Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 76
Filtrar
1.
Cureus ; 13(8): e17573, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34646628

RESUMO

Sodium-glucose co-transporter 2 inhibitors (SGLT2-I) have revolutionized the treatment of type 2 diabetes mellitus during the last decade. It has not only proven to be very effective for glycemic control but also has adjunctive effects in the management of heart failure, hypertension, and diabetic nephropathy, and even contributes to weight loss. Another benefit is the apparent lack of major side effects, particularly hypoglycemia, apart from euglycemic diabetic ketoacidosis. The most well-known side effects are genital mycotic infections and urinary tract infections (UTI). Although pruritus is less well known, we highlight in this case study this side effect as notable albeit uncommon so as to sensitize clinicians to its possibility.

4.
Int J Nephrol Renovasc Dis ; 14: 173-192, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34135618

RESUMO

Purpose: The determinants of quality of life for patients on renal replacement therapy vary across the world. The aim of this study is to determine the quality of life of patients on renal replacement therapy in Trinidad and Tobago and predictors thereof. Patients and Methods: This cross-sectional study took place over a 1-year period. Data were obtained from 530 out of 1383 patients meeting inclusion criteria (100 transplants, 80 peritoneal dialyses, 350 hemodialyses) using the survey instruments. Stratified random sampling with proportional allocation was used to select patients at hemodialysis centres. The Kidney Disease Quality of Life questionnaire (KDQOL-36), EuroQol and demographic questionnaires were administered via face-to-face interviews. SPSS24, STATA14 and MINITAB18 were used for descriptive and inferential data analysis. Results: Of the 530 patients, 52.5% were male, 37.5% were in the 56-65 years age group and 51.3% were of Indo-Trinbagonian descent. Hypertension (25.5%) and type 2 diabetes mellitus (62.0%) were reported as the main causes of kidney disease in the dialysis group. In the transplant category, chronic glomerulonephritis (45%) was the main aetiology of kidney disease. The KDQOL-36 domain scores and significantly associated variables included modality of renal replacement, Charlson's Comorbidity Index, ethnicity, income and employment status. Transplant patients had higher mean subcomponent Kidney Disease Quality of Life scores and performed better in the EuroQol than patients on dialysis. Patients on peritoneal dialysis had a better quality of life than hemodialysis patients. Among patients on hemodialysis, an arteriovenous fistula significantly impacted their quality of life. Conclusion: Renal transplant recipients enjoy the best quality of life and health state among patients on renal replacement therapy in Trinidad and Tobago. Increasing patients' access to renal transplantation or peritoneal dialysis will markedly improve health status for the number of years of renal replacement therapy.

5.
Radiol Case Rep ; 16(6): 1493-1498, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33936355

RESUMO

Retroperitoneal liposarcomas are rare mesenchymal tumors which carry a poor prognosis because of their late presentation. When symptoms do occur, they are usually nonspecific and related to mass effect or invasion of local structures. Rarely, retroperitoneal liposarcomas can clinically and biochemically mimic phaeochromocytomas. We discuss one such case of a 56-year-old Afro-Trinidadian female who presented to her primary care physician with a 3-month history of weakness, intermittent sweating, difficulty sleeping and elevated blood pressure. After a 2 week trial of an oral antihypertensive regime her blood pressure was still elevated and she complained of new right sided abdominal pain. A subsequent Computed Tomography scan of her abdomen revealed an enhancing, heterogeneous right suprarenal mass suspicious for pheochromocytoma. Urinary catecholamines were also elevated and an MRI of her abdomen supported the diagnosis of pheochromocytoma although intralesionsal fat was noted, an uncommon feature of pheochromocytomas. She was booked for laparoscopic adrenalectomy. Histological analysis of the resected specimen confirmed a dedifferentiated retroperitoneal liposarcoma. While the imaging features of phaeochromocytomas and retroperitoneal liposarcomas can be similar, the presence of intralesional fat on CT and MRI should favour the diagnosis of a retroperitoneal liposarcoma, albeit the clinical and biochemical picture.

6.
Cureus ; 13(3): e14087, 2021 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-33903844

RESUMO

Often described as a clinico-radiological entity, posterior reversible encephalopathy syndrome (PRES) is being increasingly diagnosed nowadays. However, mystery still surrounds its exact etiology. Though there are no standardized diagnostic criteria for this syndrome, there is a consistent feature associated with it: brain vasogenic edema in combination with neurotoxicity. The nonspecific nature of this condition leaves room for the diagnosis to be overlooked, leading to delays in providing appropriate treatment and unfavorable patient outcomes. PRES is associated with a variety of medical conditions including hypertension, eclampsia, autoimmune conditions, renal failure, sepsis, and an immunocompromised state, such as that secondary to the use of immunosuppressive therapy, human immunodeficiency virus (HIV), and organ transplants. Treatment by a multidisciplinary team and prompt identification and reversal of the underlying cause can lead to beneficial outcomes, as in the case we present in this report.

