Association between lung function and dyspnoea and its variation in the multinational Burden of Obstructive Lung Disease (BOLD) study.

BACKGROUND: Dyspnoea is a common symptom of respiratory disease. However, data on its prevalence in general populations and its association with lung function are limited and are mainly from high-income countries. The aims of this study were to estimate the prevalence of dyspnoea across several world regions, and to investigate the association of dyspnoea with lung function. METHODS: Dyspnoea was assessed, and lung function measured in 25,806 adult participants of the multinational Burden of Obstructive Lung Disease study. Dyspnoea was defined as ≥2 on the modified Medical Research Council (mMRC) dyspnoea scale. The prevalence of dyspnoea was estimated for each of the study sites and compared across countries and world regions. Multivariable logistic regression was used to assess the association of dyspnoea with lung function in each site. Results were then pooled using random-effects meta-analysis. RESULTS: The prevalence of dyspnoea varied widely across sites without a clear geographical pattern. The mean prevalence of dyspnoea was 13.7 % (SD=8.2 %), ranging from 0 % in Mysore (India) to 28.8 % in Nampicuan-Talugtug (Philippines). Dyspnoea was strongly associated with both spirometry restriction (FVC

Prevalence and risk factors of airflow obstruction in a Caribbean population.

SETTING: The prevalence of airflow obstruction (AO) in the Caribbean population is unknown.OBJECTIVE: To measure the prevalence of and risk factors for AO (post-bronchodilator ratio of forced expiratory volume in 1 sec to forced vital capacity of <0.7) in the Trinidad and Tobago general population using the Burden of Obstructive Lung Disease methodology.DESIGN: National cross-sectional, stratified, cluster sampling of adults aged ≥40 years.RESULTS: AO prevalence was 9.5% among 1104 participants, most of whom were unaware of this. Compared to those aged 40-49 years, the adjusted odds ratio of AO by age group was 2.73 (60-69 years) and 3.30 (≥70 years). Risk factors for AO were unemployment (OR 4.31), being retired (OR 2.17), smoking ≥20 pack-years (OR 1.88) and exposure to dusty jobs for more than 1 year (OR 2.06). Related symptoms were history of wheezing, unscheduled visits to the doctor or admission to hospital for breathing problems and in subjects with at least one respiratory symptom (OR 1.90), at least one risk factor (OR 2.81), either symptoms or risk factors (OR 3.71) and both symptoms and risk factors (OR 5.78) (P < 0.05 in all cases).CONCLUSION: AO prevalence in the general population of Trinidad and Tobago aged ≥40 years was 9.5%, almost all of which was undiagnosed. AO was associated with smoking, age >59 years, lack of employment and working in a dusty job.

Occupational dust exposure is independently associated with Chronic Obstructive Pulmonary Disease (COPD) in Trinidad and Tobago population

Objective: COPD is a leading cause of mortality and morbidity worldwide. Although cigarette smoking is a well-known risk factor for COPD, nonsmokers may account for one fourth to half of all cases. The Burden of Obstructive Lung Disease in Trinidad and Tobago (BOLD-TT) study objective was to measure the COPD prevalence and its risk factors in the local population aged 40 years and older. Design and Methodology: In this cross-sectional survey participants were selected using two-stage stratified-cluster sampling to represent the national population in terms of gender, age and ethnic distributions. Quality assured spirometry and questionnaires were administered. Results: Among the 1,104 participants, 36% reported occupational dust exposure for more than one year and about 40% of them were never-smokers. Overall 9.5% (95% CI: 7.78 to 11.23%) of the studied population showed COPD, accounting for an estimated 49,170 persons (95% CI = 40,267; 58,124) in Trinidad and Tobago. The majority (60%) of the diagnosed COPD was attributable to non-smoking causes, and more than half of them reported occupational dust exposure. Multiple logistic regression analysis confirmed COPD's independent association with working in a dusty job (OR 2.05; 95% CI=1.26, 3.35). Conclusions: Risk of COPD in the Trinidad and Tobago general population is significantly associated with occupational dust exposure which is probably contributing about one-third of current COPD burden. International studies showed that only about 15% of overall COPD could be ascribed to occupational risk factors. The higher occupational related COPD risk in the local population should be further studied prospectively.

