Diffusion-weighted MRI to detect early response to chemoradiation in cervical cancer: A systematic review and meta-analysis.

OBJECTIVE: Diffusion-weighted magnetic resonance imaging (DWI) has shown promise in predicting response to therapy in several malignancies. This systematic review and meta-analysis aimed to evaluate DWI in the prediction of response to treatment in patients with cervical cancer. METHODS: A systematic search was conducted on PubMed, Web of Science, Cochrane and Google Scholar databases Studies that evaluated DWI and apparent diffusion coefficient (ADC) for response evaluation before, during and after treatment with a correlation to conventional response criteria were included. The primary endpoint was the mean ADC values of cervical cancer at these timepoints. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) was used to assess the quality of the studies. RESULTS: Nine studies, comprising 270 patients, were included. Pre-treatment ADC values showed no correlation with eventual response. However, in our meta-analysis, there was a significant correlation with early treatment ADC values obtained within the first 3 weeks of therapy and response, as well as a significant correlation with the percentage change in ADC (ΔADC) and response. In addition, the pooled mean ΔADC percentage was also significantly higher in responders than in non-responders (49.7% vs 19.7%, respectively, p = 0.016). CONCLUSION: DWI shows potential as a biomarker of early treatment response in patients with cervical carcinoma. Use of the change in ADC particularly within the first 3 weeks of therapy seems to be predictive of response and may serve as a suitable marker in the determination of early response.

Screening for gestational diabetes mellitus: a Caribbean perspective.

Gestational diabetes mellitus (GDM) is defined as a glucose intolerance first recognised in pregnancy. The World Health Organization (WHO) in 2015 revised the definition into either diabetes in pregnancy (DIP) which includes pre-existing diabetes (type 1 or type 2) that antedates pregnancy or diabetes diagnosed during pregnancy with the WHO diagnostic criteria for diabetes mellitus (DM) in the non-pregnant state, and GDM for milder forms of hyperglycaemia in pregnancy. The main purpose of the screening and diagnosis of GDM is to identify pregnancies in which the foetus is at a high risk of an adverse perinatal outcome, and the mother and the offspring are of serious long-term sequelae. This review of the literature provides an overview of associated prevalence, risk factors and diagnosis of GDM. It also addresses the benefits of screening with supportive evidence. Based on this review, we recommend especially in low-resourced countries such as the Caribbean, adoption of a universal screening with the two-step method.

Assessment of fish consumption and mercury exposure among pregnant women in Jamaica and Trinidad & Tobago.

BACKGROUND: Fish is an essential and traditional element in the diet of most Caribbean people. However it also contains methylmercury which can have severe effects on fetal neurodevelopment. The objective of this study was to assess the fish intake of a selected group of pregnant women from Jamaica and Trinidad & Tobago and evaluate prenatal mercury exposure, using the placenta as a biomarker. METHOD: Food frequency questionnaires and placental samples were obtained from participating parturients at the time of delivery at the University Hospital of the West Indies in Kingston, Jamaica (N = 100, from November 2012 to March 2013) and the Mt Hope Women's hospital in St Joseph, Trinidad & Tobago (N = 30, in June 2015). The participants were asked to identify the species of fish and the frequency of consumption. Placental samples were analysed for mercury using cold vapour atomic absorption. RESULTS: The fish consumption preferences for pregnant women, varies based on the marine fish catch production of each country. The main fish species that contributed to the highest estimated methylmercury exposure in Jamaica and Trinidad & Tobago were cod and shark, respectively. There was a weak association between maternal fish intake and placental mercury concentrations. The mean placental mercury concentrations in Jamaica and Trinidad & Tobago were 0.74 ± 0.5 µg/kg and 1.46 ± 0.6 µg/kg, wet weight respectively. CONCLUSION: The results from this study showed an influence of Caribbean fish intake preferences on mercury exposure and thus a recommendation for continuous bio-monitoring for public health purposes.

Determinants of successful deanship.

With the significant changes taking place in health and education as well as the rising demands and expectations, deans of medical faculties must exhibit strong and effective leadership skills. Deans need to focus on the broad scope and to translate their dreams into applied institutional operations and functions. It is thus necessary that the deans must identify the institution's core ideology, lead strategic planning, create a common vision and offer direction to the collective membership of the institution. Some personal qualities that appear to be critical for effective deanship include being visionary, fair, trustworthy and exemplary. Prospective deans should receive training in leadership. New deans must be properly informed on the strategic plan of the faculty before they are appointed.

Review of gynaecology

This book entitled Revision of Gynaecology should be very useful for medical students as well as junior doctors. Apart from a thorough revision of the major areas in gynaecology, this book also includes advice on examination techniques and multiple choice questions and short answer questions. The final MBBS Examination in Obstetrics and Gynaecology at the University of the West Indies has been undergoing major reforms in recent times especially with the introduction of multiple choice questions and thus this book allows for developing ones' skills in examination techniques. You will find in this book important information on common cases in the gynaecological clinical examinations such as fibroids, utero-vaginal prolapse, postmenopausal bleeding, common gynaecological cancers and ovarian cyts. Topics such as ectopic pregnancy, dilatation and curettage, contraception and sterilisation are commonly asked in the oral examination. This book would also be valuable in your day to day care of patients (AU)

Students' perspectives on the educational environment, Faculty of Medical Sciences, Trinidad.

