Significance of Serum Protein Electrophoresis in the Detection of Multiple Myeloma: A Diagnostic Interpretation of Patients with Varied Immunoglobulins.

BACKGROUND: To determine the relationship between serum protein electrophoresis (SPE) and serum immunoglobulin profiles of patients with multiple myeloma (MM). METHODS: This is a retrospective study conducted at the Eric Williams Medical Sciences Complex, focusing on patients over 18 years who received diagnostic blood tests for MM. Results for SPE and serum immunoglobulin profiles were obtained using lab logbooks. Descriptive and inferential statistics techniques were used to analyze the data. RESULTS: The median age of MM patients in Trinidad and Tobago is of 69 years. The ratio of male and female patients with the MM is 50:50. Out of 131 patients, 24 (18.32%) had M bands present, 60 (45.80%) had an increase in gamma globulin, and 16 (12.21%) had a decrease in albumin. In cases of M band presence and raised gamma, there was noticeable increase in IgG concentration and a slight increase in IgM concentration. There was also an increase in IgA concentration in patients with the M-band but a decrease in concentration in those with raised gamma. Patients with an elevated gamma had a significant increase in IgG diameter and IgG concentration. CONCLUSIONS: This study showed a relationship between the presence of M bands and serum immunoglobulins. It has proven the significance of SPE and immunoglobulins, like IgG and IGM, in the detection of MM in the early and advanced stages. Therefore, it is recommended that SPE be used, along with other laboratory tests, in the diagnosis of MM.

Demographic and Lifestyle Factors that affect HbA1c awareness amongst type II diabetic patients in Trinidad

• Trinidad and Tobago is amongst the countries with the greatest burden of type II diabetes in the western hemisphere • Educating type II diabetic patients in controlling their glycosylated hemoglobin (HbA1c) are recommended as measures to reduce morbidity and mortality associated with type II diabetic complications • Measurement of HbA1c in type II diabetic patients represents their glycemic history for the former 8 ­ 12 weeks and should be tested every 3 months to monitor patients' metabolic control • This study is aimed at measuring HbA1c awareness amongst T2D population in Trinidad and making recommendations based on results

Promoting developmental supportive care in preterm infants and families in a level III neonatal intensive care unit (NICU) setting in India.

Despite evidence of short- and long-term benefits of developmental care, several studies have documented nurses' lack of knowledge and skills related to developmental care concepts. This study aims to enhance neonatal nurses' abilities to acquire care practices (knowledge and skills) regarding Developmental Supportive Care (DSC). A nonrandomized before and after intervention design was adopted to improve the knowledge and skills of staff nurses in DSC practices for preterm infants in Level III B NICU. The study included 50 level III B NICU nurses (25 in interventional group, 25 in control group) located within a tertiary care hospital in India. A significant increase in the mean knowledge score was seen among participants in the intervention group (pre-test: 16.6 ±â€¯3.1, post-test: 29.9 ±â€¯4.1, p = 0.01) but not in the control group (pre: 16.4 ±â€¯2.2, post: 18.6 ±â€¯3.6, p = 0.98). The improvement in the skills of providing DSC among neonatal nurses was also higher in the intervention group (106.4 ±â€¯7.4) relative to the control group (65.8 ±â€¯3.6), p < 0.01, at 0.05 level of significance. The Developmental Supportive Care Program (DSCP) had a significant impact in improving the knowledge and skills of nurses in providing care and preventing complications in preterm infants.

Oblique Retro-Aortic Left Renal Vein and its Clinical Importance.

Kidneys are the organs that remove the waste products of the metabolic activities. A smooth blood flow to the kidneys is essential to maintain their function. Abnormalities of the renal vasculature may result not only in impairing the renal function but can lead to conditions like varicocele. During an autopsy of an adult male, we observed renal vascular variations. The left renal vein had a retro-aortic course before its termination into the inferior vena cava. It was joined with the inferior vena cava at the level of inferior mesenteric artery with an acute angle. The left testicular vein joined the left renal vein with an acute angle. The right kidney was supplied by two renal arteries. The knowledge about retro-aortic course of the left renal vein may be important during renal transplantation. The oblique course of left renal vein and the termination of left testicular vein into it with an acute angle may increase the chances of left sided varicocele.