7.
Med Hypotheses ; 144: 110220, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33254527

RESUMO

Marked ethnic variations in complications and mortality have been noted following infection with COVID-19, with Black, Asian, and minority ethnic groups (BAME) being particularly hard hit. We hypothesise that glucocorticoid resistance stemming from several intrinsic reasons such as chronic social stress and lower circulating levels of Vitamin D may contribute to the exaggerated inflammatory response, more severe disease and poorer outcomes observed in BAME.


Assuntos
COVID-19/tratamento farmacológico , Glucocorticoides/uso terapêutico , Grupos Minoritários , Grupo com Ancestrais do Continente Africano , Anti-Inflamatórios/uso terapêutico , Grupo com Ancestrais do Continente Asiático , COVID-19/complicações , COVID-19/epidemiologia , Resistência a Medicamentos , Grupos Étnicos , Humanos , Modelos Biológicos , Pandemias , SARS-CoV-2 , Índice de Gravidade de Doença , Estresse Psicológico/complicações
9.
Artigo em Inglês | MEDLINE | ID: mdl-32879902

RESUMO

Air pollution is the most significant environmental risk factor for all-cause mortality, and it has caused substantial disability-adjusted life-years and economic loss. Air pollution intensified the mortality during past pandemics, Spanish flu in 1918 and SARS-CoV-1 in 2003. It increases host susceptibility and virulence of respiratory infections and reduces viral clearance. Thus, a question arises whether there will be any impact of air pollution on the current pandemic coronavirus disease 2019 (COVID-19)? Thus far, history and science are directing towards an immense potential impact of air pollution on the COVID-19 pandemic. Some of the devastated countries with the current pandemic are those with a poor air quality index. Further epidemiological and ecological studies are necessary to confirm this association. Also, countries must mobilize funding for mitigation of air pollution to benefit environmental health and ameliorate its potential effects on pandemics of the future.


Assuntos
Poluição do Ar/efeitos adversos , COVID-19/epidemiologia , Pandemias/estatística & dados numéricos , COVID-19/mortalidade , Humanos , Incidência
11.
J Hum Hypertens ; 2020 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-32704029

RESUMO

Hypertension is a major risk factor for cardiovascular disease globally. Although Indian studies have addressed the prevalence of hypertension and its associated factors, this study focuses upon women in the reproductive age group, 15-49 years, who have undiagnosed hypertension. We use NFHS-4 data for secondary analyses of prevalence and factors associated with undiagnosed hypertension among women aged 15-49 years in India. Multiple logistic regression was undertaken to identify associated factors. Our analyses showed that overall prevalence of undiagnosed hypertension was 18.69% among women aged 15-49 years in India. In rural areas, it was 17.09% compared  and 21.73% in urban areas. By comparison, only 8.86% self-reported a diagnosis of hypertension. Factors associated with undiagnosed hypertension were age, less than or more than normal BMI, higher wealth quintiles, no education, religion, caste, and geographical zones. Almost one in five women aged 15-49 years in India has undiagnosed hypertension with implications for personal and reproductive health.

12.
P R Health Sci J ; 39(2): 216-221, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32663921

RESUMO

OBJECTIVE: Both periodontal disease and peripheral neuropathy are complications associated with poorly controlled diabetes. This study aimed to determine whether periodontal disease was more prevalent and more severe among patients with severe diabetic peripheral neuropathy. METHODS: A case-control study was performed; 46 patients with and 48 without the slipping slipper sign (SSS)-a surrogate clinical marker for severe peripheral neuropathy-were recruited from a diabetic outpatient clinic. Demography and data from the Basic Periodontal Examination (BPE) were assessed, in addition to the patients' periodontal health by 2 examiners blinded to patients' SSS status. Multivariate logistic regression was used to evaluate the associations between the risk factors for and the presence of the SSS, adjusting for age, gender, and ethnicity. RESULTS: The mean age of the sample was 55.8 years (±10.69 years). Most of the participants (77.7%) had either never been to a dentist or had last attended a dental clinic more than a year before this examination, and 83% did not have a dentist. Periodontal disease was advanced in 61.7%, and there was no association between the SSS and periodontal disease. Dental-service utilization variables were significantly associated with the SSS. Patients who did not have a regular dentist were more than 7 times more likely to have the SSS than were those who did (OR = 7.70; 95% CI: 1.12 53.21). CONCLUSION: In diabetic patients, oral health-related risk factors, such as not having a dentist, wearing a denture or dentures, and visiting a dentist once a year or more, may be associated with systemic complications, including peripheral neuropathy. Early collaboration between dentists and doctors on the care of patients with diabetes is recommended.

