1
|
Maharaj R, Cave C, Motilal S, Naraynsignh V. Delays in adjuvant radiotherapy for primary breast cancer is harmful, especially in low-income countries. Trop Doct 2024; 54:126-130. [PMID: 37956657 DOI: 10.1177/00494755231212694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Our retrospective cohort study of the effects of radiotherapy delay on the oncological outcome of breast cancer patients showed a prolonged radiotherapy waiting interval was associated with a statistically significant increase in the 3-year breast cancer-specific mortality. This research should stimulate setting up protocols geared towards minimizing delays.
Collapse
Affiliation(s)
- Ravi Maharaj
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago
| | - Christo Cave
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago
| | - Shastri Motilal
- Department of Paraclinical Sciences, University of the West Indies, Eric Williams Medical Sciences Complex, Champs Fleurs, Trinidad and Tobago
| | - Vijay Naraynsignh
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago
| |
Collapse
|
2
|
Motilal S, Khan R, St Bernard G, Ivey MA, Reid SD. Positive influences of the COVID-19 pandemic on community dwelling adults in Trinidad and Tobago: a cross sectional study. J Ment Health 2023; 32:869-878. [PMID: 36083113 DOI: 10.1080/09638237.2022.2118690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/15/2022] [Accepted: 07/23/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Since the onset of the coronavirus (COVID-19) pandemic its negative effects have been highlighted globally. There is little literature that examines the positive impact on daily living. AIMS To examine the positive influences of government-imposed COVID-19 public health restrictions on adults throughout Trinidad and Tobago (TT) and their associated factors. METHOD A cross-sectional study, using an adapted pretested online survey instrument, was conducted amongst non-institutionalised, community-dwelling adults using convenience sampling. RESULTS Of 1287 completed and weighted responses, the mean age (S.D.) was 39.2 (14.6) years, 49% were males, and 61% completed secondary level education. The top 5 positive experiences were more time spent with family (80%), more down-time (78%), learning new skills (68%), more time for hobbies (66%), self-care (57%), more time spent with friends (55%) and eating healthier (50%). The importance of religion, working from home, and an increase in marijuana use emerged as positive correlates for certain positive experiences, while participants with chronic illness, and a positive anxiety or depression screen, were negatively associated with most positive experiences. CONCLUSIONS Despite the negative consequences of the COVID19 pandemic, several positives were highlighted in this study. These findings have implications for social policies toward building resilience within the community.
Collapse
Affiliation(s)
- Shastri Motilal
- Unit of Public Health and Primary Care, Department of Paraclinical Sciences, Faculty of Medical Sciences, The University of the West Indies, St. Augustine Campus, Trinidad and Tobago
| | - Raveed Khan
- Unit of Public Health and Primary Care, Department of Paraclinical Sciences, Faculty of Medical Sciences, The University of the West Indies, St. Augustine Campus, Trinidad and Tobago
| | - Godfrey St Bernard
- Sir Arthur Lewis Institute of Social and Economic Studies, University of the West Indies, St. Augustine Campus, Trinidad and Tobago
| | - Marsha A Ivey
- Unit of Public Health and Primary Care, Department of Paraclinical Sciences, Faculty of Medical Sciences, The University of the West Indies, St. Augustine Campus, Trinidad and Tobago
| | - Sandra D Reid
- Psychiatry Unit, Department of Clinical Medical Sciences, Faculty of Medical Sciences, The University of the West Indies, St. Augustine Campus, Trinidad and Tobago
| |
Collapse
|
3
|
Seecheran NA, Rafeeq S, Maharaj N, Swarath S, Seecheran V, Seecheran R, Seebalack V, Jagdeo CL, Seemongal-Dass R, Quert AYL, Giddings S, Ramlackhansingh A, Sandy S, Motilal S, Seemongal-Dass R. Correlation of RETINAL Artery Diameter with Coronary Artery Disease: The RETINA CAD Pilot Study-Are the Eyes the Windows to the Heart? Cardiol Ther 2023; 12:499-509. [PMID: 37318673 PMCID: PMC10423171 DOI: 10.1007/s40119-023-00320-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/25/2023] [Indexed: 06/16/2023] Open
Abstract
INTRODUCTION This study aimed to determine whether there was any correlation between coronary artery disease (CAD) and retinal artery diameter at an academic tertiary medical center in Trinidad and Tobago. METHODS This prospective study evaluated patients (n = 77) with recent invasive coronary angiography (CAG) and the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score who subsequently underwent optical coherence tomography-angiography (OCT-A) at the Eric Williams Medical Sciences Complex (EWMSC) from January 2021 to March 2021. Routine medical history and cardiovascular medications were also recorded. Spearman's rank correlation coefficient and Mann-Whitney U-tests were used to compare correlations and medians between groups. RESULTS The average patient age was 57.8 years old, with the majority being male [n = 55 (71.4%)] and of South Asian ethnicity [n = 53 (68.8%)]. Retinal artery diameter was negatively correlated with the SYNTAX score (-0.332 for the right eye, p = 0.003 and -0.237 for the left eye, p = 0.038). A statistically significant relationship was also demonstrated in females and diabetic patients. There were no serious adverse events (SAEs). CONCLUSION A significantly negative correlation was observed between retinal artery diameter and SYNTAX score. This study alludes to the practical use of optical coherence tomography-angiography (OCT-A) as a noninvasive diagnostic modality for patients with cardiovascular disease (CVD). Further large-scale, multicentric studies are required to confirm these exploratory findings. TRIAL REGISTRATION NUMBER NCT04233619.
Collapse
Affiliation(s)
- Naveen Anand Seecheran
- Department of Clinical Medical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago.
- Faculty of Medical Sciences, The University of the West Indies, 2nd Floor, Building #67, Eric Williams Medical Sciences Complex, Mt. Hope, West Indies, Trinidad and Tobago.
