Experiences with SARS-CoV-2 (Covid-19) in Trinidad and Tobago, a small island developing state: realities and opportunities.

The COVID-19 pandemic has exerted significant global challenges that are expressed in a variety of socio-politico-economic scenarios, depending upon individual countries' preparedness and resilience. The impact COVID-19 in Small Island Developing States (SIDS), most of which are categorized as Lower and Middle-Income Countries, has been pronounced. Furthermore, many of these SIDS possess specific vulnerabilities to global threats. This paper contextualizes the experience of Trinidad and Tobago from some perspectives of geoeconomics, healthcare, and international relations. In many ways, the experience is similar to that of other SIDS with the inherent nuances of a post-colonial world. Trinidad and Tobago was ranked number one by the Oxford University COVID-19 Government Response Tracker (OxCGRT) "Lockdown rollback checklist: Do countries meet WHO recommendations for rolling back lockdown?". Despite the significant political support to combat the disease, by the end of 2022, the country had recorded over four thousand deaths and just over 50% of the population is vaccinated. This paper seeks to discuss the successes and challenges faced by this twin island state.

Dengue hemorrhagic fever in Trinidad and Tobago: a case for a conservative approach to platelet transfusion.

Dengue fever is endemic to Trinidad and Tobago. A retrospective analysis of all adult admissions at a tertiary hospital in Trinidad treated for dengue during January 1-December 31, 2008 was performed. A total of 186 patients were treated during this period: 98.9% (184) of the patients were thrombocytopenic; 45.2% were severely thrombocytopenic; 13 patients showed development of minor hemorrhage and only one case of major hemorrhage; platelet transfusion was given for 7% (13) of the cases; and 6 cases for which platelet transfusion was given did not show evidence of plasma leakage (12 of these cases did not show evidence of hemorrhage). There was a strong association between the lowest platelet value and hemoconcentration (χ(2) = 13.16, P < 0.025). No association was found between giving a platelet transfusion and hemoconcentration or hemorrhage. Thrombocytopenia seen in dengue resolves spontaneously and independent of any transfusion used.

Association of low serum creatinine, abnormal lipid profile, gender, age and ethnicity with type 2 diabetes mellitus in Trinidad and Tobago.

OBJECTIVE: To study the association of low serum creatinine, abnormal lipid profile and demographic variables with type 2 diabetic Trinidadian subjects. METHODS: Data were obtained from a cohort of 1122 diabetic and non-diabetic patients from clinics in Trinidad. Variables measured included demographics, HbA1(c), serum creatinine, lipid profile values and diabetic status. RESULTS: The sample consisted of 476 males (61.6% diabetic) and 646 females (50.3% diabetic). Most patients (59.2%) were Indo-Trinidadian, 23.4% were Afro-Trinidadian and 13.5% were of 'mixed' and 'other' categories. The majority (55.1%) of the patients were diabetic and diabetics were older than non-diabetics (p=0.000). Abnormal lipid profile OR=0.728, CI (0.532, 0.994), serum creatinine categories OR=1.520, CI (1.317, 1.754), gender OR=0.690, CI (0.533, 0.892) and age groups OR=1.305, CI (1.185, 1.437) were useful predictors of type 2 diabetes. Ethnicity was not a useful predictor: OR=1.007, CI (0.869, 1.168). Serum creatinine (mean) was found to be lower in diabetics aged 21-50 than in their non-diabetic counterparts. However, above 50 years old, the reverse was true. Serum creatinine means were higher in males than in females (p=0.000). CONCLUSION: Abnormal lipid profile, gender, age and serum creatinine are associated with type 2 diabetes. While age and gender are non-modifiable risk factors, steps should be taken to monitor and control the serum creatinine and lipid profile values of diabetics and non-diabetics.

Conservative management for idiopathic granulomatous mastitis mimicking carcinoma: case reports and literature review.

Idiopathic granulomatous mastitis (IGM) is a relatively rare condition and may commonly mimic carcinoma. Clinically and radiologically, these lesions could be misdiagnosed as carcinoma and histopathology is the most definitive method of diagnosis and to differentiate it from other granulomatous conditions such as sarcoidosis and Wegener's granulomatosis. We report two cases of IGM presenting with ill-defined indurated mass, peau d'orange and ulcerative lesions clinically mimicking carcinoma. They were successfully treated with corticosteroids. Even abscesses can be aspirated and avoid surgery. A high index of suspicion is necessary to diagnose this condition to prevent unnecessary mastectomy.

Erythema migrans-like illness among Caribbean islanders.

Erythema migrans is the skin manifestation of Lyme disease and southern tick-associated rash illness. Neither disease is found in the Caribbean. We report 4 cases of erythema migrans of a possible emerging clinical entity, Caribbean erythma migrans-like illness.