Indo-Caribbean population has lower vital capacities than Afro-Caribbean population in Trinidad and Tobago

Objective: Low forced vital capacity (FVC) is a good predictor of mortality and morbidity including cardiovascular disease, diabetes and chronic kidney disease in the general population. Objective of the current post-hoc analysis was to compare the FVCs among the major ethnic groups of Trinidad and Tobago. Design and Methodology: The Burden of Obstructive Lung Disease in Trinidad and Tobago (BOLD-TT) study was conducted to measure the COPD prevalence and its risk factors in the local population of 40 years and older by using questionnaires and quality assured spirometry. The participants were selected using two-stage stratified, cluster sampling to represent the national population in terms of gender, age and ethnic distributions. To avoid the influence of contentious international spirometry predictive values, FVC was used as a continuous variable after adjusting for age, gender, height and height square. Results: Among the 1,104 participants, 42% were Indo- Caribbeans, and 36% were Afro-Caribbeans. Indo- Caribbeans had a similar prevalence of abnormal waist circumference (57.0% vs. 58.7%; p=0.751), a lower prevalence of obesity (30.0% vs. 41.8%; p=0.008), but a higher prevalence of abnormal waist-hip ratio (74.1% vs. 57.5%; p<0.001) and diabetes (21% vs. 10%; p<0.001) than the Afro- Caribbeans. Multiple regression analysis indicated that FVC was independently associated with ethnicity and revealed lower volumes in Indo- Caribbean participants than Afro-Caribbeans (-180ml; 95%CI:-90ml,-269ml; p<0.001). Conclusions: The Indo-Caribbean population has a lower FVC than the Afro-Caribbean population which was independent of age, gender, and height. Healthrelated consequences of low FVC among local ethnic groups warrant further research using longitudinal studies.

Asymptomatic 'normal' subjects may have a respiratory health burden as assessed by the St Georges Respiratory Questionnaire (SGRQ)

Objectives: The Burden of Obstructive Lung Disease study in Trinidad and Tobago identified subjects with obstruction and no symptoms in approximately 5% of the general population over 40 years old. We reviewed data from a previously published study involving asymptomatic subjects to determine respiratory health burden and relation to lung function. Results: Subject characteristics were: 16 (64%) males, Mean (SD) age 64.8 (6.78) years, forced expiratory volume (FEV1) 2.25 (0.77)L, forced vital capacity (FVC) 2.91 (1.02) L, FEV1/FVC 78.1 (8.31)%. Parameters assessed were FEV1 (1.21 to 3.69 L); FVC (1.32 to 4.88 L); FEV1/FVC (65.2 - 94.7%); SGRQ Total Score (0 to 20.8). Three subjects (12%) had a FEV1/FVC ratio of less than 70%. The correlations (rho, p) of total SGRQ scores were FEV1 (-0.62, 0.001), FEV1% (-0.52, 0.008); FVC (-0.69, < 0.001). Conclusion: Asymptomatic normal elderly subjects had significant respiratory health burden as measured by the SGRQ and this was worse in those with a lower FEV1%. This may apply to elderly persons in the general population.

Sex and social class inequities in physical and mental health: an analysis using data from the Burden of Obstructive Lung Disease Trinidad and Tobago (BOLD-TT) study

Objectives: To examine sex and social class differences in physical and mental health in the Trinidad and Tobago population aged ≥40 years. Design and Methodology: Data from the BOLD-TT study, which included a stratified cluster sample of 1104 persons, were analysed. The Veteran Rand (VR)-12 instrument assessed physical (general health, physical functioning and role playing and bodily pain) and mental health (vitality, role-emotional, mental health and social functioning); using a physical health component (PCS) and mental health component (MCS) scores. Highest level of education attained, and employment status were used as measures of social class. General Linear Models were used to examine differences in PCS and MCS by sex, education and employment, controlling for age. Results: Mean age of the participants was 54.1 (SD10.8) years; 59.9% were females; 47% had no/primary education; 56% were employed. Mean PCS and MCS (SEM) scores were 47.8 (0.3) and 54.7 (0.3). Females had lower mean PCS and MCS than males (p<.001 in each case). There were significant mean differences in PCS (p<.001) and MCS (p=.04) by employment status. Persons who were not working had lower mean PCS (p<.001) and MCS (p=.002) than those employed. There were differences in PCS by education (p=.019); persons with no/primary education had lower PCS than those with post-secondary and university education. Multiple regression identified employment (p<.001) and education (p=.097) as independent predictors of PCS while sex (p=.002) and employment (p=.021) predicted MCS. Conclusion: The VR-12 provided initial results indicating health inequities i.e. poorer health status among females, the unemployed and uneducated.