| | - Salma Rafeeq
- Department of Medicine, North Central Regional Health Authority, Mt. Hope, Trinidad and Tobago
| | - Nicole Maharaj
- Department of Medicine, North Central Regional Health Authority, Mt. Hope, Trinidad and Tobago
| | - Steven Swarath
- Department of Medicine, North Central Regional Health Authority, Mt. Hope, Trinidad and Tobago
| | - Valmiki Seecheran
- Department of Medicine, North Central Regional Health Authority, Mt. Hope, Trinidad and Tobago
| | - Rajeev Seecheran
- Department of Medicine, Kansas University Medical Center, Wichita, KS, USA
| | - Victoria Seebalack
- Department of Medicine, North Central Regional Health Authority, Mt. Hope, Trinidad and Tobago
| | - Cathy-Lee Jagdeo
- Department of Medicine, North Central Regional Health Authority, Mt. Hope, Trinidad and Tobago
| | - Rajiv Seemongal-Dass
- Department of Medicine, North Central Regional Health Authority, Mt. Hope, Trinidad and Tobago
| | | | - Stanley Giddings
- Department of Clinical Medical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Anil Ramlackhansingh
- Department of Clinical Medical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Sherry Sandy
- Department of Clinical Medical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Shastri Motilal
- Department of Clinical Medical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Robin Seemongal-Dass
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago
| |
Collapse
|
4
|
Reid SD, Motilal S, Pooransingh S, St. Bernard G, Ivey MA. Differential Mental Health Impact of COVID-19 Lockdowns on Persons with Non-Communicable Diseases in Trinidad and Tobago. Int J Environ Res Public Health 2023; 20:6543. [PMID: 37623129 PMCID: PMC10454168 DOI: 10.3390/ijerph20166543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/16/2023] [Accepted: 08/02/2023] [Indexed: 08/26/2023]
Abstract
Persons with chronic non-communicable diseases (NCDs) were identified as particularly at risk of severe morbidity and mortality during the COVID-19 pandemic. Little is written about the impact of COVID-19 on this sub-population in the Caribbean, where the prevalence of NCDs is disproportionately high. This study aimed to ascertain COVID-related concerns, and the mental health impact of the pandemic among persons with and without NCDs in Trinidad and Tobago, during the acute period of COVID-19 lockdowns early in the pandemic. An anonymous online survey collected cross-sectional data from a convenience sample nationwide. Of 1287 respondents, 219 self-identified as having an NCD. Findings suggest that the pandemic was experienced unequally by persons with NCDs, who were more likely to be concerned about health and wellbeing and to report health inequalities-unemployment, social isolation and negative effects of government restrictions. Compared to those without NCDs, they were more likely to increase use of marijuana during the lockdown period, and to report severe anxiety/depression that can result in exacerbation of NCDs. Interventions for persons with NCDs must address the mental health consequences of any pandemic, including increased drug use, and also address social inequalities to reduce sustained post-pandemic mental health impact and negative health outcomes.
Collapse
Affiliation(s)
- Sandra D. Reid
- Psychiatry Unit, Department of Clinical Medical Sciences, Faculty of Medical Sciences, The University of the West Indies (The UWI), Champs Fleurs, Trinidad and Tobago
| | - Shastri Motilal
- Public Health and Primary Care Unit, Department of Paraclinical Sciences, Faculty of Medical Sciences, The University of the West Indies (The UWI), Champs Fleurs, Trinidad and Tobago; (S.M.); (S.P.); (M.A.I.)
| | - Shalini Pooransingh
- Public Health and Primary Care Unit, Department of Paraclinical Sciences, Faculty of Medical Sciences, The University of the West Indies (The UWI), Champs Fleurs, Trinidad and Tobago; (S.M.); (S.P.); (M.A.I.)
| | - Godfrey St. Bernard
- Sir Arthur Lewis Institute of Social and Economic Studies, The University of the West Indies (The UWI), St. Augustine, Trinidad and Tobago;
| | - Marsha A. Ivey
- Public Health and Primary Care Unit, Department of Paraclinical Sciences, Faculty of Medical Sciences, The University of the West Indies (The UWI), Champs Fleurs, Trinidad and Tobago; (S.M.); (S.P.); (M.A.I.)
| |
Collapse
|
5
|
Motilal S, Ward D, Mahabir K, Lopez T, Logan R, Maharaj S, Maloney J, Marson M, Marcelle C. COVID-19 Vaccine Hesitancy in Trinidad and Tobago: A Qualitative Study. Cureus 2023; 15:e43171. [PMID: 37560056 PMCID: PMC10409563 DOI: 10.7759/cureus.43171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 08/11/2023] Open
Abstract
Background After three years of COVID-19, the WHO declared that the pandemic was no longer a global health emergency. Vaccination remains part of the management strategy, given the current phase of the pandemic. This study explored the reasons for COVID-19 vaccine hesitancy in Trinidad and Tobago (TT). Methodology A qualitative study of persons 18 years and over from the eastern, northwest, northcentral, and southwestern geographical areas of TT, who are unvaccinated and hesitant, was done by convenience sampling. Formal in-depth virtual interviews were done on a one-to-one basis using a semi-structured questionnaire. The interviews were recorded and transcribed using the principles of reflexive thematic analysis of participants' responses. Results From 25 participants' responses, the main themes for being vaccine-hesitant were fear, inefficacy, information inadequacy, perceived susceptibility, mistrust, herbal alternatives, and religious hesitations. Additionally, their motivations for receiving the vaccine in the future were surrounded by themes of necessity, perceived susceptibility, health benchmark, and assurance. Conclusion and recommendations This qualitative investigation identified traditional factors contributing to COVID-19 vaccine hesitancy and unique determinants such as herbal use and religious beliefs within the TT context. These insights could inform future research and facilitate the development of tailored strategies to address persistent vaccine hesitancy for COVID-19.
Collapse
Affiliation(s)
- Shastri Motilal
- Paraclinical Sciences, The University of the West Indies at St. Augustine, St. Augustine, TTO
| | - Daina Ward
- Paraclinical Sciences, The University of the West Indies at St. Augustine, St. Augustine, TTO
| | - Kymera Mahabir
- Paraclinical Sciences, The University of the West Indies at St. Augustine, St. Augustine, TTO
| | - Thea Lopez
- Paraclinical Sciences, The University of the West Indies at St. Augustine, St. Augustine, TTO
| | - Raesha Logan
- Paraclinical Sciences, The University of the West Indies at St. Augustine, St. Augustine, TTO
| | - Shastri Maharaj
- Paraclinical Sciences, The University of the West Indies at St. Augustine, St. Augustine, TTO
| | - Jenair Maloney
- Paraclinical Sciences, The University of the West Indies at St. Augustine, St. Augustine, TTO
| | - Monique Marson
- Paraclinical Sciences, The University of the West Indies at St. Augustine, St. Augustine, TTO
| | - Chadé Marcelle
- Paraclinical Sciences, The University of the West Indies at St. Augustine, St. Augustine, TTO
| |
Collapse
|
6
|
Maharaj RG, Motilal S, Khan R, Rampersad F. A No-Cost, Bedside, Self-Traction Maneuver for Relief From Chronic Cervical Radiculopathy: A Case Report. Cureus 2023; 15:e43963. [PMID: 37746470 PMCID: PMC10515476 DOI: 10.7759/cureus.43963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2023] [Indexed: 09/26/2023] Open
Abstract
Cervical radiculopathy secondary to spondylosis is common in the elderly. Systematic reviews suggest that no single treatment modality represents the standard of care. A no-cost, bedside, self-traction intervention can be a useful adjunct to current options. A 60-year-old South Asian male presented with severe cervical radiculopathic pain in April 2019, proven by magnetic resonance imaging to be secondary to spondylosis. Since late 2019, he has been doing a daily self-traction procedure in which he lies prone with the anterior chest and abdomen flat on a bed, shoulders just off the mattress edge, and arms to the side. The position is maintained for 60 seconds, where the weight of the head provides traction. Overhead cervical traction has not been needed for the past three years, and the pain has been bearable. His Neck Disability Index has decreased from 25 to 2. This no-cost, minute-long daily maneuver has provided relief from chronic cervical neuropathic pain due to cervical spondylosis.