Terminal bifurcation of the right testicular vein and left testicular arterio-venous anastomosis.

The testis is the organ upon which the survival of the human species depends. Abnormalities of testicular vessels may lead to loss of gametogenesis and hormone production. Reported here is a case of bilateral variations of the testicular vessels observed in a male cadaver during the first year MBBS dissection classes. The right testicular vein bifurcated into two veins just before its termination and both the branches terminated into the inferior vena cava. The left testicular artery arose from the abdominal aorta just above the level of origin of the inferior mesenteric artery. There was an arterio-venous anastomosis between the left testicular vein and the left testicular artery. The arterio-venous anastomosis might be functionally important as it can change the quality of the blood entering the testis.

Use of 1540nm fractionated erbium:glass laser for split skin graft resurfacing: a case study.

The field of laser skin resurfacing has evolved rapidly over the past two decades from ablative lasers, to nonablative systems using near-infrared, intense-pulsed light and radio-frequency systems, and most recently fractional laser resurfacing. Although fractional thermolysis is still in its infancy, its efficacy in in the treatment of skin disorders have been clearly demonstrated. Here we present a case report on the safety and efficacy of a 1540nm erbium:glass laser in the treatment of the waffle pattern of a meshed skin graft in a 38-year-old patient with type V skin in the Caribbean.

Incidences and Clinical Implications of Communications between Musculocutaneous Nerve and Median Nerve in the Arm - A Cadaveric Study.

OBJECTIVES: Variations such as communications between median nerve and musculocutaneous nerve or in their abnormal branching pattern constitute a major concern in clinical and surgical field. Knowledge of these variations not only provides the clinician with a proper interpretation of the case, but also minimizes the complication in surgical approaches in this region. METHOD: We examined 50 isolated upper limbs to investigate the possible incidences of various types of communications between these two neighbouring peripheral nerves. RESULT: Twenty-eight per cent of limbs were found to have communication between these two nerves. When categorized according to Venieratos and Anagnostopoulou's classification method, 11 out of 14 cases (79%) showed type I communications, two out of 14 (14%) showed type II and the remaining one (7%) showed type III communication pattern. CONCLUSION: Prior knowledge of communications between these two neighbouring nerves, both in terms of their incidences and pattern of communications, may be of considerable significance to neurologists and orthopaedic surgeons in dealing with nerve entrapment syndromes in the upper limb of patients.

Relationship of fasting total homocysteine, high sensitivity C-reactive protein and features of the metabolic syndrome in Trinidadian subjects.

OBJECTIVES: To assess the relationship of homocysteine, hs-CRP, with known cardiovascular risk factors of the metabolic syndrome. METHOD: Cross sectional study comprised 182 diabetic outpatients (70 males and 112 females), attending endocrinology clinics in Trinidad. RESULTS: Both male and females showed significant linear relationships between high sensitive C-reactive protein (hs-CRP), blood pressure and diabetes (r = -0.2 < R or R > 0.2). In females hs-CRP showed significant linear relationship with HDL, triglyceride, blood pressure and diabetes mellitus (p < 0.0001). The inverse relationship of hs-CRP with HDL implies the strong association of hs-CRP with metabolic syndrome. The multivariate logistic regression analysis showed significant relation of hs-CRP, metabolic syndrome and diabetes mellitus. There was no significant relationship of tHCY to any of the features studied. CONCLUSION: Serum C-reactive protein is significantly related to features of the metabolic syndrome. Total plasma homocysteine, appears to be independent of both hs-CRP and features of the metabolic syndrome.

Variations of the celiac trunk and its branches associated with the shift of vascular hilum (porta hepatis) of the liver.