A Descriptive Study of Chronic Obstructive Pulmonary Disease in Tertiary Care Clinics of a Caribbean Island / Estudio descriptivo de la enfermedad pulmonar obstructiva crónica en clínicas de atención terciaria de una isla caribeña

ABSTRACT Objective: To determine the relationship between severity of chronic obstructive pulmonary disease (COPD) and quality of life as well as COPD's correlation with depressive symptoms in West Indian subjects. Methods: This is a cross-sectional, observational study of outpatients with COPD in tertiary care. The severity of COPD was determined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage, GOLD group, and body mass index, airflow obstruction, dyspnoea and exercise capacity (BODE) index. Quality of life was assessed by the St George Respiratory Questionnaire (SGRQ) and COPD Assessment Test (CAT), and depression was assessed by the Center for Epidemiologic Studies Depression Scale (CES-D). Results: A total of 105 patients (85.7% male, 37.1% Indo-Trinidadian, 42.9% Afro-Trinidadian, 64.8% primary level education) were recruited with a mean age of 66.9 years (standard deviation: 9.60 years). The median body mass index was 25 kg/m2; 26.7% were underweight. Risk factors identified were: ever-smokers (27.6%), marijuana (20%), biomass (81.9%), passive smoke (70.5%), occupational exposures (80%). The CES-D of 25% of the patients was ≥16. Co-morbidities included diabetes (22%), hypertension (29%), gastro-oesophageal reflux disease (10%) and previous myocardial infarction (15%). A total of 59% of the patients reported a monthly household income of less than US$800. Lower level of education was associated with worse SGRQ (total and impact), lower forced expiratory volume in one second, modified Medical Research Council scale (mMRC) of ≥ 2 and higher BODE index. Higher GOLD group correlated with worse SGRQ, CAT and CES-D. Higher CES-D was associated with shorter six-minute walk distance, worse SGRQ, CAT and mMRC scores, higher GOLD group and increased COPD admissions per year. Patients with a CES-D of ≥ 16 walked shorter distances. Higher BODE quartile was associated with worse SGRQ, CAT and CES-D scores. Conclusion: Higher GOLD group and higher BODE quartile were associated with worse quality of life scores and higher depression scores. Patients in higher GOLD groups should be screened for depression. Education on COPD should be targeted at those of lower socioeconomic status.

RESUMEN Objetivo: Determinar la relación entre la severidad de la enfermedad pulmonar obstructiva crónica (EPOC) y la calidad de vida, así como la correlación de la EPOC con síntomas depresivos en sujetos antillanos. Métodos: Se realizó un estudio observacional transversal de pacientes ambulatorios con EPOC en cuidados terciarios. La severidad de la EPOC fue determinada por la etapa de la Iniciativa Global para la Enfermedad Pulmonar Obstructiva Crónica (GOLD, en inglés), el grupo GOLD, así como el índice de masa corporal, la obstrucción del flujo de aire, la disnea y la capacidad de ejercicio (índice BODE). La calidad de vida fue evaluada mediante el Cuestionario Respiratorio de Saint George (CRSG) y la prueba de evaluación de la EPOC (CAT, en inglés), en tanto que la depresión fue evaluada por la Escala de Depresión del Centro de Estudios Epidemiológicos (CES-D). Resultados: Un total de 105 pacientes (85.7% varones, 37.1% indotrinitenses, 42.9% afrotrinitenses, 64.8% nivel de educación primaria) fueron reclutados con una edad promedio de 66.9 años (desviación estándar: 9.60 años). El índice de masa corporal promedio fue de 25 kg/m2; 26.7% por debajo del peso normal. Los factores de riesgo identificados fueron: fumar ocasionalmente (27.6%), marihuana (20%), biomasa (81.9%), humo pasivo (70.5%), exposición ocupacional (80%). El CES-D del 25% de los pacientes fue ≥ 16. Las comorbilidades incluyeron diabetes (22%), hipertensión (29%), enfermedad por reflujo gastroesofágico (10%), y previo infarto del miocardio (15%). Un total de 59% de los pacientes reportaron un ingreso mensual familiar de menos de $800 USD. El nivel más bajo de educación se asoció con un peor (CRSG) (total e impacto), menor volumen espiratorio forzado en un segundo, Escala del Consejo de Investigaciones Médicas modificada (mMRC) de ≥ 2, y más alto índice de BODE. Un grupo más alto de GOLD se correlacionó con peores resultados de CRSG, CAT y CES-D. El CES-D más alto se asoció con una caminata de una distancia más corta en seis minutos, peores puntuaciones de CRSG, CAT y mMRC, un grupo más alto de GOLD, y mayores ingresos de EPOC por año. Los pacientes con CES-D de ≥ 16 caminaron distancias más cortas. El cuartil más alto de BODE estuvo asociado con las puntuaciones peores de CRSG, CAT y CES-D. Conclusión: El grupo GOLD más alto y el cuartil más alto de BODE se asociaron con peores puntuaciones de calidad de vida y puntuaciones de depresión más altas. Los pacientes en los grupos de GOLD más altos deben ser tamizados para detectar si padecen depresión. La educación sobre la EPOC debe estar dirigida a aquellos que tienen una situación socioeconómica inferior.

