVC and risk factors. RESULTS: Among the 1104 participants studied a lower post-bronchodilator FVC was independently associated with a large waist circumference (- 172 ml; 95% CI, - 66 to - 278), Indo-Caribbean ethnicity (- 180 ml; 95% CI, - 90 to - 269) and being underweight (- 185 ml; 95% CI, - 40 to - 330). A higher FVC was associated with smoking cannabis (+ 155 ml; 95% CI, + 27 to + 282). Separate analyses to examine associations with health variables indicated that participants with diabetes (p = 0∙041), history of breathlessness (p = 0∙007), and wheeze in the past 12 months (p = 0∙040) also exhibited lower post-bronchodilator FVC. CONCLUSION: These findings suggest that low FVC in this Caribbean population is associated with ethnicity, low body mass index (BMI), large waist circumference, chronic respiratory symptoms, and diabetes.


Asunto(s)
Grupos Étnicos/estadística & datos numéricos , Enfermedades Pulmonares/fisiopatología , Delgadez/fisiopatología , Capacidad Vital , Circunferencia de la Cintura , Adulto , Anciano , Anciano de 80 o más Años , Índice de Masa Corporal , Región del Caribe/epidemiología , Estudios Transversales , Diabetes Mellitus/epidemiología , Diabetes Mellitus/fisiopatología , Femenino , Humanos , Modelos Lineales , Enfermedades Pulmonares/epidemiología , Masculino , Persona de Mediana Edad , Factores de Riesgo , Espirometría , Encuestas y Cuestionarios , Delgadez/epidemiología
20.
Turk Thorac J ; 20(1): 12-17, 2019 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-30664421

RESUMEN

OBJECTIVES: Both chronic obstructive pulmonary disease (COPD) and diabetes mellitus (DM) are highly prevalent in Trinidad, West Indies. Our objective was to evaluate the prevalence of DM in a cohort of Trinidadian patients with COPD and investigate the possible impact of diabetes on COPD using standard outcome measures, that is, lung function, exacerbations, quality of life and depression questionnaires, as well as mortality. MATERIALS AND METHODS: This was a cross-sectional follow-up study utilizing a cohort of 105 patients from chest clinics in the three major general hospitals in Trinidad. RESULTS: Diabetes was diagnosed based on a glycated hemoglobin (HbA1c) level of ≥6.5% (or a prior self-reported history), and for pre-diabetes, of 5.7%-6.4%. Of 105 patients, 40% fulfilled the criteria for diabetes and 40% for pre-diabetes. Of those diagnosed with diabetes, 38% obtained this diagnosis de novo. A history of intravenous corticosteroid use was associated with higher HbA1c levels (p=0.043) upon diagnosis. The percentage of predicted forced vital capacity was negatively related to HbA1c (p=0.033), but those with diabetes also had a greater body mass index (p=0.001). After a 1-year follow-up, mortality was significantly greater among patients with diabetes (p=0.026). Patients with at least one exacerbation in the past year or poorer lung function parameters had worse quality of life (p≤0.040) and depression (p≤0.018) scores. Notably, 31.4% of the total cohort exhibited clinically significant depression scores. CONCLUSION: This study revealed that a high proportion of COPD patients in tertiary care had diabetes or pre-diabetes.

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