The Effect of Hydroxyurea Therapy on Adverse Clinical Events and Haematological Indices in Paediatric Patients with Sickle Cell Anaemia / Efecto de la Terapia con Hidroxiurea en los Eventos Clínicos Adversos y los Indices Haematológicos de Pacientes Paediátricos con Aanemia de Células Falciformes

ABSTRACT Objective: The aim of this study was to determine the effect of hydroxyurea on adverse clinical events and haematological indices in paediatric patients with sickle cell anaemia. Method: This study compared the same cohort of patients before and after hydroxyurea therapy, monitoring the rate of adverse events, pre- and post-treatment and haematological indices. Results: Of the 40 patients, the incidence rate of painful crises post-treatment was 80% lower than pre-treatment. Post-treatment incidence rates of painful crises managed at home, requiring emergency department care or requiring admission to the ward were also lower - 79%, 81% and 84%, respectively. There was no significant difference in the incidence of other clinical events. The haemoglobin concentration increased within the first month and plateaued while the mean corpuscular volume (MCV) and mean corpuscular haemoglobin concentration (MCHC) continued to increase until six months before plateauing out. The white blood cell count (WBC) and absolute neutrophil count (ANC) decreased over the first month before levels stabilized. The reticulocyte percentage and the absolute reticulocyte count (ARC) decreased over the first three months before plateauing while the platelet count remained stable. Conclusion: Hydroxyurea significantly reduced the incidence of painful crises. There were significant increases in haemoglobin, MCV and MCHC with decreases in WBC, ANC, ARC, and reticulocyte percentage while the platelet count remained relatively stable.

RESUMEN Objetivo: El objetivo de este estudio fue determinar el efecto de la hidroxiurea sobre los eventos clínicos adversos y los índices hematológicos en pacientes pediátricos con anemia falciforme. Método: Este estudio comparó una misma cohorte de pacientes antes y después del tratamiento con hidroxiurea, monitoreando la tasa de eventos adversos, el tratamiento previo y posterior, y los índices hematológicos. Resultados: En los 40 pacientes, la tasa de incidencia de postratamiento de crisis dolorosas fue 80% inferior a la del pretratamiento. Las tasas de incidencia de postratamientos de crisis dolorosas que fueron tratadas en el hogar, atendidas en el departamento de emergencias, o requirieron ingreso hospitalario, fueron también menores -79%, 81%y 84%, respectivamente. No hubo diferencias significativas en la incidencia de otros eventos clínicos. La concentración de hemoglobina aumentó en el primer mes y se estabilizó, mientras que el volumen corpuscular medio (VCM) y la concentración de hemoglobina corpuscular media (CHCM) continuaron aumentando hasta seis meses antes de estabilizarse. nivelarse. El conteo de glóbulos blancos (CGB) y el conteo absoluto de neutrófilos (CAN) disminuyeron durante el primer mes antes de que los niveles se estabilizaran. El porcentaje de reticulocitos y el conteo absoluto de reticulocitos (CAR) disminuyeron durante los primeros tres meses antes de estabilizarse, mientras que el conteo de plateletas permaneció estable. Conclusión: La hidroxiurea redujo significativamente la incidencia de crisis dolorosas. Hubo aumentos significativos de hemoglobina, VCM y CHCM con disminuciones de CGB, CAN, CAR, y porcentaje de reticulocitos mientras que el conteo plaquetario permaneció relativamente estable.

Dental Students' and Examiner perceptions of an OSCE in the DDS programme in Trinidad