Collapse
Affiliation(s)
- Rohan G Maharaj
- Paraclinical Sciences, The University of the West Indies, St. Augustine, TTO
| | - Shastri Motilal
- Paraclinical Sciences, The University of the West Indies, St. Augustine, TTO
| | - Raveed Khan
- Paraclinical Sciences, The University of the West Indies, St. Augustine, TTO
| | - Fidel Rampersad
- Department of Medicine, The University of the West Indies, St. Augustine, TTO
| |
Collapse
|
7
|
Motilal S, Mohepath N, Moncur J, Mohess R, Mohan V, Mohammed S, Moore D, Mosca K, Mulchan T. Parental Knowledge, Attitudes, and Perceptions Impacting Willingness to Vaccinate Against the Human Papillomavirus in Trinidad. Cureus 2023; 15:e43581. [PMID: 37593070 PMCID: PMC10430892 DOI: 10.7759/cureus.43581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2023] [Indexed: 08/19/2023] Open
Abstract
Background Cervical cancer remains a major cause of morbidity and mortality in young women in Trinidad and Tobago. This study aimed to determine the knowledge, attitudes, perceptions, and beliefs of Trinidadian parents toward human papillomavirus (HPV) vaccination. In addition, factors predictive of willingness to vaccinate were explored. Methodology In this cross-sectional study conducted between March and May 2019, a paper-based survey was self-administered to parents of children in the 5-12-year age group in seven geographically representative Trinidadian primary schools. Results Of the 420 questionnaires distributed, 160 were returned completed (38% response rate). General knowledge that HPV causes cervical cancer and genital warts and is spread by sexual contact was common among 81%, 71%, and 81% of parents, respectively. At least 40% of the respondents expressed uncertainty about the vaccine's long-lasting health problems and its effectiveness in preventing genital warts and cervical cancer. Half of the parents were unsure if the vaccine was harmful. The perceptions that vaccine safety data are fabricated, drug companies cover up the dangers of vaccines, vaccine efficacy data are often fabricated, people are deceived about vaccine efficacy and safety, and conspiracy beliefs were held by 15.5%, 26.1%, 13%, 21.7%, and 28.5% of parents, respectively. There was a negative correlation between knowledge and conspiracy belief scores (ρ = -0.30, p < 0.001). Overall, 45.3% of parents were willing to immunize their children against HPV. Being informed about HPV by a health professional (odds ratio (OR) = 2.9, 95% confidence interval (CI) 1.5-5.8), knowledge of the benefits (OR = 4.6, 95% CI = 2.2-9.6), and a health professional offering the option of vaccination (OR = 3.7, 95% CI = 1.7-8.0) were associated with significantly increased odds of parents willing to vaccinate their child. The agreement that vaccine safety data are often fabricated (OR = 0.31, 95% CI = 0.12-0.84), pharmaceutical companies cover up the dangers of vaccines (OR = 0.14, 95% CI = 0.06-0.37), waiting at the clinic being time-consuming (OR = 0.37, 95% CI = 0.15-0.89), and the beliefs that adolescents are too young to get a vaccine to prevent sexually transmitted disease (OR = 0.16, 95% CI = 0.11-0.83) were associated with a significantly decreased willingness to vaccinate. Conclusions While general knowledge about HPV was high, there remain several areas for parental education regarding the HPV vaccine. Misbeliefs need to be addressed and multilevel interventions are needed to improve HPV vaccine uptake in our setting.
Collapse
Affiliation(s)
- Shastri Motilal
- Department of Paraclinical Sciences, The University of the West Indies, St. Augustine, TTO
| | - Nicholas Mohepath
- Department of Paraclinical Sciences, The University of the West Indies, St. Augustine, TTO
| | - Jana Moncur
- Department of Paraclinical Sciences, The University of the West Indies, St. Augustine, TTO
| | - Ricky Mohess
- Department of Paraclinical Sciences, The University of the West Indies, St. Augustine, TTO
| | - Vasthala Mohan
- Department of Paraclinical Sciences, The University of the West Indies, St. Augustine, TTO
| | - Shanaz Mohammed
- Department of Paraclinical Sciences, The University of the West Indies, St. Augustine, TTO
| | - Diana Moore
- Department of Paraclinical Sciences, The University of the West Indies, St. Augustine, TTO
| | - Katherina Mosca
- Department of Paraclinical Sciences, The University of the West Indies, St. Augustine, TTO
| | - Tisha Mulchan
- Department of Paraclinical Sciences, The University of the West Indies, St. Augustine, TTO
| |
Collapse
|
8
|
Jankie S, Sewdass K, Smith W, Naraynsingh C, Johnson J, Farnon N, Mahadeo K, Motilal S. A cross-sectional survey of prospective healthcare professionals' knowledge, attitudes and perceptions of medical Cannabis. Explor Res Clin Soc Pharm 2023; 10:100275. [PMID: 37168830 PMCID: PMC10165452 DOI: 10.1016/j.rcsop.2023.100275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 04/19/2023] [Indexed: 05/13/2023] Open
Abstract
Background Compounds isolated from Cannabis possess many beneficial effects creating a renewed worldwide interest in its therapeutic potential. With increased legalization for medicinal use globally, healthcare professionals must be familiar with the drug's uses and potential adverse effects. Objective To determine prospective healthcare providers' knowledge, attitude and perception to medical Cannabis. Method A self-administered online questionnaire comprising 21 questions to assess the knowledge, attitude and perception of medical Cannabis was distributed via google forms among students at the Faculty of Medical Sciences, the University of the West Indies, St Augustine Campus. Chi-square analysis was used to detect significant associations between demographics and measured variables. A p-value <0.05 was considered significant. Results Popular perceived therapeutic benefits of Cannabis were chronic pain (91.2%), anxiety (84.2%) and seizures (71.1%), and identification of the risks associated with the use of Cannabis was low. Users of Cannabis were able to identify indications and symptoms that can be treated with Cannabis but were less aware of the adverse effects of the drug than non-users (p < 0.001). More than three-quarters (87.3%) believed they could identify therapeutic uses and adverse effects but only 14.2% were ready to answer queries from patients. The main source of Cannabis information was the internet and information was lacking in the medical school curriculum. Conclusion The majority of students could not identify the drug's indications and adverse effects. There is a need to improve training for all prospective medical personnel to cater for the change in legislation status.
Collapse
Affiliation(s)
- Satish Jankie
- School of Pharmacy, Faculty of Medical Sciences, The University of the West Indies, St, Augustine, Trinidad and Tobago
- Corresponding author at: School of Pharmacy, Faculty of Medical Sciences, Building 39, Ground Floor, Eric Williams Medical Sciences Complex, Champ Fleurs, Mt Hope, Trinidad and Tobago.