Benign cervical multi-nodular goiter presenting with acute airway obstruction: a case report.

INTRODUCTION: Benign cervical goiters rarely cause acute airway obstruction. CASE PRESENTATION: We report the case of a 64-year-old woman of African descent who presented with acute shortness of breath. She required immediate intubation and later a total thyroidectomy for a benign cervical multi-nodular goiter with no retrosternal tracheal compression. CONCLUSION: Benign multi-nodular goiters are commonly left untreated once euthyroid. Peak inspiratory flow rates should be measured via spirometry in all goiters to assess the degree of tracheal compression. Once tracheal compression is identified, an elective total thyroidectomy should be performed to prevent morbidity and mortality from acute airway obstruction.

Benign cervical multi-nodular goiter presenting with acute airway obstruction: a case report

INTRODUCTION: Benign cervical goiters rarely cause acute airway obstruction. CASE PRESENTATION: We report the case of a 64-year-old woman of African descent who presented with acute shortness of breath. She required immediate intubation and later a total thyroidectomy for a benign cervical multi-nodular goiter with no retrosternal tracheal compression. CONCLUSION: Benign multi-nodular goiters are commonly left untreated once euthyroid. Peak inspiratory flow rates should be measured via spirometry in all goiters to assess the degree of tracheal compression. Once tracheal compression is identified, an elective total thyroidectomy should be performed to prevent morbidity and mortality from acute airway obstruction.

Perioperative outcome of carotid endarterectomy with regional anesthesia: two decades of experience from the Caribbean

STUDY OBJECTIVE: To evaluate the perioperative outcome of carotid endarterectomy (CEA) with regional anesthesia. DESIGN: Retrospective chart review of consecutive patients who underwent CEA with regional anesthesia in a 23-year period. SETTING: Operating rooms of a general hospital in a developing country. MEASUREMENTS: Demographic data, perioperative clinical data, postoperative morbidity and unplanned admissions were recorded. MAIN RESULTS: A total of 183 CEA procedures were performed. In 172 cases, CEA was done exclusively with deep cervical plexus block and local infiltration, while in 11 (6%) cases, there was a need for conversion to general anesthesia intraoperatively. Clamping of the internal carotid artery (ICA) for a three-minute period was the method used to monitor any development of neurological impairment. Perioperative complications included intraoperative seizures in one patient, intraoperative transient hemiparesis in three patients, postoperative transient hemiparesis in two patients, and intraoperative hemiplegia in one patient. One hundred fifty-three patients (83.6%) were discharged home within 24 hours, and 29 (15.8%) were discharged home in 48 hours. The hemiplegic patient had a hospital stay of 12 days. There was no perioperative mortality. CONCLUSIONS: Regional anesthesia is a safe method for CEA in a limited-resources setting, as it facilitates intraoperative clinical assessment of the effects of ICA clamping.

Perioperative outcome of carotid endarterectomy with regional anesthesia: two decades of experience from the Caribbean.

STUDY OBJECTIVE: To evaluate the perioperative outcome of carotid endarterectomy (CEA) with regional anesthesia. DESIGN: Retrospective chart review of consecutive patients who underwent CEA with regional anesthesia in a 23-year period. SETTING: Operating rooms of a general hospital in a developing country. MEASUREMENTS: Demographic data, perioperative clinical data, postoperative morbidity and unplanned admissions were recorded. MAIN RESULTS: A total of 183 CEA procedures were performed. In 172 cases, CEA was done exclusively with deep cervical plexus block and local infiltration, while in 11 (6%) cases, there was a need for conversion to general anesthesia intraoperatively. Clamping of the internal carotid artery (ICA) for a three-minute period was the method used to monitor any development of neurological impairment. Perioperative complications included intraoperative seizures in one patient, intraoperative transient hemiparesis in three patients, postoperative transient hemiparesis in two patients, and intraoperative hemiplegia in one patient. One hundred fifty-three patients (83.6%) were discharged home within 24 hours, and 29 (15.8%) were discharged home in 48 hours. The hemiplegic patient had a hospital stay of 12 days. There was no perioperative mortality. CONCLUSIONS: Regional anesthesia is a safe method for CEA in a limited-resources setting, as it facilitates intraoperative clinical assessment of the effects of ICA clamping.

Fish faddism causing low-level mercury poisoning in the Caribbean: two case reports

Two otherwise healthy middle-aged males presented with persistent abdominal and lower- back pain, progressive weakness, paraesthesias, fatigue and weight loss over 8-12 months. Extensive work-up failed to localize organ pathology. Both men, strongly aware of the nutritional benefits of fish had a diet dedicated of canned and fresh fish. Raised blood mercury levels confirmed clinical suspicion and serial levels declined with symptom resolution after excluding dietary fish. To gain reported health benefits of fish as a healthy food modest consumption is encouraged. Efforts to monitor fish consumption and mercury residues in fish are recommended in Trinidad and Tobago.