Objective: The School of Dentistry introduced an Objective Structured Clinical Examination (OSCE) in 2014 for Year 3 students in its Doctor of Dental Surgery (DDS) programme, designed to ensure patient care competency. The objective of the study was to determine student and examiner perceptions of thedental OSCE which takes place in Year 3 Semester I. Design and Methodology: All year 3 dental students (n=27) and examiners (n=14) took part in the study. Following ethical approval, a cross-sectional survey method was used. Data were collected on structured questionnaires administered to students and examiners to obtain their perceptions of the OSCE stations which included: History taking, Examination of a patient, Radiographic examination, Basic Life Support and six other specialty stations. Results: Student survey: Fifteen (15) students (55.6%) agreed that the OSCE was fair and 73.1% agreed they were well organized. However, only 55.6% thought there was sufficient time. Nearly 75% felt the OSCE was representative of real clinical scenarios but only 48.1% agreed it was valid in terms of assessing clinical competence. Examiner Survey: Nearly 93% of examiners thought their OSCE station was well organized and that the time allocated was sufficient. One hundred percent (100%) agreed that their OSCE station was fair, a good assessment of the students' competency to begin seeing patients and that the OSCE was a valid form of assessing clinical competence. Conclusion: While less than half of students thought that the OSCE was valid in terms of assessing clinical competence, all of the Examiners thought that it was valid. The discrepancy between student and examiner perceptions needs further investigation.

Baseline characteristics and outcomes of children with cancer in the English-speaking Caribbean: A multinational retrospective cohort.

BACKGROUND: English-speaking Caribbean (ESC) childhood cancer outcomes are unknown. PROCEDURE: Through the SickKids-Caribbean Initiative (SCI), we established a multicenter childhood cancer database across seven centers in six ESC countries. Data managers entered patient demographics, disease, treatment, and outcome data. Data collection commenced in 2013, with retrospective collection to 2011 and subsequent prospective collection. RESULTS: A total of 367 children were diagnosed between 2011 and 2015 with a median age of 5.7 years (interquartile range 2.9-10.6 years). One hundred thirty (35.4%) patients were diagnosed with leukemia, 30 (8.2%) with lymphoma, and 149 (40.6%) with solid tumors. A relative paucity of children with brain tumors was seen (N = 58, 15.8%). Two-year event-free survival (EFS) for the cohort was 48.5% ± 3.2%; 2-year overall survival (OS) was 55.1% ± 3.1%. Children with acute lymphoblastic leukemia (ALL) and Wilms tumor (WT) experienced better 2-year EFS (62.1% ± 6.4% and 66.7% ± 10.1%), while dismal outcomes were seen in children with acute myeloid leukemia (AML; 22.7 ± 9.6%), rhabdomyosarcoma (21.0% ± 17.0%), and medulloblastoma (21.4% ± 17.8%). Of 108 deaths with known cause, 58 (53.7%) were attributed to disease and 50 (46.3%) to treatment complications. Death within 60 days of diagnosis was relatively common in acute leukemia [13/98 (13.3%) ALL, 8/26 (30.8%) AML]. Despite this, traditional prognosticators adversely impacted outcome in ALL, including higher age, higher white blood cell count, and T-cell lineage. CONCLUSIONS: ESC childhood cancer outcomes are significantly inferior to high-income country outcomes. Based on these data, interventions for improving supportive care and modifying treatment protocols are under way. Continued data collection will allow evaluation of interventions and ensure maximal outcome improvements.

Neurodevelopmental Outcome of Childhood Cancer Survivors Treated at the Eric Williams Medical Sciences Complex.

OBJECTIVE: To investigate the neurodevelopmental outcome of childhood cancer survivors treated at the Eric Williams Medical Sciences Complex (EWMSC). METHODS: Study participants were children treated at EWMSC from January 2003 to March 31, 2012 for various childhood cancers. All had completed treatment and were in remission. The McCarthy Scales of Children's Abilities (MSCA) was administered. The study was conducted from December 2011 to March 31, 2012. RESULTS: Twenty-six children were evaluated, a response rate of 74%. There were 12 males and 14 females. Ages ranged from 3.25 to 9.00 years. Four (15.4%) children scored a general cognitive index (GCI) < 68. One child (3.8%) scored a GCI > 132. The children's mean estimated mental age was found to be significantly lower than their mean actual age (p = 0.0086). Children treated for solid tumours had the least difference between their actual ages and estimated mental ages (p = 0.0301). The mean GCI for the genders was 97.4 for females and 81.0 for males; this difference was statistically significant (p = 0.0302). Age at diagnosis, type and length of treatment were not found to significantly affect development. CONCLUSION: The paediatric cancer survivors in this survey were found to have delays in their development. This group of children should have their development closely monitored. This would ensure that any delays in development can be discovered early and appropriate interventions instituted, so that childhood cancer survivors are adequately prepared for adult life beyond cancer.