| | - Keshav Sewdass
- School of Pharmacy, Faculty of Medical Sciences, The University of the West Indies, St, Augustine, Trinidad and Tobago
| | - William Smith
- School of Dentistry, Faculty of Medical Sciences, The University of the West Indies, St, Augustine, Trinidad and Tobago
| | - Candy Naraynsingh
- School of Dentistry, Faculty of Medical Sciences, The University of the West Indies, St, Augustine, Trinidad and Tobago
| | - Jenelle Johnson
- School of Veterinary Medicine, Faculty of Medical Sciences, The University of the West Indies, St, Augustine, Trinidad and Tobago
| | - Niall Farnon
- Optometry Unit, Faculty of Medical Sciences, The University of the West Indies, St, Augustine, Trinidad and Tobago
| | - Kavita Mahadeo
- School of Advanced Nursing, Faculty of Medical Sciences, The University of the West Indies, St, Augustine, Trinidad and Tobago
| | - Shastri Motilal
- Department of ParaClinical Sciences, Faculty of Medical Sciences, The University of the West Indies, St, Augustine, Trinidad and Tobago
| |
Collapse
|
9
|
Welch T, Rampersad F, Motilal S, Seecheran NA. Comparison of cardiac CT angiography coronary artery dimensions and ethnicity in Trinidad: the CADET pilot study. Open Heart 2022; 9:openhrt-2021-001922. [PMID: 35354659 PMCID: PMC8968509 DOI: 10.1136/openhrt-2021-001922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/07/2022] [Indexed: 11/11/2022] Open
Abstract
Background This study aimed to determine if there were any significant differences in coronary artery (CA) dimensions at prespecified segments during cardiac CT angiography (CCTA) compared with ethnicity at an academic tertiary medical centre in Trinidad and Tobago. Methods Patients (n=170) who underwent CCTA from July 2016 to June 2021 at the Eric Williams Medical Sciences Complex were selected based on predefined selection criteria. The size of the left main and proximal, mid and distal diameters of the left anterior descending, left circumflex and right coronary artery (RCA) were measured using quantitative coronary angiography, syngo.CT Coronary Analysis (Siemens Healthineers AG, Erlangen, Germany). Routine medical history, cardiovascular medications and anthropometric data were also recorded. Comparisons were performed using an independent sample t-test and analysis of variance for continuous variables. Results One hundred and seventy participants were enrolled in this study. There were no statistically significant associations between gender and CA dimensions; however, there were significant associations between South Asian and Caribbean black ethnicities for almost all CA dimensions except for the distal RCA segment. These findings were replicated when the analysis was adjusted for body surface area with the addition of the mid-RCA segment, which was bordering near-significance (p value 0.051). Conclusions Significantly smaller CA dimensions were observed in South Asian patients compared with Caribbean black patients undergoing CCTA. This pilot study could be clinically significant for Trinidadian patients at risk of developing coronary artery disease. Trial registration number NCT04774861.
Collapse
Affiliation(s)
- Tonya Welch
- Department of Clinical Medical Sciences, The University of the West Indies, Saint Augustine, Trinidad and Tobago
| | - Fidel Rampersad
- Department of Clinical Medical Sciences, The University of the West Indies, Saint Augustine, Trinidad and Tobago
| | - Shastri Motilal
- Department of Clinical Medical Sciences, The University of the West Indies, Saint Augustine, Trinidad and Tobago
| | - Naveen Anand Seecheran
- Department of Clinical Medical Sciences, The University of the West Indies, Saint Augustine, Trinidad and Tobago
| |
Collapse
|
10
|
Khan R, Gangar M, Gangar M, Motilal S. Eight years of antibiotic consumption at a primary care outpatient facility in Trinidad and Tobago 2011-18: a synopsis of consumption trends. JAC Antimicrob Resist 2021; 3:dlab162. [PMID: 34676367 PMCID: PMC8527501 DOI: 10.1093/jacamr/dlab162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/27/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To explore antibiotic consumption and surveillance patterns in Trinidad and Tobago. METHODS A retrospective observational study was conducted. Stock requisition and logbooks from a District Health Facility in Trinidad were examined for the period 2011-18. Daily Defined Doses (DDDs) for each antibiotic were computed and extrapolated to represent the antibiotic consumption per 1000 residents within the population. RESULTS The mean consumption across the years was 2.917 DDD per 1000 residents per day. The most consumed antibiotics were cefuroxime, amoxicillin/clavulanic acid, and azithromycin, with mean DDDs of 0.879, 0.695 and 0.373 respectively. The least consumed antibiotics were cefaclor and clarithromycin, with DDDs of 0.0006 and 0.0005, respectively. CONCLUSIONS Trinidad and Tobago is not mentioned in the WHO surveillance report on antibiotic consumption. Our most recent (2018) estimate of total antibiotic consumption was 3.224 DDD per 1000 habitants per day. This figure is an underestimate, as data was derived solely from the public sector. Notwithstanding, this data is novel and can provide a baseline for future comparison and development of national surveillance programmes.
Collapse
Affiliation(s)
- Raveed Khan
- Department of Paraclinical Sciences, The University of the West Indies, St Augustine, Trinidad and Tobago
| | - Misty Gangar
- Tallahassee Memorial Healthcare, Tallahassee, FL, USA
| | | | - Shastri Motilal
- Department of Paraclinical Sciences, The University of the West Indies, St Augustine, Trinidad and Tobago
| |
Collapse
|
11
|
Motilal S, Paul-Charles J, Asnani M, Khan R, Ricketts-Roomes T, Pinder-Butler S, Herbert J, Farquharson C, Conliffe C, Standard-Goldson A, Smith K, Morris E, Maharaj RG. 2020 family medicine postgraduate examinations at The University of the West Indies: successes and challenges in the time of COVID-19 pandemic. Postgrad Med J 2021; 97:423-426. [PMID: 34039692 PMCID: PMC8159667 DOI: 10.1136/postgradmedj-2021-140242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/03/2021] [Accepted: 05/06/2021] [Indexed: 11/16/2022]
Abstract
Little has been published regarding postgraduate assessments during the COVID-19 pandemic. There is an urgent need to graduate well-trained specialists including family physicians who play a key role in patient care. The successes and challenges encountered in mounting qualifying 2020 Family Medicine examinations during the COVID-19 pandemic at the University of the West Indies are described in this paper. Human resource, planning, use of technology and virtual environments are discussed, which enabled successful examinations at this multicampus regional site.