The knowledge of vascular variations, like other anatomical variations, is important during the operative, diagnostic and endovascular procedures in abdomen. This report describes variations in the celiac trunk and abnormal entry of hepatic arteries into the liver as found during routine dissection in approximately 65 years old female cadaver. The celiac trunk was two inches long and gave 2 inferior phrenic arteries, a left gastric artery, and then bifurcated into a splenic and a common hepatic artery. The common hepatic artery gave rise to left hepatic artery, which entered the liver through fissure for ligamentum venosum. The common hepatic artery then divided into right hepatic and gastroduodenal arteries. The cystic artery was a branch of the left hepatic artery. The porta hepatis of the liver was situated on the right side of the caudate lobe.The knowledge of variation reported here is important during endovascular procedures, cholecystectomy and liver transplantation from the living donors (Fig. 2, Ref. 18).

Relationship of biochemical parameters, BMI and blood pressure with age, gender and ethnicity of Trinidadian type 2-diabetic subjects.

OBJECTIVE: To determine the relationship of biochemical parameters, BMI and blood pressure with age, gender and ethnicity of Trinidadian type 2-diabetic subjects. METHODS: A retrospective case control study comprised of 1794 patient (740 males and 1054 females). RESULTS: The correlation was found for lipid profile with age and gender in diabetic subjects. There was a positive significant correlation in LDL-C values for all age groups. Serum creatinine concentrations significantly varied amongst ethnicity (p = 0.02). Of the known ethnicities, East Indians had the highest mean creatinine value (1.00 ± 0.47 mg/dl). The univariate general linear model showed that lipid profile had many associations with gender and ethnicity in type 2 diabetic subjects. LDL-C had significant differences between gender (p = 0.04) and diabetes (p = 0.01). CONCLUSIONS: Varied lipid profile with elevated systolic blood pressure and BMI are associated in type 2 diabetic patients with respect to age, gender and ethnicity.

Epidemiology of multiple myeloma and the role of M-band detection on serum electrophoresis in a small developing country. A retrospective study.

OBJECTIVE: The objective of the study was to determine the role of M-band component on serum protein electrophoresis and bone marrow biopsy in the diagnosis. METHODS: Data was collected on 34 patients with MM diagnosed and/or treated. RESULTS: There were equal numbers of men 17 (50%) and women 17 (50%). All patients were first screened for the presence of M-Band using serum protein electrophoresis (SPE) followed by bone marrow biopsy as the confirmatory test. Only two patients screened negative by SPE. On the other hand six patients who tested positive by SPE were negative on biopsy. Thus the sensitivity of the SPE was 96% and specificity 71%. This means that 29 patients had an established diagnosis of MM. There was a slight male predominance when compared to females. CONCLUSION: The data showed that the SPE and bone biopsy are the important tools in the diagnosis of multiple myeloma in a small developing country.

Early antenatal serum lipid levels and the risk of pre-eclampsia in Trinidad and Tobago.

OBJECTIVE: To determine the lipid levels in early pregnancy and the risk for pre-eclampsia in a Trinidad population. METHODS: Prospective cohort study comprised 156 pregnant women attending antenatal clinic visits prior to 20 weeks at an average of 14 weeks. Blood samples were analysed for lipid levels. Of which 102 participants were followed until delivery and were monitored for pre-eclampsia. Data was analysed using univariate linear and stepwise logistic regression analysis. RESULTS: In the study 11 women developed pre-eclampsia and 91 remained normal. Mean triglyceride levels were found significantly higher in the pre-eclampsia group (p = 0.001). Mean HDL levels were low and LDL/HDL ratios were high in pre-eclampsia group. Women with triglycerides above 130 mg/dL had increased risk of pre-eclampsia (adjusted OR 14.046; 95% CI 1.254-157.334) compared with those with triglycerides levels 91 mg/dL or less. CONCLUSION: Increased serum triglyceride levels in early pregnancy before 20 weeks are associated with pre-eclampsia.

Drug utilization patterns in pregnant women: a case study at the Mount Hope Women's Hospital in Trinidad, West Indies.