Parent perceptions of paediatric oncology services at the Eric Williams Medical Sciences Complex, Trinidad and Tobago.

OBJECTIVE: To assess the perceptions of parents of children with cancer and to determine level of satisfaction with the paediatric oncology services at the Eric Williams Medical Sciences Complex (EWMSC). DESIGN AND METHODS: Parents of children with cancer were surveyed during the period 12-27 October 2009 as part of a wider needs assessment project using a questionnaire designed to obtain information on their perception of medical, physical and psychosocial resources during the family encounter at the EWMSC. RESULTS: Overall, parents expressed a high level of satisfaction with the quality of delivery of medical and pharmaceutical services which were at no direct cost to the patient. Issues of concern included a lack of a structured clinic appointment system, inadequate patient care assistance on the ward for very young patients and the housing of non-oncology patients in the oncology specialty unit. Apart from their child's illness, fear of job and income loss was a major stressor for parents. CONCLUSION: Medical needs of patients were perceived to be well met, but there was need to address the psychosocial, physical and educational needs of parents.

Challenges of providing comprehensive clinical service within the public health sector: a case study of the Paediatric Oncology service

OBJECTIVE: To assess the needs of the departments at the Eric Williams Medical Sciences Comlpex (EWMSC) which provide critical support to the paediatric oncology service. DESIGN and METHODS: Key members of staff actively involved in the delivery of paediatric oncology services at the EWMSC were surveyed using self-administered questionaries. Information sought was related to medical, operational, human resource, financial, administrative, infrastructural and psychosocial challenges in providing the service. RESULTS: Twenty members of staff from six departments participated and reported priority challenges in human resources, operational and infrastructural areas in all six departments, Medical diagnostic, administrative and financial issues were high priority in four departments and social/psychological issues in the social work department. CONCLUSION: Human resources, infrastructural support of services and data management needs were identified as key challenges. Using a combination of basic and novel approaches to overcome these challenges would lead to improved patient outcome.

Parent perceptions of paediatric oncology services at the Eric Williams medical sciences complex, Trinidad and Tobago / Percepciones de madres y padres sobre los servicios de oncología pediátrica en el complejo Eric Williams de ciencias médicas, en Trinidad y Tobago

OBJECTIVE: To assess the perceptions of parents of children with cancer and to determine level of satisfaction with the paediatric oncology services at the Eric Williams Medical Sciences Complex (EWMSC). DESIGN AND METHODS : Parents of children with cancer were surveyed during the period 12-27 October 2009 as part of a wider needs assessment project using a questionnaire designed to obtain information on their perception of medical, physical and psychosocial resources during the family encounter at the EWMSC. RESULTS: Overall, parents expressed a high level of satisfaction with the quality of delivery of medical and pharmaceutical services which were at no direct cost to the patient. Issues of concern included a lack of a structured clinic appointment system, inadequate patient care assistance on the ward for very young patients and the housing of non-oncology patients in the oncology specialty unit. Apart from their child's illness, fear of job and income loss was a major stressor for parents. CONCLUSION: Medical needs of patients were perceived to be well met, but there was need to address the psychosocial, physical and educational needs of parents.

OBJETIVO: Evaluar las percepciones de madres y padres de niños con cáncer, y determinar el nivel de satisfacción con los servicios de oncología pediátrica del Complejo Eric Williams de Ciencias Médicas (EWMSC). DISEÑO Y MÉTODOS: Se hicieron encuestas a los padres y madres de niños con cáncer, durante el periodo del 12-27 de octubre de 2009, como parte de un proyecto de evaluación de las necesidades. Se diseñó un cuestionario para obtener información acerca de su percepción de los recursos médicos, físicos y psicosociales durante el encuentro de familias en el Complejo Eric Williams de Ciencias Médicas Complejo (EWMSC). RESULTADOS: En general, padres y madres manifestaron un alto nivel de satisfacción con la calidad de los servicios médicos y farmacéuticos sin costo alguno para los pacientes. Los problemas de mayor preocupación incluían la falta de un sistema bien estructurado de citas médicas, atención inadecuada en relación con la asistencia en la sala de los pacientes muy jóvenes, y el alojamiento de los pacientes no oncológicos en la unidad de especialidad de oncología. Aparte de la enfermedad de sus niños, el miedo a perder el trabajo y los ingresos, era una de las causas principales de stress en los padres. CONCLUSIÓN: Las percepciones daban por bien satisfechas las necesidades de los pacientes, pero apuntaban al imperativo de atender las necesidades psicosociales, físicas y educativas de padres y madres.