The Dundee Ready Education Environment Measure (DREEM) was administered to 70 final-year medical students and 36 first-year medical interns (pre-registration house officers). The overall total mean DREEM scores for the five subscales-namely, students' perceptions of the atmosphere, students' perceptions of learning, students' social self-perceptions, students'perceptions of teachers and students' academic self-perceptions-was 109.9 and the total mean scores for the subgroups-male students, male interns, female students and female interns-were 103.39, 111.82, 111.33 and 113.15, respectively. The lowest scores were assigned to students' social self-perceptions and students' perceptions of the atmosphere. All of the participants except the male interns recorded the highest scores for the subscale academic self-perceptions.

An audit of perinatal mortality

Perinatal mortality rates are considered in the western world to be a quantitative barometer of maternity care. This 6-year prospective perinatal audit was conducted at a tertiary hospital in order to determine foetal out-come, and the common causes of foetal and early neonatal deaths. Of a total of 30,987 births, there were 469 stillbirths and 391 early neonatal deaths, giving a perinatal mortality rate of 27.7 per 1000 total births. The leading causes of stillbirths were hypertensive disorders of pregnancy, abruptio placentae, diabetes mellitus, intrapartum foetal distress and lethal congenital anomalies. Neonatal deaths were mainly due to the respiratory distress syndrome (57.8 percent), birth asphyxia (22.2 percent) and sepsis (13.5 percent). A dedicated medical team, including a neonatologist, to manage pre-eclampsia, and more senior obstetric involvement in the labour ward are recommended. (AU)

Gynaecology made simple for medical students U.W.I

This book entitled "Gynaecology made simple" is a revised edition of "Short notes in Gynaecology". It was prepared with the fervent wish that you, our medical students, would find it useful as you prepare for your final examinations. We think that a revision on how to take a gynaecological history is vital, especially when one takes into consideration that the final examination in Obstetrics and Gynaecology is heavily weighted in favour of the clinical component. You would find in this booklet common cases in the Gynaecological Clinical Examination such as fibroids, utero-vaginal prolapse, postmenopausal bleeding and ovarian cyst. Topics such as ectopic pregnancy, dilatation and curettage, hysterectomy and sterilization are commonly asked in the Oral Examination. We feel certain that this booklet would also be valuable in your day to day care of patients after graduation. An addition in this edition involves some common cases in the Clinical Examination as well as tips for you in the Oral Examination. It must be emphasized that this booklet must be used in conjunction with the recommended textbook in Gynaecology. We the authors would welcome any constructive criticism (AU)

Gynaecology made simple for medical students U. W. I

This book entitled "Gynaecology made simple" is a revised edition of "Short notes in Gynaecology". It was prepared with the fervent wish that you, our medical students, would find it useful as you prepare for your final examinations. We think that a revision on how to take a gynaecological history is vital, especially when one takes into consideration that the final examination in Obstetrics and Gynaecology is heavily weighted in favour of the clinical component. You would find in this booklet common cases in the Gynaecological Clinical Examination such as fibroids, utero-vaginal prolapse, postmenopausal bleeding and ovarian cyst. Topics such as ectopic pregnancy, dilatation and curettage, hysterectomy and sterilization are commonly asked in the Oral Examination. We feel certain that this booklet would also be valuable in your day to day care of patients after graduation. An addition in this edition involves some common cases in the Clinical Examination as well as tips for you in the Oral Examination. It must be emphasized that this booklet must be used in conjunction with the recommended textbook in Gynaecology. We the authors would welcome any constructive criticism

Examination performance of medical students: a view from Trinidad

We analysed the outcome of the final MBBS (Bachelor of Medicine and Bachelor of Surgery) examination oat the St. Augustine Campus, University of the West Indies, for 686 students attempting them for the first time between 1975 and 1986. The mean failure rate was lowest in medicine between 1975 and 1981, in obstetrics and gynaecology between 1982 and 1989 and in surgery during the last 7 years. The students' poor performance in some areas indicates the need for recognizing the importance of creating and establishing an educational climate in which the quality of teaching comes under scrutiny. The marking system in medicine should be reviewed.(AU)

Examination performance of medical students: a view from Trinidad

We analysed the outcome of the final MBBS (Bachelor of Medicine and Bachelor of Surgery) examination oat the St. Augustine Campus, University of the West Indies, for 686 students attempting them for the first time between 1975 and 1986. The mean failure rate was lowest in medicine between 1975 and 1981, in obstetrics and gynaecology between 1982 and 1989 and in surgery during the last 7 years. The students' poor performance in some areas indicates the need for recognizing the importance of creating and establishing an educational climate in which the quality of teaching comes under scrutiny. The marking system in medicine should be reviewed.