Fish faddism causing low-level mercury poisoning in the Caribbean: two case reports.

Two otherwise healthy middle-aged males presented with persistent abdominal and lower- back pain, progressive weakness, paraesthesias, fatigue and weight loss over 8-12 months. Extensive work-up failed to localize organ pathology. Both men, strongly aware of the nutritional benefits of fish had a diet dedicated of canned and fresh fish. Raised blood mercury levels confirmed clinical suspicion and serial levels declined with symptom resolution after excluding dietary fish. To gain reported health benefits of fish as a healthy food modest consumption is encouraged. Efforts to monitor fish consumption and mercury residues in fish are recommended in Trinidad and Tobago.

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.

What do we do about the problem of overweight and obesity in the Americas?

Within the last two decades the prevalence of obesity in the developed world has moved from single digits to near 20 percent. Even more alarming is that within the same time frame the prevalence of overweight in the developing world has exceeded that in the developed countries, with. for example, rates of up to 30 percent in adult females being reported in the Caribbean. This disproportionate increase in the developing world is expected to accelerate even further since individuals, health care providers, and planners have been slow to either recognize or react to the problem. Individuals have been blinded by cultural factors that interpret obesity as desirable and a sign of wealth and economic success. Many planners lack sufficient financial resources and personnel-and, most importantly, adequate local data with which to influence public policy decisions. Clinicians have been coached in the model of acute care, and they operate in environments ill suited to handling chronic, lifestyle-related diseases.

Glucocorticoids and the skin

Glucocorticoids are the most effective anti-inflammatory agents currently available, but a variety of adverse effects limit their clinical usefulness. This work explores further two facets of their interaction between glucocorticoids and the skin, with the aim of identifying means of reducing glucocorticoid toxicity. (a) Metabolism of glucocorticoids by skin: Human skin is active in the terminal metabolism of corticol to cortisone, but the biological implications of this process in skin are uncertain. BEcause there are technical difficulties in dealing with human skin, an animal model, the nude mouse, has been evaluated for its suitability to the study of the metabolism of corticosterone to IIB-dehydrocorticosterone (the homologous reaction in rodents of cortisol to cortisone conversion in man); a process mediated by IIB-hydroxysteroid dehydrogenase. (b) Skin vasoconstrictor response (blanching) to topical glucocorticoids: Glucocorticoids applied topically to human skin produce vasoconstriction in dermal vessels, the degree of which correlates closely with the potency and clinically efficacy of these compounds (AU)

Is medicine as a professional career a good financial investment

It may be common perception that doctors earn too much. The aim of this study was to determine whether the financial returns after graduation in medicine are commensurate with the cost of training, and for comparative purposes, have also evaluated corresponding cost return ratios for a cohort of engineers and business undergraduates who entered the University of the West Indies simultaneously. Standard financial analytical techniques viz., net present value (NPV), internal rate of return (IRR) and hours adjusted net cash flow were employed to determine the return on educational investment over a thirteen-(13) year horizon. Our assumptions were that the cost of education was borne by a subsidized students' revolving loan, and the cost of living by a loan at commercial rates, and that all graduates obtained employment as soon as they graduated in the public service. Opportunity cost was calculated at the salary of a clerk in the public service. Our findings revealed that engineering graduates were the only group with an hours adjusted (NPV) that was positive (0.08). Physicians fared worse with persistently negative hours adjusted NPV. The annual yield on educational investment (hours adjusted IRR) was 9.5 percent for business, 14.6 percent for engineers and negative (incalculable) for physicians. When sensitivity analysis was performed, engineers and business groups improved their returns but the status of physicians was no better. Without subsidization the cost of education relative to returns could preclude medicine as a career choice (AU)

Benign cervical multi-nodular goiter presenting with acute airway obstruction: a case report

Introduction: Benign cervical goiters rarely cause acute airway obstruction. Case presentation: We report the case of a 64-year-old woman of African descent who presented with acute shortness of breath. She required immediate intubation and later a total thyroidectomy for a benign cervical multi-nodular goiter with no retrosternal tracheal compression. Conclusion: Benign multi-nodular goiters are commonly left untreated once euthyroid. Peak inspiratory flow rates should be measured via spirometry in all goiters to assess the degree of tracheal compression. Once tracheal compression is identified, an elective total thyroidectomy should be performed to prevent morbidity and mortality from acute airway obstruction.