Collapse
Affiliation(s)
- Shastri Motilal
- Paraclinical Sciences, The University of the West Indies, St. Augustine Campus, Faculty of Medical Sciences, St Augustine, Trinidad and Tobago
| | - Joanne Paul-Charles
- The University of the West Indies, Cave Hill Campus, Faculty of Medical Sciences, St Michael, Barbados
| | - Monika Asnani
- Caribbean Institute for Health Research-Sickle Cell Unit, The University of the West Indies at Mona Faculty of Medical Sciences, Mona, Saint Andrew, Jamaica
| | - Raveed Khan
- Paraclinical Sciences, The University of the West Indies, St. Augustine Campus, Faculty of Medical Sciences, St Augustine, Trinidad and Tobago
| | - Tana Ricketts-Roomes
- Department of Community Health and Psychiatry, The University of the West Indies at Mona Faculty of Medical Sciences, Mona, Saint Andrew, Jamaica
| | | | - Joseph Herbert
- The University of the West Indies, Cave Hill Campus, Faculty of Medical Sciences, Bridgetown, Saint Michael, Barbados
| | - Carnille Farquharson
- University of the West Indies School of Clinical Medicine and Research, Nassau, Bahamas
| | - Catherine Conliffe
- University of the West Indies School of Clinical Medicine and Research, Nassau, Bahamas
| | - Aileen Standard-Goldson
- Department of Community Health and Psychiatry, The University of the West Indies at Mona Faculty of Medical Sciences, Mona, Saint Andrew, Jamaica
| | - Kristen Smith
- Department of Community Health and Psychiatry, The University of the West Indies at Mona Faculty of Medical Sciences, Mona, Saint Andrew, Jamaica
| | - Euclid Morris
- The University of the West Indies, Cave Hill Campus, Faculty of Medical Sciences, Bridgetown, Saint Michael, Barbados
| | - Rohan G Maharaj
- Paraclinical Sciences, The University of the West Indies, St. Augustine Campus, Faculty of Medical Sciences, St Augustine, Trinidad and Tobago
| |
Collapse
|
12
|
Motilal S, Taylor J, Sookram K, Sooknanan S, Sooknanan S, Sookoo J, Stroude S, Sudama C, Tatiparthi T, Thompson H. Quality of life in medical students during the COVID-19 pandemic. J Contemp Clin Pract 2021. [DOI: 10.18683/jccp.2021.1068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
|
13
|
Seecheran N, Ramdeen A, Debideen N, Ali K, Grimaldos K, Grimaldos G, Karan A, Seecheran R, Seecheran V, Persad S, Abdullah H, Peram L, Giddings S, Motilal S, Tello-Montoliu A, Schneider D. The Effect of Empagliflozin on Platelet Function Profiles in Patients with Stable Coronary Artery Disease in Trinidad: The EFFECT Pilot Study. Cardiol Ther 2020; 10:189-199. [PMID: 33306161 PMCID: PMC8126525 DOI: 10.1007/s40119-020-00208-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 11/25/2020] [Indexed: 12/14/2022] Open
Abstract
Introduction This prospective pharmacodynamic (PD) study aimed to assess the effect of the sodium–glucose cotransporter 2 inhibitor (SGLT2i) empagliflozin on platelet reactivity. Methods Patients with stable coronary artery disease (CAD) and type 2 diabetes mellitus (T2DM) (n = 20) who were actively treated with dual antiplatelet therapy (DAPT) of aspirin 81 mg daily and clopidogrel 75 mg daily were recruited. Platelet function was measured with the VerifyNow™ P2Y12 assay (Instrumentation Laboratory, Massachusetts, USA) and assessed before the initiation of and after 10 days of treatment with empagliflozin 25 mg once daily maintenance dose regimen. Results were compared with a paired t test. Results The mean P2Y12 reaction units (PRU) on empagliflozin was significantly less than without empagliflozin at baseline (187.35, 95% confidence interval (CI) 155.38–219.32 vs. 217.25, CI 180.60–253.90; p < 0.030). The mean difference in PRU was 29.90 (95% CI 3.17–56.63). No patients experienced any serious adverse events (SAEs). Conclusions Significantly attenuated platelet reactivity was observed on empagliflozin as compared to without empagliflozin. This dedicated pharmacodynamic study could be clinically pertinent for Trinidadian patients with stable CAD and T2DM on DAPT. Further studies are required to confirm these exploratory findings. (Funded by the University of the West Indies, St. Augustine; EFFECT). Clinical Trial Registration ClinicalTrials.gov number NCT04342819.
Collapse
Affiliation(s)
- Naveen Seecheran
- The University of the West Indies, St. Augustine, Trinidad and Tobago.
| | - Arvinash Ramdeen
- North Central Regional Health Authority, Mount Hope, Trinidad and Tobago
| | - Niranjan Debideen
- North Central Regional Health Authority, Mount Hope, Trinidad and Tobago
| | - Kabeer Ali
- North Central Regional Health Authority, Mount Hope, Trinidad and Tobago
| | - Kathryn Grimaldos
- North Central Regional Health Authority, Mount Hope, Trinidad and Tobago
| | | | - Abhinav Karan
- North Central Regional Health Authority, Mount Hope, Trinidad and Tobago
| | - Rajeev Seecheran
- North Central Regional Health Authority, Mount Hope, Trinidad and Tobago
| | - Valmiki Seecheran
- North Central Regional Health Authority, Mount Hope, Trinidad and Tobago
| | - Sangeeta Persad
- North Central Regional Health Authority, Mount Hope, Trinidad and Tobago
| | - Harun Abdullah
- North Central Regional Health Authority, Mount Hope, Trinidad and Tobago
| | - Lakshmipathi Peram
- North Central Regional Health Authority, Mount Hope, Trinidad and Tobago
| | - Stanley Giddings
- The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Shastri Motilal
- The University of the West Indies, St. Augustine, Trinidad and Tobago
| | | | - David Schneider
- Cardiovascular Research Institute of Vermont, Colchester, VT, USA
| |
Collapse
|
14
|
Seecheran N, Boodhai B, Maharaj A, Ramdeen A, Debideen N, Ochalal V, Singh R, Seecheran R, Seecheran V, Persad S, Abdullah H, Peram L, Motilal S, Tello-Montoliu A, Schneider D. The Effect of Low-Dose Ticagrelor on Platelet Function Profiles in Patients With Stable Coronary Artery Disease in Trinidad: The TWIST Pilot Study. Cardiol Ther 2020; 9:493-503. [PMID: 32766961 PMCID: PMC7584691 DOI: 10.1007/s40119-020-00195-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Indexed: 10/29/2022] Open
Abstract
INTRODUCTION This prospective, pharmacodynamic study aimed to explore the potential applicability of a low-dose ticagrelor regimen in a heterogeneous Trinidadian subpopulation. METHODS Patients with stable coronary artery disease (n = 25) who were actively treated with dual antiplatelet therapy of aspirin 81 mg daily and clopidogrel 75 mg daily were recruited. Platelet function was measured with the VerifyNow P2Y12 assay (Accriva Diagnostics, San Diego, CA, USA) and assessed before initiation of and after 14 days of treatment with a low-dose ticagrelor 45 mg twice daily maintenance dose regimen. Results were compared with a paired t test. RESULTS The mean P2Y12 reaction units (PRU) score on ticagrelor was significantly less compared to that of clopidogrel (50.4, 95% confidence interval (CI) 29-73.9; vs. 149.6, 95% CI 129.4-169.9; p value < 0.001). Of the patients, 4% experienced Medical Research Council class 1 dyspnea, and Bleeding Academic Research Consortium class 1 bleeding on the ticagrelor regimen (one patient each). CONCLUSIONS Significantly attenuated platelet reactivity was seen on the low ticagrelor maintenance dose as compared to clopidogrel. This dedicated pharmacodynamic study could be applicable and informative for Trinidadian stable coronary artery disease patients. Further studies are required to confirm these exploratory findings.(Funded by the University of the West Indies, St. Augustine). TRIAL REGISTRATION ClinicalTrials.gov number NCT04206176.