13.
Respirology ; 25(8): 802-803, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32533588
14.
J Neuromuscul Dis ; 7(2): 175-181, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31929118

RESUMO

BACKGROUND: Neuropathic feet are at very high risk for infection and amputation. The slipping slipper sign (SSS) is elicited by a simple questionnaire test reported to detect the presence of severe diabetic peripheral neuropathy. This test can be administered by non-medical staff. In this study, subjects with and without the SSS were evaluated by nerve conduction studies (NCS) and ultrasound measurements of the right sural nerve diameters as well as with traditional scoring systems for peripheral and autonomic neuropathy. OBJECTIVE: To demonstrate that the Slipping Slipper Sign can be used as an index of severe diabetic peripheral neuropathyMethod:This was a prospective cross sectional study in which 74 patients with diabetes (38 positive and 36 negative for SSS) underwent ultrasonography and NCS of the right sural nerve by an examiner blinded to SSS status. Findings were evaluated against demography, clinical history, anthropometry as well as traditional clinical and autonomic neuropathic scores. RESULTS: Patients without the SSS [median (IQR) = 10.0 years (4.0-20.3)] had a significantly shorter duration of diabetes compared with those with the SSS [median (IQR) = 15.0 years (8.5-25.0)], p = 0.028. The frequencies of retinopathy (36.8% vs 2.8%, p <  0.05) and cerebrovascular accidents (18.4% vs 13.9 %, p <  0.05) were higher among those with SSS compared with those without. Differences in nerve conduction characteristics were markedly significant. The amplitude of the sural sensory nerve action potential (SNAP) was ([median (IQR)] 0 microvolts vs 4.0 microvolts (0.0-10.8) p <  0.002) between those with and without SSS, respectively whilst none of patients with SSS had a recordable SNAP vs 78% without a SSS. Similarly, maximal thickness of the right sural nerve at the ankle 3.0 mm (2.3-3.4) vs 3.5 mm (3.0-3.9), and leg 3.4 mm (2.7-3.8) vs 3.9 mm (3.3-4.2) was reduced, p <  0.01 in patients with the SSS compared with those with a negative SSS. CONCLUSION: The SSS identifies feet with objective neurophysiological and imaging characteristics of severe neuropathy.


Assuntos
Neuropatias Diabéticas/diagnóstico por imagem , Neuropatias Diabéticas/diagnóstico , Neuropatias Diabéticas/fisiopatologia , Nervo Sural/diagnóstico por imagem , Nervo Sural/fisiopatologia , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Condução Nervosa/fisiologia , Estudos Prospectivos , Índice de Gravidade de Doença , Método Simples-Cego , Ultrassonografia
15.
Artigo em Inglês | MedCarib | ID: biblio-1284261

RESUMO

This study aims to evaluate the effect or lack thereof, of glucocorticoids on Black, Asian, and Minority ethnic groups (BAME) when compared to white populations in the setting of COVID-19 treatment


Assuntos
Humanos , Masculino , Feminino , Grupos Étnicos , COVID-19
17.
Med Hypotheses ; 130: 109270, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31383344

RESUMO

Idiopathic oedema is a syndrome affecting primarily women that is characterized by frustrating intermittent fluid retention, with hallmarks of obesity, periodic oedema, anxiety, and a susceptibility to develop type 2 diabetes. Management is typically reassurance and weight control, with no known drug class proven to provide consistent relief. We hypothesise that sodium-glucose cotransporter 2 inhibition is a logical intervention in the treatment of idiopathic oedema, having effects on obesity, blood pressure, impaired glucose tolerance, sympathetic overdrive, and reduction in swelling - the most common and distressing complaint. Sodium-glucose cotransporter 2 inhibition by promoting greater electrolyte-free, but glucose driven, water clearance with preferential fluid clearance from the interstitial space, without compromising intravascular volume, may provide symptomatic relief of swelling and bloating. The consequent weight reduction secondary to caloric loss from renal glycosuria and decreased adiposity would prevent disease progression of type 2 diabetes or pre-diabetes. With diminished adrenergic output from central and peripheral autonomic influences, reduction of blood pressure occurs, and by similar mechanisms, anxiety may be reduced.