The outcome of febrile neutropenic episodes in paediatric oncology at the Wendy Fitzwilliam Paediatric Hospital.

OBJECTIVE: To evaluate the incidence, presentation, treatment and outcome of febrile neutropenic episodes of patients treated at the Wendy Fitzwilliam Paediatric Hospital (WFPH) in Trinidad and Tobago. METHODOLOGY: Using a retrospective cohort method, the records of all the patients registered at the Paediatric Oncology Unit at The WFPH, receiving chemotherapy for haematological or solid tumour malignancies from May 2001 to April 2008 and having episodes of febrile neutropenia were analysed. RESULTS: Seventy one episodes of febrile neutropenia were analysed from the 36 patient records. Episode frequency ranged from 1 to 5. The mean duration of febrile neutropenic episodes was 5.01 days (+/- SD 5.2), with range from 1-25 days. Acute Lymphoblastic Leukaemia (ALL) accounted for 43.7%. The mean WBC for the study population was 0.88 x 10(9)/L (+/- SD 0.61), with the mean absolute neutrophil count (ANC) at 0.16 x 10(9)/L (+/- SD 0.23). Antifungal therapy was used in 6 cases and the incidence of blood culture positive sepsis was 8.5%. Complete resolution occurred in 65 episodes CONCLUSION: Febrile neutropenia episodes treated at the WFPH have a very favourable outcome (91.5%). The further analysis of the relationships found in this study between the total white blood cell count at presentation and the duration of antimicrobial therapy, the duration of the febrile neutropenic episodes and outcome is needed.

The outcome of febrile neutropenic episodes in paediatric oncology at the Wendy Fitzwilliam Paediatric Hospital / La evolución clínica de los episodios neutropénicos febriles en la oncología pediátrica en el Hospital Pediátrico Wendy Fitzwilliam

OBJECTIVES: To evaluate the incidence, presentation, treatment and outcome of febrile neutropenic episodes of patients treated at the Wendy Fitzwilliam Paediatric Hospital (WFPH) in Trinidad and Tobago. METHODOLOGY: Using a retrospective cohort method, the records of all the patients registered at the Paediatric Oncology Unit at The WFPH, receiving chemotherapy for haematological or solid tumour malignancies from May 2001 to April 2008 and having episodes of febrile neutropenia were analysed. RESULTS: Seventy one episodes of febrile neutropenia were analysed from the 36 patient records. Episode frequency ranged from 1 to 5. The mean duration of febrile neutropenic episodes was 5. 01 days (± SD 5. 2), with range from 1 - 25 days. Acute Lymphoblastic Leukaemia (ALL) accounted for 43. 7%. The mean WBC for the study population was 0. 88 x 10(9)/L (± SD 0. 61), with the mean absolute neutrophil count (ANC) at 0. 16 x 10(9)/L (± SD 0. 23). Antifungal therapy was used in 6 cases and the incidence of blood culture positive sepsis was 8. 5%. Complete resolution occurred in 65 episodes CONCLUSIONS: Febrile neutropenia episodes treated at the WFPH have a very favourable outcome (91. 5%). The further analysis of the relationships found in this study between the total white blood cell count at presentation and the duration of antimicrobial therapy, the duration of the febrile neutropenic episodes and outcome is needed.