Collapse
Affiliation(s)
- Naveen Seecheran
- The University of the West Indies, St. Augustine, Port of Spain, Trinidad and Tobago.
| | - Brent Boodhai
- North Central Regional Health Authority, Champs Fleurs, Mount Hope, Trinidad and Tobago
| | - Aarti Maharaj
- North Central Regional Health Authority, Champs Fleurs, Mount Hope, Trinidad and Tobago
| | - Arvinash Ramdeen
- North Central Regional Health Authority, Champs Fleurs, Mount Hope, Trinidad and Tobago
| | - Niranjan Debideen
- North Central Regional Health Authority, Champs Fleurs, Mount Hope, Trinidad and Tobago
| | - Vishesh Ochalal
- North Central Regional Health Authority, Champs Fleurs, Mount Hope, Trinidad and Tobago
| | - Randall Singh
- North Central Regional Health Authority, Champs Fleurs, Mount Hope, Trinidad and Tobago
| | - Rajeev Seecheran
- North Central Regional Health Authority, Champs Fleurs, Mount Hope, Trinidad and Tobago
| | - Valmiki Seecheran
- North Central Regional Health Authority, Champs Fleurs, Mount Hope, Trinidad and Tobago
| | - Sangeeta Persad
- North Central Regional Health Authority, Champs Fleurs, Mount Hope, Trinidad and Tobago
| | - Harun Abdullah
- North Central Regional Health Authority, Champs Fleurs, Mount Hope, Trinidad and Tobago
| | - Lakshmipathi Peram
- North Central Regional Health Authority, Champs Fleurs, Mount Hope, Trinidad and Tobago
| | - Shastri Motilal
- North Central Regional Health Authority, Champs Fleurs, Mount Hope, Trinidad and Tobago
| | | | - David Schneider
- Cardiovascular Research Institute of Vermont, Colchester, Vermont, USA
| |
Collapse
|
15
|
Ramsubeik K, Motilal S, Sanchez-Ramos L, Ramrattan LA, Kaeley GS, Singh JA. Diagnostic accuracy of salivary gland ultrasound in Sjögren's syndrome: A systematic review and meta-analysis. Ther Adv Musculoskelet Dis 2020; 12:1759720X20973560. [PMID: 33281953 PMCID: PMC7682247 DOI: 10.1177/1759720x20973560] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/25/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND To systematically review the diagnostic accuracy of salivary gland ultrasound in primary Sjögren's syndrome (pSS). METHODS PubMed, Embase, CINAHL, Cochrane Central and Scopus and ClinicalTrials.gov were searched to identify diagnostic or validation studies in patients with pSS meeting the diagnostic criteria. A diagnostic test meta-analysis was performed using a bivariate model to calculate the pooled sensitivity, specificity, positive/negative likelihood ratios, and the diagnostic odds ratio. Meta-regression analyses were done for several pSS covariates. RESULTS Sixty-five studies met our criteria for the qualitative review. Fifty-four studies with a total of 6087 patients were included in the meta-analysis. Pooled sensitivity for salivary gland ultrasound was 80% [95% confidence interval (CI): 77-83%; I 2 = 78%], and specificity was 90% (95% CI: 87-92%; I 2 = 76%). The pooled positive and negative likelihood ratios were 8 (95% CI: 6.4-10) and 0.22 (95% CI: 0.19-0.25), respectively. The corresponding pooled diagnostic odds ratio (DOR) was 37 (95% CI: 28-48). Separate meta-regression models resulted in similar diagnostic estimates: (a) adjusted for mean age: sensitivity 81% (95% CI:77-84%; I 2 = 99%) and specificity 90% (95% CI: 87-93%; I2 = 99%); (b) adjusted for mean disease duration, sensitivity 79% (95% CI:72-84%; I 2 = 99%), and specificity 90% (89-94%; I 2 = 99%). The diagnostic estimates were robust to sensitivity analyses by quality criteria, pSS diagnostic criteria and ultrasound scoring systems. CONCLUSION Salivary gland ultrasound is a valuable modality for the diagnosis of Sjögren's syndrome. It is plausible that salivary gland ultrasound can be used as an important criterion for the diagnosis of pSS.
Collapse
Affiliation(s)
- Karishma Ramsubeik
- Division of Rheumatology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Shastri Motilal
- Department of Para Clinical Sciences, The University of the West Indies, St Augustine, Trinidad and Tobago
| | - Luis Sanchez-Ramos
- Division of Maternal and Fetal Medicine, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Laurie Ann Ramrattan
- Division of Rheumatology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Gurjit S. Kaeley
- Division of Rheumatology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Jasvinder A. Singh
- Department of Medicine, Birmingham VA Medical Center, Faculty Office Tower 805B, 510, 20th Street South, Birmingham, AL 35233, USA
| |
Collapse
|
16
|
Seecheran N, Jagdeo CL, Seecheran R, Seecheran V, Persad S, Peram L, Evans M, Edwards J, Thackoorcharan S, Davis B, Davis S, Dawkins B, Dayaram A, De Freitas M, Deonarinesingh T, Dhanai J, Didier C, Motilal S, Baboolal N. Screening for depressive symptoms in cardiovascular patients at a tertiary centre in Trinidad and Tobago: investigation of correlates in the SAD CAT study. BMC Psychiatry 2020; 20:498. [PMID: 33032571 PMCID: PMC7545556 DOI: 10.1186/s12888-020-02909-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 10/01/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND This study aimed to screen cardiovascular patients for depressive symptoms at a tertiary centre in Trinidad and Tobago; and to determine any significant associations amongst patients' demographics, comorbidities, and cardiovascular medications with depressive symptoms. METHODS In this observational, cross-sectional study, patients (n = 1203) were randomly selected from the cardiology outpatient clinics at the Eric Williams Medical Sciences Complex. After meeting selection criteria, informed consent was obtained, and patients were administered a case report form, which included the Patient Health Questionnaire-9 (PHQ-9). Descriptive analyses included frequency, percentage and summary statistics. Inferential analyses included 95% confidence intervals (CIs), independent sample t-test, Fisher's exact test, Chi-square test, and multivariate logistic regression. RESULTS The study had a 96% respondent rate, whereby the average age was 62 years old. Slightly less than half were male, and 52.5% were female. Over 90 % of the sample had cardiovascular disease (CVD). One-quarter of the sample had a PHQ-9 score of ≥10, with almost one-fifth having no depressive symptoms. Females, lower levels of education and income were all found to be statistically significant at risk for depressive symptoms (all p-values < 0.001). Comorbidities associated with depressive symptoms included hypertension, prior cerebrovascular events, chronic kidney disease, and chronic obstructive pulmonary disease with odds ratios (ORs) and 95% confidence intervals (CIs) of OR 1.988 (CI 1.414-2.797), OR 1.847 (CI 1.251-2.728), OR 1.872 (CI 1.207-2.902) and OR 1.703 (CI 1.009-2.876) respectively. Only the cardiovascular medication of ticagrelor was found to be significantly associated with depressive symptoms (p-value < 0.001). CONCLUSIONS Twenty-five percent of screened cardiovascular patients displayed significant depressive symptoms with a PHQ-9 ≥ 10. This study also highlights the importance of implementing a multidisciplinary approach to managing cardiovascular disease and screening for depressive symptoms in this subpopulation. Further studies are required to validate these findings. TRIAL REGISTRATION ClinicalTrials.gov number, NCT03863262 . This trial was retrospectively registered on 20th February 2019.