OBJECTIVE: To explore drug (prescription, over-the-counter and herbal) utilization in pregnant women attending a public sector tertiary healthcare institution. METHODS: This was a cross-sectional case study in women attending antenatal clinics at the Mount Hope Women's Hospital. Women (506) who consecutively presented for routine care at the antenatal clinic were interviewed on the medication they took. Descriptive statistics and logistic regression for predictors of drug use were done using SPSS 16. RESULTS: There were 200 (39.5%) primigravidae, 306 (60.5%) multigravidae and 299 (59%) women were in the third trimester of pregnancy. Most women (69.8%) were between 20-35 years of age. Women took an average of 1.32, 1.22 and 0.94 prescribed drugs in each trimester respectively. Multivitamins (59.8%) and iron/folic acid (54.2%) were the most frequently prescribed drugs. Regardless of trimester only 20% of women took supplemental calcium. Very few women (2.4%) took herbal medications. Paracetamol was the most common over-the-counter (OTC) medication in all trimesters. Women with secondary level education were most likely to use OTC iron/folic acid (p = 0.02), paracetamol and histamine2 receptor antagonists [H2RAs] (p = 0.001). More primigravidae took non-steroidal anti-inflammatory drugs (p = 0.02) and more women in the first trimester used antiemetics (p = 0.001). Age group (p = 0.048), marital status (p = 0.001) and the trimester of pregnancy (p = 0.001) were predictors of drug utilization. CONCLUSION: Overall, women in tertiary healthcare institutions took medication as prescribed particularly multivitamins and iron/folic acid. More women with higher education took OTC paracetamol, iron/folic acid and vitamin supplements. Herbal supplements were rarely used. Research on drug utilization in primary care facilities is recommended.

Microbial population dynamics in laboratory-scale solid waste bioreactors in the presence or absence of biosolids.

AIMS: Decomposition of solid waste is microbially mediated, yet little is known about the associated structure and temporal changes in prokaryotic communities. Bioreactors were used to simulate landfill conditions and archaeal and bacterial community development in leachate was examined over 8 months. METHODS AND RESULTS: Municipal solid waste (MSW) was deposited in laboratory bioreactors with or without biosolids and combustion residues (ash). The near-neutral pH fell about half a log by day 25, but recovered to approximately 7.0 by day 50. Cell concentrations in bioreactors containing only MSW were significantly higher than those from co-disposal bioreactors. Archaeal and bacterial community structure was analysed by denaturing gradient gel electrophoresis targeting 16S rRNA genes, showing temporal population shifts for both domains. mcrA sequences retrieved from a co-disposal bioreactor were predominantly affiliated with the orders Methanosarcinales and Methanomicrobiales. CONCLUSION: Regardless of waste composition, microbial communities in bioreactor leachates exhibited high diversity and distinct temporal trends. The solid waste filled bioreactors allowed simulation of solid waste decomposition in landfills while also reducing the variables. SIGNIFICANCE AND IMPACT OF THE STUDY: This study advances the basic understanding of changes in microbial community structure during solid waste decomposition, which may ultimately improve the efficiency of solid waste management.

Multiple variations of the right renal vessels.

Multiple variations of the right renal and testicular vessels were found during routine dissection in a 65-year-old male cadaver. The cadaver was healthy and did not have any other anomalies. The variations found were: presence of three right renal arteries, origin of the right inferior suprarenal artery from the middle right renal artery, two right renal veins, origin of the right testicular artery from the inferior right renal artery and the termination of the right testicular vein into the right renal vein. A sound knowledge of vascular variations in relation to the right kidney and right suprarenal gland is important in kidney transplantation and suprarenal surgery.

Wound healing activity of Persea americana (avocado) fruit: a preclinical study on rats.

OBJECTIVE: Avocado (Persea americana) oil is rich in nutrient waxes, proteins and minerals, as well as vitamins A, D and E. It is an excellent source of enrichment for dry, damaged or chapped skin. This study aimed to evaluate the wound-healing activity of fruit extract of Persea americana in rats. METHOD: The effect of topical and oral administration of Persea americana fruit extract (300 mg/kg/day) on excision and dead space wound models was evaluated. The rats used in the excision wound model were divided into four groups of five each and received either topical or oral treatment. The rats used in the dead space wound model were divided into two groups of five each and were treated orally. Healing was assessed by the rate of wound contraction, period of epithelialisation, granulation tissue weight and hydoxyproline content. RESULTS: In the excision wound model, complete healing (full epithelialisation) was observed on average on day 14 in the rats who receive oral or topical treatment. In contrast, the controls took approximately 17 days to heal completely. The extract-treated wounds were found to epithelialise faster than the controls (p < 0.001). Wet and dry granulation tissue weight and the hydroxyproline content of the tissue obtained from extract-treated animals used in the dead space wound model were significantly higher (p < 0.05) compared with the controls. CONCLUSION: Rate of wound contraction, epithelialisation time together with the hydroxyproline content and histological observations support the use of Persea americana in the management of wound healing.

