100% survival: a cardiac surgery centre experience inTrinidad and Tobago

OBJECTIVE: To report the 2012 results of a cardiac surgerycentre in Trinidad and Tobago. METHODS: Data was reviewed on 245 consecutive patients who underwent cardiac surgery in 2012 at Eric Williams MedicalScience Complex (E.W.M.S.C) Mount Hope, Trinidad. RESULTS: Mean patient age was 58.5 ±9.5 years; 147 patients(60%) were male and the mean calculated EUROSCORE IIwas 1.7. Coronary artery bypass surgery was the most commonprocedure, performed on 190 patients, 98% were done on the beating heart and 3.15% (6 patients) were redo-CABG. Thirteen patients (5.3%) underwent CABG plus other procedures, 9patients (3.7%) had aortic valve replacement, 21 patients (8.6%)had mitral valve repair/replacement, 2 patients (0.8%) had double valve replacement and 10 patients (4.1%) a variety ofother procedures including atrial or ventricular septal defect closure, fibro-elastoma removal, type A Aortic dissection.The operative mortality in the study period was 0%, and at 6months follow-up all patients were alive. CONCLUSION: Excellent results similar to the best institutions in the world can be obtained even in a medium volume centre in a developing country.

Cannabis use and first-episode psychosis: relationship with manic and psychotic symptoms, and with age at presentation.

BACKGROUND: Cannabis use has been reported to be associated with an earlier onset of symptoms in patients with first-episode psychosis, and a worse outcome in those who continue to take cannabis. In general, studies have concentrated on symptoms of psychosis rather than mania. In this study, using a longitudinal design in a large naturalistic cohort of patients with first-episode psychosis, we investigated the relationship between cannabis use, age of presentation to services, daily functioning, and positive, negative and manic symptoms. METHOD: Clinical data on 502 patients with first-episode psychosis were collected using the MiData audit database from seven London-based Early Intervention in psychosis teams. Individuals were assessed at two time points--at entry to the service and after 1 year. On each occasion, the Positive and Negative Syndrome Scale, Young Mania Rating Scale and Global Assessment of Functioning Scale disability subscale were rated. At both time points, the use of cannabis and other drugs of abuse in the 6 months preceding each assessment was recorded. RESULTS: Level of cannabis use was associated with a younger age at presentation, and manic symptoms and conceptual disorganization, but not with delusions, hallucinations, negative symptoms or daily functioning. Cannabis users who reduced or stopped their use following contact with services had the greatest improvement in symptoms at 1 year compared with continued users and non-users. Continued users remained more symptomatic than non-users at follow-up. CONCLUSIONS: Effective interventions for reducing cannabis use may yield significant health benefits for patients with first-episode psychosis.

An observational study of intraoperative transfusion management in a cardiac surgical unit in Trinidad and Tobago.

OBJECTIVE: To investigate the intraoperative transfusion requirements in off-pump coronary artery bypass grafting (OPCABG) and the cost implication of blood products and cell savers on a background of limited resources. METHODS: Prospective data collection identified 60 patients undergoing OPCABG surgery at the Eric Williams Medical Sciences Complex, Trinidad and Tobago. Data relating to these patients (including preoperative haemoglobin (Hb), graft number, presence of diabetes, ejection fraction, preoperative serum creatinine, intraoperative blood use and blood loss) and costing for cell saver disposables and prepared donor (or allogenic) blood were obtained. RESULTS: Twenty units of packed red blood cells (pRBCs) were given in theatre to 27% (16 of 60) of patients. Transfusion requirement was significantly lower in patients with fewer grafts, higher preoperative Hb level and non-diabetic patients. Cell saver disposables and one unit of pRBCs were estimated to cost TT$5000 and TT$1700, respectively. Each patient's transfusion cost TT$2125.00 per unit. CONCLUSION: The study demonstrates the financial implications of routine cell saver use in OPCABG in a setting of limited resources. The cost-effectiveness of routine cell saver use remains to be elucidated, but we recommend the selective use of cell savers in patients who are at a higher risk for transfusion.