Risk factors for first-time acute myocardial infarction patients in Trinidad.

BACKGROUND: The relative importance of coronary artery disease (CAD) risk varies globally. The aim of this study was to determine CAD risk factors for acute myocardial infarction (AMI) among patients in public health care institutions in Trinidad using a case-control type study design. METHODS: The sample comprised 251 AMI patients hospitalized between March 1, 2011 and April 30, 2012 and 464 age- and sex-matched non-AMI patients with no terminal or life-threatening illness and who did not undergo treatment for CAD. SPSS version 19 was used for data analysis that included chi-square tests, unadjusted and adjusted odds ratios (OR) and conditional multiple binary logistic regression. RESULTS: There was no difference in age between AMI and non-AMI patients (p = 0.551). Chi-square test revealed that clinical and lifestyle variables including stressful life, diabetes, hypertension, hypercholesterolaemia, ischaemic heart disease (IHD), a family history of IHD (p ≤ 0.001), smoking (p = 0.007) and alcohol consumption (p = 0.013) were associated with AMI; sex (p = 0.441), ethnicity (p = 0.366), age group (p = 0.826) and renal failure (p = 0.487) were not. Both unadjusted and adjusted (for age) ORs showed that the odds of hypertension, IHD and alcohol consumption were greater among AMI patients than among non-AMI patients for males; diabetes and IHD for females; and that the odds of a stressful life was greater among non-AMI patients and were the same for both groups with respect to sex, age > 45 years, hypercholesterolemia, renal insufficiency, and family history of IHD. Conditional multiple logistic regression showed that smoking [OR: 0.274, p ≤ 0.001, 95% CI for OR (0.140, 0.537)], a stressful life [OR: 2.697, p ≤ 0.001, 95% CI for OR (1.585, 4.587)], diabetes [OR: 0.530, p = 0.020, 95% CI for OR (0.310, 0.905)], hypertension [OR: 0.48, p = 0.10. 95% CI for OR (0.275, 0.837)] and IHD [OR: 0.111, p ≤ 0.001, 95% CI for OR (0.057, 0.218)] were the only useful AMI predictors. CONCLUSIONS: Smoking, diabetes, hypertension, IHD and decrease stress are useful AMI predictors.