Assuntos
Edema/tratamento farmacológico , Inibidores do Transportador 2 de Sódio-Glicose/farmacologia , Transportador 2 de Glucose-Sódio/metabolismo , Ansiedade/complicações , Sistema Nervoso Autônomo , Compostos Benzidrílicos/farmacologia , Pressão Sanguínea , Estudos Cross-Over , Eletrólitos , Feminino , Intolerância à Glucose , Glucosídeos/farmacologia , Hemodinâmica , Humanos , Modelos Teóricos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Perda de Peso
18.
Radiol Case Rep ; 14(7): 791-794, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31011381

RESUMO

Splenic artery pseudoaneursym is relatively rare and its rupture is usually fatal. We report a case of a 48-year-old male with 2 prior episodes of alcoholic pancreatitis that presented with massive per rectal bleeding from rupture of a splenic artery pseudoaneurysm into the transverse colon. Gold standard of diagnosis is CT angiography of the abdomen. We present the first case in the literature where a diagnosis has been made with noncontrast CT of the abdomen and described the radiologic features that facilitated this diagnosis.

19.
Open Heart ; 6(1): e000841, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30997117

RESUMO

Objectives: This novel, pilot study aimed to assess the estimated prevalence of high on-treatment platelet reactivity (HPR) in Trinidad and Tobago. Methods: Patients (n=40) who were awaiting elective percutaneous coronary intervention on maintenance dual antiplatelet therapy (DAPT) with aspirin 81 mg daily and clopidogrel 75 mg or loaded at least 48 hours prior were recruited. Platelet reactivity with the VerifyNow P2Y12 assay (Accriva Diagnostics, San Diego, California, USA) was assessed prior to cardiac catheterisation. Results: 60.7% (17/28) of the South Asian (Indo-Trinidadians) patients had HPR, whereas 14.3% (1/7) of Africans and 40% (2/5) of mixed ethnicity had HPR. There was a significant association between HPR (P2Y12 reaction units >208) and ethnicity with South Asians (Indo-Trinidadians) (OR 5.4; 95% CI 1.18 to 24.66, p=0.029). Conclusions: This pilot study serves to introduce the preliminary observation that the estimated prevalence of HPR is considerably higher within the heterogeneous population in Trinidad at 50% as compared with predominantly Caucasian studies. Furthermore, the HPR is significantly higher in South Asians (Indo-Trinidadians) (>60% of patients) which has severe clinical repercussions considering the cardiovascular disease pandemic. Clopidogrel may not be a satisfactory or optimal antiplatelet agent in this subgroup, and therefore, another more potent antiplatelet such as ticagrelor should be used instead. Further large-scale studies are imperative to confirm these findings. (Funded by the University of the West Indies, St. Augustine; POINT ClinicalTrials.gov number, NCT03667066.).

20.
Endocr Pract ; 25(7): 657-662, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30865530

RESUMO

Objective: A previous Trinidadian survey highlighted the investigative and therapeutic approaches selected by general practitioners (GPs) in managing thyrotoxicosis. The main objective of this study was to compare practice with existing guidelines. Methods: In this cross-sectional study a pretested de novo questionnaire was self-administered to GPs throughout Trinidad. The survey evaluated GPs' choices in management of thyrotoxicosis cases and compared their responses to the 2016 American Thyroid Association guidelines as well as with those previously reported locally. Results: A total of 159 completed questionnaires were analyzed (59% response rate). Thyroid stimulating hormone was the preferred (94%) biochemical test to confirm thyrotoxicosis etiology. A combination of ultra-sound and thyroid scintigraphy, thyroid ultrasound alone, and scintigraphy only were the testing options selected by 41%, 38%, and 12%, respectively. Generally medical therapy with antithyroid drugs was the preferred treatment option with 86% of respondents selecting this option for the index case of newly diagnosed female Graves disease. The greatest proportion of respondents that selected radioactive iodine (RAI) was 35% for both the index case as well as the male equivalent. Surgery was the most popular option at 25% for patients with a toxic multinodular goiter. Having access to RAI and scintigraphy was reported by 32% and 28%, respectively. Conclusion: GPs appear to be constrained to making rational choices based upon availability rather than what the guidelines recommend. In the absence of formal continuing medical education for GPs on thyrotoxicosis, dissemination of guidelines at the primary care level may reduce this gap. Abbreviations: ATA = American Thyroid Association; ATD = antithyroid drugs; CME = continued medical education; GP = general practitioner; RAI = radioactive iodine; SURG = surgery; T4 = thyroxine; TSH = thyroid-stimulating hormone.


Assuntos
Clínicos Gerais , Doença de Graves , Hipertireoidismo , Neoplasias da Glândula Tireoide , Tireotoxicose , Estudos Transversais , Feminino , Humanos , Radioisótopos do Iodo , Masculino , Trinidad e Tobago , Estados Unidos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...