Collapse
Affiliation(s)
- Naveen Seecheran
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, University of the West Indies, 2nd Floor, Building #67, Eric Williams Medical Sciences Complex, Mt. Hope, Trinidad, St. Augustine, WI, Trinidad and Tobago.
| | - Cathy-Lee Jagdeo
- grid.430529.9Department of Clinical Medical Sciences, Faculty of Medical Sciences, University of the West Indies, 2nd Floor, Building #67, Eric Williams Medical Sciences Complex, Mt. Hope, Trinidad, St. Augustine, WI Trinidad and Tobago
| | - Rajeev Seecheran
- grid.430529.9Department of Clinical Medical Sciences, Faculty of Medical Sciences, University of the West Indies, 2nd Floor, Building #67, Eric Williams Medical Sciences Complex, Mt. Hope, Trinidad, St. Augustine, WI Trinidad and Tobago
| | - Valmiki Seecheran
- grid.430529.9Department of Clinical Medical Sciences, Faculty of Medical Sciences, University of the West Indies, 2nd Floor, Building #67, Eric Williams Medical Sciences Complex, Mt. Hope, Trinidad, St. Augustine, WI Trinidad and Tobago
| | - Sangeeta Persad
- grid.430529.9Department of Clinical Medical Sciences, Faculty of Medical Sciences, University of the West Indies, 2nd Floor, Building #67, Eric Williams Medical Sciences Complex, Mt. Hope, Trinidad, St. Augustine, WI Trinidad and Tobago
| | - Lakshmipatty Peram
- grid.430529.9Department of Clinical Medical Sciences, Faculty of Medical Sciences, University of the West Indies, 2nd Floor, Building #67, Eric Williams Medical Sciences Complex, Mt. Hope, Trinidad, St. Augustine, WI Trinidad and Tobago
| | - Matthew Evans
- grid.430529.9Department of Clinical Medical Sciences, Faculty of Medical Sciences, University of the West Indies, 2nd Floor, Building #67, Eric Williams Medical Sciences Complex, Mt. Hope, Trinidad, St. Augustine, WI Trinidad and Tobago
| | - Justine Edwards
- grid.430529.9Department of Clinical Medical Sciences, Faculty of Medical Sciences, University of the West Indies, 2nd Floor, Building #67, Eric Williams Medical Sciences Complex, Mt. Hope, Trinidad, St. Augustine, WI Trinidad and Tobago
| | - Sheri Thackoorcharan
- grid.430529.9Department of Clinical Medical Sciences, Faculty of Medical Sciences, University of the West Indies, 2nd Floor, Building #67, Eric Williams Medical Sciences Complex, Mt. Hope, Trinidad, St. Augustine, WI Trinidad and Tobago
| | - Britney Davis
- grid.430529.9Department of Clinical Medical Sciences, Faculty of Medical Sciences, University of the West Indies, 2nd Floor, Building #67, Eric Williams Medical Sciences Complex, Mt. Hope, Trinidad, St. Augustine, WI Trinidad and Tobago
| | - Shari Davis
- grid.430529.9Department of Clinical Medical Sciences, Faculty of Medical Sciences, University of the West Indies, 2nd Floor, Building #67, Eric Williams Medical Sciences Complex, Mt. Hope, Trinidad, St. Augustine, WI Trinidad and Tobago
| | - Barbrianna Dawkins
- grid.430529.9Department of Clinical Medical Sciences, Faculty of Medical Sciences, University of the West Indies, 2nd Floor, Building #67, Eric Williams Medical Sciences Complex, Mt. Hope, Trinidad, St. Augustine, WI Trinidad and Tobago
| | - Anisha Dayaram
- grid.430529.9Department of Clinical Medical Sciences, Faculty of Medical Sciences, University of the West Indies, 2nd Floor, Building #67, Eric Williams Medical Sciences Complex, Mt. Hope, Trinidad, St. Augustine, WI Trinidad and Tobago
| | - Michelle De Freitas
- grid.430529.9Department of Clinical Medical Sciences, Faculty of Medical Sciences, University of the West Indies, 2nd Floor, Building #67, Eric Williams Medical Sciences Complex, Mt. Hope, Trinidad, St. Augustine, WI Trinidad and Tobago
| | - Tsarina Deonarinesingh
- grid.430529.9Department of Clinical Medical Sciences, Faculty of Medical Sciences, University of the West Indies, 2nd Floor, Building #67, Eric Williams Medical Sciences Complex, Mt. Hope, Trinidad, St. Augustine, WI Trinidad and Tobago
| | - Jiovanna Dhanai
- grid.430529.9Department of Clinical Medical Sciences, Faculty of Medical Sciences, University of the West Indies, 2nd Floor, Building #67, Eric Williams Medical Sciences Complex, Mt. Hope, Trinidad, St. Augustine, WI Trinidad and Tobago
| | - Cherelle Didier
- grid.430529.9Department of Clinical Medical Sciences, Faculty of Medical Sciences, University of the West Indies, 2nd Floor, Building #67, Eric Williams Medical Sciences Complex, Mt. Hope, Trinidad, St. Augustine, WI Trinidad and Tobago
| | - Shastri Motilal
- grid.430529.9Department of Clinical Medical Sciences, Faculty of Medical Sciences, University of the West Indies, 2nd Floor, Building #67, Eric Williams Medical Sciences Complex, Mt. Hope, Trinidad, St. Augustine, WI Trinidad and Tobago
| | - Nelleen Baboolal
- grid.430529.9Department of Clinical Medical Sciences, Faculty of Medical Sciences, University of the West Indies, 2nd Floor, Building #67, Eric Williams Medical Sciences Complex, Mt. Hope, Trinidad, St. Augustine, WI Trinidad and Tobago
| |
Collapse
|
17
|
Clement Y, Singh S, Motilal S, Maharaj R, Nunez-Smith M. The Authors Reply. Ethn Dis 2020; 30:703-704. [PMID: 32990691 DOI: 10.18865/ed.30.4.703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
This reply is in response to Letter to the Editor from Raj and Mathaiyan regarding our original article, “A Protocol for the Study of Polymorphisms and Response to Metformin in Patients with Type 2 Diabetes in Trinidad.” doi.org/10.18865/ed.30.S1.211 Ethn Dis. 2020;30(4):703-704.
Collapse
Affiliation(s)
- Yuri Clement
- Faculty of Medical Sciences, the University of the West Indies, Trinidad and Tobago and Yale School of Medicine, New Haven, CT
| | - Shamjeet Singh
- Faculty of Medical Sciences, the University of the West Indies, Trinidad and Tobago and Yale School of Medicine, New Haven, CT
| | - Shastri Motilal
- Faculty of Medical Sciences, the University of the West Indies, Trinidad and Tobago and Yale School of Medicine, New Haven, CT
| | - Rohan Maharaj
- Faculty of Medical Sciences, the University of the West Indies, Trinidad and Tobago and Yale School of Medicine, New Haven, CT
| | - Marcella Nunez-Smith
- Faculty of Medical Sciences, the University of the West Indies, Trinidad and Tobago and Yale School of Medicine, New Haven, CT
| |
Collapse
|
18
|
Motilal S. Physician related barriers towards insulin therapy at primary care centres in Trinidad: a cross-sectional study. BMC Fam Pract 2020; 21:197. [PMID: 32957991 PMCID: PMC7507810 DOI: 10.1186/s12875-020-01271-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/15/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Physician related factors with respect to insulin therapy can contribute to diabetes mellitus (DM) mismanagement. Patient related factors have been previously explored in a Trinidad survey. The main objective of this study was to explore primary care physicians' (PCPs) related barriers towards insulin therapy. METHODS A cross-sectional study on a convenience sample of PCPs in the public primary care system was done using an online survey. RESULTS Of the 170 PCPs contacted, 75 (44%) responded. There were 47 females (62.7%) and 28 males (37.3%) with a mean age of 35.9 yrs. Nearly 40% of physicians admitted that the education given to patients was inadequate to allow initiation of insulin therapy. Half the respondents admitted to insufficient consultation times and inadequate appointment frequency to allow for intensification of insulin therapy. Forty percent of PCPs admitted that HbA1c results were unavailable to guide their management decisions. Only 6.7% of physicians said they had access to rapid acting insulin, while 5.3% said they had access to insulin pens. CONCLUSION PCPs in Trinidad treating diabetes at the public primary care clinics face several barriers in administering proper insulin therapy. Addressing these factors can improve glycemic control in this population.