Prevalence of COPD in Trinidad and Tobago - A National Study

Purpose: Chronic Obstructive Pulmonary Disease (COPD) is preventable and treatable, yet it is the third leading cause of death and fifth leading cause of disability globally. Local studies in restricted settings have reported about 20% COPD prevalence, but the national prevalence and risk factors are unknown. We aimed to measure the prevalence of COPD and its risk factors in Trinidad and Tobago as part of the multicentre Burden of Obstructive Lung Disease (BOLD) Study. Research Design and Methodology Used: A cross-sectional study was conducted during 2014-2015 using the BOLD standardised protocol. A stratified cluster sample of non-institutionalised males and females aged ≥ 40 years (N = 1104) and a sample of 18-39 year olds (N = 807) were selected. Questionnaires on respiratory symptoms, health status, and exposure to COPD risk factors were administered and spirometry conducted before and after bronchodilator. Spirometry quality control measures utilised were (1) direct spirometer feedback and (2) BOLD international centre review. Spirometry readings below international standards required technician retraining. Post- bronchodilator forced expiratory volume in the first second of expiration (FEV1) was expressed as a percentile of the forced vital capacity (FVC). COPD was defined by FEV1/FVC < 70% and a smoker as having smoked >200 cigarettes in a lifetime. Logistic regression was used to examine associations a (expressed as Odds Ratios (OR) and multivariate logistic regression to determine independent risk factors. Findings: There was a 95% response rate The mean age (SD) of these participants was 54 (11) years and Body Mass Index (BMI) 29 (7) kg/m2; with N (%) males, 443 (40) males; Afro-Trinidadians 400 (37), Indos 454(42), Mixed 234 (21), ever-smokers 302 (27), current smokers 157 (14), Adverse events 13(<1%)]. The prevalence of COPD was 9.5%, Of those with COPD, only 4% reported a previous doctor diagnosed COPD. COPD was more likely among those aged 60-69 years or over 70 (OR=4.15 and 5.88 respectively, p<0.001), among males (OR=1.64, p=0.023), ever smokers (OR=1.72, p=.016), retirees and the unemployed (OR=4.41 and 3.59 respectively, p<.001), with BMI<21 (OR=2.64, p=.001), asthma (OR=5.20, p<.001) or wheezing (OR=3.48, p<.001). Multivariate analysis showed significant risk factors for COPD were: older age groups, low BMI, working over a year in dusty jobs, cigarette or cannabis smoking. There was no non-responder bias in age, gender, ethnicity, smoking or BMI but unacceptable spirometry was more likely in the elderly and smokers. Among the 807 participants aged 18-39 years old, 23% smoked with the prevalence of smoking in males being 32% vs. 11.7% in females (p < 0.001). Conclusions: COPD is prevalent yet under-diagnosed in the general population. Health care education and use of spirometry for prevention of COPD should target males, the elderly, smokers, those working in dusty jobs and those with a history of asthma or wheeze. We suggest spirometry measurements be available at all district health facilities.

Global Registry of Acute Coronary Events (GRACE) Risk Score as a Predictor of In-hospital Mortality for Acute Coronary Syndrome in Trinidad and Tobago.

OBJECTIVE: To determine whether risk stratification using the Global Registry of Acute Coronary Events (GRACE) risk score is a predictor of in-hospital mortality for patients with acute coronary syndrome (ACS) in a multi-ethnic Caribbean population. METHOD: During a six-month period, all patients meeting the GRACE diagnostic criteria for one of the acute coronary syndromes were entered into a prospective single-centre study at one of the major public hospitals in Trinidad and Tobago. Clinical data, the GRACE risk score and in-hospital morbidity and mortality were recorded. Patients were placed into three GRACE risk categories: low, intermediate or high risk. RESULTS: There were 372 patients (mean age 63 years; males 56% and females 44%; hypertension 69%, diabetes mellitus 58%, positive smoking history 43%, previous myocardial infarction 34%), of which 25% were ST-segment elevation myocardial infarction, 56% non-ST-segment myocardial infarction and 19% unstable angina pectoris. In-hospital mortality was 8.3%. There were 35%, 33% and 32% of patients in the high, intermediate and low GRACE risk categories, respectively. The GRACE risk score demonstrated good discrimination (C statistic 0.82, 95% CI 0.755, 0879; p < 0.001) and good calibration (Hosmer-Lemeshow; p = 0.096) for in-hospital mortality in this ACS cohort. CONCLUSION: The GRACE risk score was found to be a reliable predictor of in-hospital mortality in this ACS population and therefore can be used to identify those high-risk patients who may benefit from aggressive management strategies, thereby allowing for more effective use of limited resources.

High prevalence of diabetes mellitus in a cohort of Trinidadian patients with chronic obstructive pulmonary disease