Investigation of wound healing activity of Lantana camara L. in Sprague dawley rats using a burn wound model.

Summary: Lantana camara is used in herbal medicine for the treatment of skin itches, as an antiseptic for wounds, and externally for leprosy and scabies. The objective of our study is to investigate burn wound healing activity of the leaf extract of L.camara in rats. The animals were divided into two groups of 6 each. The test group animals were treated with the ethanol extract of L. camara (100 mg kg-1 day-1) topically and the control group animals were left untreated. Healing was assessed by the rate of wound contraction, period of epithelialization. Antimicrobial activities of the extract against the specific microorganisms were assessed. The extract showed antimicrobial activity against Staphylococcus aureus, Klebsiella Pneumoniae and E.coli. Extract treated wounds were healed in about 21 days which is not distinct from the controls. Our data suggest that L.camara has antimicrobial activity but not wound healing promoting activity on burn wound. Industrial relevance: Extensive work has been done on the L. camara and demonstrated the antimicrobial and fungicidal activity of its chemical constituents. Lantana oil is used for the treatment of skin itches and as an antiseptic for wounds. It has been used in folk medicine for the treatment of cancers, chicken pox, measles, ulcers, swellings, eczema. Our earlier work showed the healing activity on excision wound model. However, there is no data to support the wound healing activity of L. camara on burn wound. Hence, we have conducted the present study to explore the wound healing activity and the antimicrobial activities of L. camara against the specific microorganisms which generally infect burn wound.

Evaluation of wound-healing potential of Catharanthus roseus leaf extract in rats.

Rats treated with 100 mg /kg/day of the Catharanthus roseus ethanol extract had high rate of wound contraction significantly decreased epithelization period, significant increase in dry weight and hydroxyproline content of the granulation tissue when compared with the controls. Wound contraction together with increased tensile strength and hydroxyproline content support the use of C. roseus in the management of wound healing.

Wound-healing activity of Morinda citrifolia fruit juice on diabetes-induced rats.

OBJECTIVE: Morinda citrifolia L. is a traditional Polynesian medicinal plant which is apparently useful for bowel disorders, skin inflammation, infection, mouth ulcers and wound healing. This study aimed to evaluate the wound-healing activity of Morinda citrifolia fruit juice in streptozotocin-induced diabetic rats. METHOD: An excision wound model was used. The animals were weight-matched and placed into three groups (n = 6 per group). Group 1 animals served as normal controls, while animals in groups 2 and 3 served as diabetic controls and experimental diabetic animals respectively. All animals were anaesthetised and a full-thickness excision wound (circular area of 300 mm2 and 2 mm deep) was created. Group 3 animals were given the juice of Morinda citrifolia fruit (100 ml per kilogram of body weight) in their drinking water for 10 days. Wound area measurements were taken on days 1, 5 and 11. Blood samples were collected simultaneously for glucose measurement. Granulation tissue that had formed on the wound was excised on day 11 and processed for histological and biochemical analysis. RESULTS: The wound area of the Morinda citrifolia-treated group reduced by 73% (p < 0.001) when compared with the diabetic controls (63%). Significant increases in the weight of granulation tissue (p < 0.001) and hydroxyproline content (p < 0.00 1, 92.16 +/- 4.02) were observed. The protein content was moderately high. Histological studies showed that collagen was laid down faster in the experimental diabetic animals than in the normal control and diabetic control groups. Fasting blood glucose values in the diabetic experimental group had reduced by 29% (p < 0.00 1) compared with the diabetic control animals. There was a good correlation between the wound contraction rate and blood glucose values. CONCLUSION: This study demonstrates that the juice of Morinda citrifolia fruit significantly reduces blood sugar levels and hastens wound healing in diabetic rats.