OBJETIVO: Evaluar la incidencia, presentación, tratamiento y evolución clínica de los episodios neutropénicos febriles de pacientes tratados en el Hospital Pediátrico Wendy Fitzwilliam (WFPH) en Trinidad y Tobago. METODOLOGÍA: Mediante un método de cohorte retrospectivo, se analizaron las historias clínicas de todos los pacientes inscritos en la Unidad de Oncología Pediátrica en WFPH, que recibieron quimioterapia para el tratamiento de neoplasias hematológicas o tumores malignos sólidos desde mayo de 2001 a abril de 2008 y tuvieron episodios de neutropenia febril. RESULTADOS: Se analizaron setenta y un episodios de neutropenia febril de las historias clínicas de 36 pacientes. La frecuencia de los episodios osciló entre 1 y 5. La duración promedio de los episodios neutropénicos febriles fue 5. 01 días (± SD 5. 2), con un rango de 1 a 25 días. La leucemia linfoblástica aguda (LLA) representó el 43, 7% de los casos. El promedio del conteo de glóbulos blancos (WBC) para la población de estudio fue 0. 88 X 10(9)/L (± SD 0, 61), con el promedio del conteo absoluto de neutrófilos (CAN) en 0. 16 X 10(9)/L (± SD 0. 23). La terapia antifúngica fue utilizada en 6 casos y la incidencia de la sepsis confirmada por cultivo positivo de la sangre fue 8. 5%. En 65 episodios (91. 5%) hubo resolución completa con 6 muertes. CONCLUSIONES: Los episodios de neutropenia febril tratados en la WFPH tienen una evolución clínica muy favorable (91. 5%). Se necesita profundizar en el análisis de las relaciones encontradas en este estudio entre el conteo total de glóbulos blancos en la presentación y la duración del tratamiento con antibióticos, la duración de los episodios neutropénicos febriles y la evolución clínica.

Incidence of childhood cancer in Trinidad and Tobago / Incidencia del cáncer infantil en Trinidad y Tobago

BACKGROUND: The Government of Trinidad and Tobago is in the process of developing a comprehensive National Oncology Programme. Regarding Paediatric Oncology, it is necessary to characterize this population to adequately direct its development. This report describes the incidence of childhood cancer in Trinidad and Tobago. PROCEDURE: The data were extracted from the National Cancer Registry of Trinidad and Tobago and the Eric Williams Medical Sciences Complex. Malignancies were coded with the International Classification of Childhood Cancer, 3rd edition. Incidence rates were calculated for the period 2001-2006, age 0-14 years and by county. RESULTS: The crude incidence rate of childhood cancer was 1.9 per 100 000 patient years (pyrs). One hundred and forty-five cases were reviewed for the six-year period with an incidence rate of 7.5 per 100 000 pyrs. The highest incidence was in children < 5 years: 14 per 100 000pyrs for males and 11.4 per 100 000 pyrs for females. Leukaemias and central nervous system tumours formed the majority of the cancers (58.6%), however nephroblastoma was more common than neuroblastoma especially in females < 5 years: 2.7 per 100 000 pyrs compared with 1.2 per 100 000 pyrs for neuroblastoma. The incidence of all childhood cancers did not vary across counties, however, there was a higher incidence of leukaemia in three counties. CONCLUSION: The results provide insight into the incidence of childhood cancer in Trinidad and Tobago. It is lower than in developed countries. There are some unique findings in the incidence of nephroblastoma in girls less than five years of age and the relatively higher incidence of leukaemia in three counties. Further analysis is required in these areas.

ANTECEDENTES: El Gobierno de Trinidad y Tobago está en proceso de desarrollar un Programa Nacional de Oncologia integral. Con respecto a la Oncología Pediátrica, es necesario caracterizar esta población adecuadamente para dirigir su desarrollo. Este informe describe la incidencia de cáncer infantil en Trinidad y Tobago. PROCEDIMIENTO: Los datos se extrajeron del Registro Nacional del Cáncer en Trinidad y Tobago y el Complejo Eric Williams para las Ciencias Médicas. Los tumores malignos fueron codificados con la Clasificación International de Cáncer Infantil, 3 era. edición. Se calcularon las tasas de incidencia para el periodo 2001-2006; en la edad 0-14 años y por condado. RESULTADOS: La tasa bruta de incidencia de cáncer infantil fue de 1.9 por 100 000 años-paciente. Se estudiaron ciento cuarenta y cinco casos por un periodo de seis años con una tasa de incidencia de 7.5 por 100 000 años-paciente. La incidencia más alta se encontró en los niños < 5 años: 14 por 100 000 años-paciente para los varones y 11.4 por 100 000 años-paciente para las hembras. Las leucemias y los tumores del sistema nervioso central constituyeron la mayor parte de los cánceres (58.6%). Sin embargo, el nefroblastoma fue más comun que el neuroblastoma, especialmente en las hembras < 5 años: 2.7 por 100 000 años-paciente en comparación con 1.2 por 100 000 años-paciente del neuroblastoma. La incidencia de todos los cánceres infantiles no varió en los condados. Sin embargo, hubo una incidencia mayor de leucemia en tres condados. CONCLUSIÓN: Los resultados dan una vision de la incidencia de cáncer infantil en Trinidad y Tobago. Esta es más baja que en los países desarrollados. Hallazgos de interés único fueron la incidencia de nefroblastomas en niñas menores de cinco años de edad y la incidencia relativamente más alta de leucemia en tres condados. Se requiere análisis ulterior en estas áreas.