OBJECTIVE: To define the prevalence of diabetes mellitus (DM) in a cohort of Trinidadian chronic obstructive pulmonary disease (COPD) patients, and investigate its relationship to lung function, quality of life, and depression. DESIGN AND METHODS: Anthropometric and spirometric data were obtained from 108 COPD (91 males) patients from Trinidad chest clinics, who also had HbA1c test results. Questionnaires on quality of life St. George’s Respiratory questionnaire ({SGRQ} and COPD Assessment Test {CAT}) and depression (Center for Epidemiologic Studies Depression Scale {CES-D & CESD-R}) were administered, and an interview conducted. RESULTS: Mean (SD) age: 67.4 (11.0) years. Median (IQR) HbA1c: 6.1 (5.7, 6.7) %. HbA1c values were obtained for 105 patients of whom 40% had diabetes, and 40% pre-diabetes. Diabetics had a greater (p=0.001) median (IQR) BMI [27.3 (24.1, 30.4)] than non-diabetics [24.2 (21.2, 27.2)]. Patients with at least one chest infection/exacerbation in the past year had increasing CAT & SGRQ Total (p<0.001), and CES-D & CESD-R (p≤0.013) scores. CAT and SGRQ total scores were negatively related to lung function and Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages (p<0.001). All lung function parameters, except Forced expiratory volume/Forced vital capacity (FEV1/FVC), decreased with increasing CES-D and CESD-R scores (p<0.05). CAT & SGRQ correlated well with CES-D & CESD-R scores (p<0.001). Intravenous corticosteroid use was positively associated with HbA1c (p=0.043). Dosage of inhaled corticosteroids was associated with lower FEV1 (p=0.034) and higher SGRQ & CAT (p≤0.048). FVC % predicted was negatively related to HbA1c (p=0.033). CONCLUSION: The prevalence of DM in the COPD patients was 40%; however no significant correlations of DM to outcome measures were observed. Patients with worse quality of life due poor lung function were more depressed.

Correlates of vigorous physical activity in adolescents in five secondary schools in Trinidad

OBJECTIVE: To determine the correlates of vigorous physical activity in adolescents in Trinidad. DESIGN AND METHODS: Adolescents (n = 344) between 11-15 years from five secondary schools in North-central Trinidad were cross-sectionally surveyed. Behavioural risk factors: alcohol and smoking use, physical activity and diet were obtained by a pilot tested interviewer administered questionnaire. In addition, anthropometric measures were obtained on site at school. Multivariate logistical regression was used to analyze correlates of vigorous physical activity by sex. RESULTS: Fruit and vegetable intake (p < 0.001) and religion (p = 0.034) were correlated with vigorous physical activity in females. Lower waist circumference (p = 0.014), age (p = 0.046) and diastolic blood pressure (p < 0.01) were correlated with vigorous physical activity in males. Body mass index (BMI) for age data indicated that 41.3% of the children were overweight or obese. However, vigorous physical activity did not correlate with BMI for age in either sex. In the final logistic regression models, higher vigorous physical activity was associated with lower diastolic blood pressure in males (p < 0.05) and an increased daily intake of fruit and vegetables in females (p < 0.001). CONCLUSION: Increased dietary intake of fruits and vegetables in females and lower diastolic blood pressure in males were associated with higher vigorous physical activity. Prospective studies are required to determine and clarify the relative importance of diet and physical activity in overweight adolescents and their risk of chronic metabolic disease.

Tuberculosis – patients’ knowledge, attitudes and practices regarding their illness

OBJECTIVE: To determine tuberculosis (TB) patients’ knowledge, attitudes and practices with respect to their illness. DESIGN AND METHODS: A cross sectional study was conducted. 208 tuberculosis patients > 18 years of age who were currently receiving treatment were included. The study sample was selected from two major regional chest clinics in Trinidad. A pilot tested questionnaire was interviewer administered to each patient. RESULTS: Out of the 208 patients interviewed (response rate 65.0%), 129 were male, and 79 were female. The majority of patients had either secondary or tertiary level of education (54.8%), whereas only 43.8% had either primary level of education or none at all. Analysis revealed that TB knowledge was affected by a patient’s level of education, where persons with secondary/tertiary levels of education had a greater knowledge about TB (p<0.005). The majority (78.4%) of patients believed that they were not stigmatized; however, 191 (91.8%) patients urged for increased public awareness about TB in order to change perceptions toward the disease. The majority of patients were compliant towards their management advice, as well as taking their prescribed medications, however non- compliance was noted to be more likely in the under 50 year age group (9.8%), rather than the over 50 year age group (1.1%). CONCLUSION: Patients with at least secondary level education had better knowledge about tuberculosis than those with primary level education. Patients indicated the need for more public awareness about TB. Compliance with management (medication and attendance at clinics) was good among the majority of the 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.

Survival outcomes in renal transplantation in Trinidad and Tobago: SORTTT study.

OBJECTIVE: To assess patient and graft survival outcomes of renal transplant recipients from the National Organ Transplant Unit, Trinidad and Tobago. DESIGN AND METHODS: A retrospective descriptive analysis of renal transplants performed within five and half years (January 2006-June 2011) at the National Organ Transplant Unit was conducted. The age, gender ethnicity, cause of renal failure, donor type, outcome and complications were examined. The one, two and three-year patient and graft survival rates were analysed and factors affecting them were discussed. RESULTS: A total of 73 renal transplantations were done. Seventy (95.9%) were from live donors and 3 (4.1%) from deceased donors. Thirty-eight patients (52.1%) were males and 35 (47.9%) were females. The one-year, two-year and three-year patient survival rates were 91.46% (SE 0.04), 89.51% (SE 0.04) and 86.31% (SE 0.05), respectively. The one-year graft survival rate was 94.34% (SE 0.03). The two-year and three-year graft survival rates were the same at 92.69% (SE 0.03). The most significant complications seen in the recipients were those related to infections and cardiovascular disease: 47.9% of patients had a urinary tract infection, with the majority occurring at twelve months and 32.5% developed dyslipidaemia for the first time at six months. Seven patients developed erythrocytosis. CONCLUSION: The patient and graft survival rates in this new transplant programme are acceptable. Complications which can occur in transplant recipients are common and have a significant impact on post-transplantation quality of life and survival. Thus, continuing assessment of co-morbid factors pre and post-transplantation as well as the analysis of donor and recipient factors will lead to an increase in both patient and graft survival.

Survival outcomes in renal transplantation in Trinidad and Tobago - SORTTT study / Resultados de la supervivencia de transplante renal en Trinidad y Tobago - estudio RSTRTT

OBJECTIVE: To assess patient and graft survival outcomes of renal transplant recipients from the National Organ Transplant Unit, Trinidad and Tobago. DESIGN AND METHODS: A retrospective descriptive analysis of renal transplants performed within five and half years (January 2006 - June 2011) at the National Organ Transplant Unit was conducted. The age, gender, ethnicity, cause of renal failure, donor type, outcome and complications were examined. The one, two and three-year patient and graft survival rates were analysed and factors affecting them were discussed. RESULTS: A total of 73 renal transplantations were done. Seventy (95.9%) were from live donors and 3 (4.1%) from deceased donors. Thirty-eight patients (52.1%) were males and 35 (47.9%) were females. The one-year, two-year and three-year patient survival rates were 91.46% (SE 0.04), 89.51 % (SE 0.04) and 86.31% (SE 0.05), respectively. The one-year graft survival rate was 94.34% (SE 0.03). The two-year and three-year graft survival rates were the same at 92.69% (SE 0.03). The most significant complications seen in the recipients were those related to infections and cardiovascular disease: 47.9% of patients had a urinary tract infection, with the majority occurring at twelve months and 32.5% developed dyslipidaemia for the first time at six months. Seven patients developed erythrocytosis. CONCLUSION: The patient and graft survival rates in this new transplant programme are acceptable. Complications which can occur in transplant recipients are common and have a significant impact on post-transplantation quality of life and survival. Thus, continuing assessment of comorbid factors pre and post-transplantation as well as the analysis of donor and recipient factors will lead to an increase in both patient and graft survival.

OBJETIVO: Evaluar los resultados de supervivencia de pacientes y transplantes en relación con recipientes de transplante renal en la Unidad Nacional de Trasplante de Órganos de Trinidad y Tobago. DISEÑO Y MÉTODOS: Se realizó un análisis descriptivo retrospectivo de trasplantes renales de cinco años y medio (enero de 2006 - junio de 2011) en la Unidad Nacional de Trasplantes de Órganos. Se examinó la edad, el género, la etnicidad, la causa de la insuficiencia renal, el tipo de donante, la evolución clínica del paciente, y las complicaciones. Se analizaron las tasas de supervivencia de pacientes y transplantes, de uno, dos y tres años, y se discutieron los factores que las afectan. RESULTADOS: Se realizaron un total de 73 trasplantes renales. Setenta (95.9%) fueron de donantes vivos, y tres (4.1%) de donantes muertos. Treinta y ocho pacientes (52.1%) eran varones y 35 (47.9%) eran hembras. Las tasas de supervivencias de uno, dos y tres años relativas a los pacientes, fueron 91.46% (SE 0.04), 89.51% (SE 0.04) y 86.31% (SE 0.05), respectivamente. La tasa de supervivencia de transplante de un año fue 94.34% (SE 0.03). Las tasas de supervivencia de transplante de dos y tres años fueron iguales, alcanzando un 92.69% (SE 0.03). Las complicaciones más significativas observadas en los recipientes fueron las relacionados con infecciones y la enfermedad cardiovascular: 47.9% de los pacientes tenían infección de las vías urinarias, teniendo lugar la mayoría de ellas a los doce meses, en tanto que el 32.5% desarrolló dislipidemia por primera vez a los seis meses. Siete pacientes desarrollaron eritrocitosis. CONCLUSIÓN: Las tasas de supervivencia de pacientes y transplantes en este nuevo programa de trasplante son aceptables. Las complicaciones que pueden ocurrir en los recipientes son comunes y tienen un impacto significativo en la calidad de vida postransplante. Por lo tanto, continua evaluación de los factores comórbidos pre- y postransplante, así como el análisis de donantes y recipientes conducirá a un aumento de la supervivencia, tanto de los pacientes como de los transplantes.