Incidence of childhood cancer in Trinidad and Tobago.

BACKGROUND: The Government of Trinidad and Tobago is in the process of developing a comprehensive National Oncology Programme. Regarding Paediatric Oncology, it is necessary to characterize this population to adequately direct its development. This report describes the incidence of childhood cancer in Trinidad and Tobago. PROCEDURE: The data were extracted from the National Cancer Registry of Trinidad and Tobago and the Eric Williams Medical Sciences Complex. Malignancies were coded with the International Classification of Childhood Cancer, 3rd edition. Incidence rates were calculated for the period 2001-2006, age 0-14 years and by county. RESULTS: The crude incidence rate of childhood cancer was 1.9 per 100,000 patient years (pyrs). One hundred and forty-five cases were reviewed for the six-year period with an incidence rate of 7.5 per 100,000 pyrs. The highest incidence was in children <5 years: 14 per 100,000 pyrs for males and 11.4 per 100,000 pyrs for females. Leukaemias and central nervous system tumours formed the majority of the cancers (58.6%), however nephroblastoma was more common than neuroblastoma especially in females <5 years: 2.7 per 100,000 pyrs compared with 1.2 per 100,000 pyrs for neuroblastoma. The incidence of all childhood cancers did not vary across counties, however there was a higher incidence of leukaemia in three counties. CONCLUSION: The results provide insight into the incidence of childhood cancer in Trinidad and Tobago. It is lower than in developed countries. There are some unique findings in the incidence of nephroblastoma in girls less than five years of age and the relatively higher incidence of leukaemia in three counties. Further analysis is required in these areas.

Evaluation of blood donor deferral causes in the Trinidad and Tobago National Blood Transfusion Service.

The majority of blood donations in Trinidad and Tobago are made as replacement by family members or friends. National Blood Transfusion Policy was drafted in 2007 to promote voluntary, repeated donation. The objective of this study is to assess the current rate and reasons for donor deferral, and the aim is to guide the proposed donor education and recruitment programme. A retrospective study of pre-donation deferral of prospective blood donors at the National Blood Transfusion Centre, Port of Spain, Trinidad and Tobago, was conducted. Records of all pre-donation deferrals over a 12-month period were studied. As many as 11,346 pre-donation screening interviews were conducted. There were 4043 (35.6%) deferrals. The most common reasons for donor deferral were exposure to high-risk sexual activity (27.6%), low haemoglobin 22.2% and hypertension 17.5%. Other reasons such as medication, chronic medical illness, tattoos, travel history, recent pregnancy, surgery or presentation outside the accepted age limit caused 33.8% of all deferrals and the majority (34.7%) of male deferrals. Low haemoglobin (44.5%) was the most common reason among females. The rate of deferral of voluntary donors was not significantly different from that for replacement donors (31.7 vs. 35.4%, P = 0.25). This study exposed a lack of public awareness as the principal reason for an unacceptably high rate of donor deferral. Donor education about selection criteria needs to be urgently addressed as an objective of the National Policy. Monitoring and evaluation of deferral rates and reasons could be used as one indicator of the effectiveness of the Policy.

A family with homozygous haemoglobin E in Trinidad and Tobago

We report the first case of homozygous E in the West Indies, and describe the family, whose ancestors came to Trinidad from India approximately 100 years ago (AU)