Report on the first palliative care conference in Trinidad and Tobago

BACKGROUND: When the burdens of curative treatment outweigh the benefits, the goal of a patient's care may change from curing to comfort also called palliative care. It improves the quality of life of patients and families who face life-threatening illness, by providing pain and symptom relief, spiritual and psychosocial support from diagnosis to the end of life and bereavement. The essential components of palliative care are effective control of symptoms and effective communication with patients, their families, and others involved in their care. Rehabilitaion, with the aim of maximizing independence, is also essential. As the disease progresses, continuity of care becomes increasingly important, coordination between services is required, and information must be transferred promptly and effeciently between professionals in the community, in hospitals, and in hospices. Objectives: This report seeks to highlight the beginnings of palliative care worldwide and in Trnidad and Tobago, how these services developed and what the citizens of Trinidad and Tobago have available at their disposal and lastly, a bit about how this field is projected to develop in the future. METHODOLOGY: For this report interviews were conducted with Dr. Richard Clerk and other members of the board of the Palliative Care Society of Trinidad and Tobago. Information was also collected at the palliative care society inaugural palliative care conference. This conference ran from the 22nd to the 23rd October, 2011. Major findings: Palliative care services in Trinidad and Tobago include 3 major hospices in Port of Spain and St. James, and other is being established at the Petrotrin Medical Centre located at Point a Pieere..... CONCLUSION: The population of Trinidad and Tobago is aging, as such there is a greater demand for palliative care, however services in Trinidad and Tobago are far from adequate for our popualtion however, great strides are being taken to resolve this deficit.....

Sarcoidosis in a 42 year old AfroCaribbean male who presented with pulmonary embolism: a case report and review of literature.

We present a case of a 42 year old Afro-Caribbean man presenting with pulmonary embolism and gastroesophageal reflux disease, Transbrachial lung biopsy revealed non-caseating granulomata and on the basis of excluding other conditions, the patient was also diagnosed with sarcoidosis. The only identifiable risk factor for his pulmonary embolus was obesity. A literature review is performed of cases with similar presentations. We propose that sarcoidosis may be a contributing factor in enhancing this prothrombotic predisposition

Audit of sudden deaths in the accident and emergency department of a tertiary hospital in Trinidad and Tobago.

OBJECTIVE: To determine the proportion of deaths due to confirmed myocardial infarction (CMI) and the aetiology of sudden death at the Port-of-Spain General Hospital (A&E) department for January to June 2008. METHODS: This retrospective study utilized the death register to determine the number of A&E deaths for the study period. Patients dying from MI were investigated using records to obtain ECG and postmortem reports. RESULTS: During the study period, 150 patients were certified dead in the A&E department. Cardiovascular causes accounted for 42.7% (n = 64) of deaths. Confirmed MI accounted for 27.3% (n = 41) of deaths and 3.3% (n = 5) were certified by a private practitioner without post-mortem examination and were classed as unconfirmed MI. Trauma related deaths followed with 27.3% (n = 41). Deaths from firearm injury were the next most common, 19.3% (n = 29). The mean age of patients dying from CMI was 64.1 years with a male to female ratio of 2:1. Males died from CMI on average 6.3 years before females. Mortality peaked for females in the 80 - 89-year age group while for males it was the 60- 69-year age group. Afro-Trinidadians accounted for 58.5% (n = 24) deaths due to CMI. More CMI patients had combined DM and HTN 36.6% (n = 15) than either condition alone. Afro-Trinidadians were more likely to be hypertensive and Indo-Trinidadians, diabetic. Death on arrival was the most common presentation for MI patients, 65.9% (n = 27). CONCLUSIONS: This study shows that the main cause of death in the A&E Department at the Port-of-Spain General Hospital was MI. Trauma related deaths followed. Men died from MI at an earlier age than women. Most MI patients were dead on arrival.