Collapse
Affiliation(s)
- Shastri Motilal
- Department of Paraclinical Sciences, Faculty of Medical Sciences, University of the West Indies, St. Augustine Campus, Eric Williams Medical Sciences Complex, Champs Fleurs, Trinidad.
| |
Collapse
|
19
|
Chattu VK, Sakhamuri S, Motilal S, Pounder LJ, Persad VK, Pierre N, Persad S, Pooran N, Pottinger AM. Tuberculosis Skin Test Screening in the National Tuberculosis Program of Trinidad and Tobago. Healthcare (Basel) 2020; 8:healthcare8030236. [PMID: 32727008 PMCID: PMC7551204 DOI: 10.3390/healthcare8030236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 11/16/2022] Open
Abstract
Globally, a quarter of the population is infected with tuberculosis (TB), caused by Mycobacterium tuberculosis. About 5–10% of latent TB infections (LTBI) progress to active disease during the lifetime. Prevention of TB and treating LTBI is a critical component of the World Health Organization’s (WHO) End TB Strategy. This study aims to examine the screening practices for prevention and treatment employed by the National Tuberculosis Program of Trinidad and Tobago in comparison to the WHO’s standard guidelines. A cross-sectional retrospective study was conducted from the TB registers (2018–2019) for persons aged 18 years and above with recorded tuberculin skin test reactions (TST). Bivariate comparisons for categorical variables were made using Chi-square or Fisher’s exact test. Binary logistic regression was used for exploring predictors of TST positivity with adjustment for demographic confounders in multivariable models. Of the total 1972 eligible entries studied, 384 (19.4%) individuals were tested positive with TST. TB contact screening (aOR 2.49; 95% CI 1.65, 3.75) and Bacillus Calmette–Guerin (BCG) vaccination status (aOR 1.66; 95% CI, 1.24 to 2.22) were associated with a positive TST reaction, whereas, preplacement screening failed to show such association when compared to those screened as suspect cases. The findings suggest that TB contact screening and positive BCG vaccination status are associated with TST positivity independent of age and gender.
Collapse
Affiliation(s)
- Vijay Kumar Chattu
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
- Occupational Medicine Clinic, St. Michael’s Hospital, Toronto, ON M5C 2C5, Canada
- Institute of International Relations, The University of the West Indies, St. Augustine, Trinidad and Tobago
- Correspondence: (V.K.C.); (S.S.); Tel.: +1-416-864-6060 (V.K.C.)
| | - Sateesh Sakhamuri
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, The University of the West Indies, St Augustine, Trinidad and Tobago; (L.J.P.); (V.K.P.); (N.P.); (S.P.); (N.P.); (A.M.P.)
- Eric Williams Medical Sciences Complex, North Central Regional Health Authority, Mount Hope, Trinidad and Tobago
- Correspondence: (V.K.C.); (S.S.); Tel.: +1-416-864-6060 (V.K.C.)
| | - Shastri Motilal
- Department of Paraclinical Sciences, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago;
| | - Liam J. Pounder
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, The University of the West Indies, St Augustine, Trinidad and Tobago; (L.J.P.); (V.K.P.); (N.P.); (S.P.); (N.P.); (A.M.P.)
| | - Vasishma Kanita Persad
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, The University of the West Indies, St Augustine, Trinidad and Tobago; (L.J.P.); (V.K.P.); (N.P.); (S.P.); (N.P.); (A.M.P.)
| | - Neelmani Pierre
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, The University of the West Indies, St Augustine, Trinidad and Tobago; (L.J.P.); (V.K.P.); (N.P.); (S.P.); (N.P.); (A.M.P.)
| | - Shivannie Persad
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, The University of the West Indies, St Augustine, Trinidad and Tobago; (L.J.P.); (V.K.P.); (N.P.); (S.P.); (N.P.); (A.M.P.)
| | - Nikesha Pooran
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, The University of the West Indies, St Augustine, Trinidad and Tobago; (L.J.P.); (V.K.P.); (N.P.); (S.P.); (N.P.); (A.M.P.)
| | - Akua Mosi Pottinger
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, The University of the West Indies, St Augustine, Trinidad and Tobago; (L.J.P.); (V.K.P.); (N.P.); (S.P.); (N.P.); (A.M.P.)
| |
Collapse
|
20
|
Gosein MA, Narinesingh D, Motilal S, Ramkissoon AP, Goetz CM, Sadho K, Mosodeen MD, Banfield R. Biparametric MRI prior to Radical Radiation Therapy for Prostate Cancer in a Caribbean Population: Implications for Risk Group Stratification and Treatment. Radiol Imaging Cancer 2020; 2:e200007. [PMID: 33778724 PMCID: PMC7983799 DOI: 10.1148/rycan.2020200007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/20/2020] [Accepted: 04/07/2020] [Indexed: 06/12/2023]
Abstract
PURPOSE To assess risk-group migration and subsequent management change following biparametric MRI using a risk-stratified approach in a group of Caribbean men with prostate adenocarcinoma being offered external beam radiation therapy (EBRT). MATERIALS AND METHODS This retrospective study assessed the biparametric MRI findings in men who opted for EBRT from January 2018 to June 2019 (n = 79; mean age, 67.9 years ± 6.2 [standard deviation]). Serum prostate-specific antigen level, digital rectal examination findings, histologic grade group (GG) from transrectal US-guided biopsy, prior androgen deprivation therapy (ADT), and any prior CT results were used to stratify patients into low-, intermediate-, and high-risk groups, according to the National Comprehensive Cancer Network risk categories. Risk-group stratification prior to MRI separated patients into low- (seven of 79 [8.9%]), intermediate- (36 of 79 [45.6%]) and high-risk (36 of 79 [45.6%]) groups. Following MRI, any risk group (low, intermediate, high, nodal involvement, and metastatic disease) or oncologic management changes were recorded. Multivariable binary logistic regression analyses were used to assess predictor of upgrade status, with adjustment for demographic covariates jointly. RESULTS Following MRI, 30 of 79 (38.0%) patients had risk-group upshifts compared with their original assessment. Patients were recategorized into low risk (one of 79, 1.3%), intermediate risk (19 of 79, 24.1%), high risk (51 of 79, 64.6%), nodal involvement (one of 79, 1.3%), and metastatic disease (seven of 79, 8.9%). From the original groupings, there were six of seven (85.7%) from the low group, 18 of 36 (50.0%) from the intermediate group, and six of 36 (16.7%) from the high group that had risk group upward shifts. There was no association with GG: GG2 versus GG1, P = .53; GG3 versus GG1, P = .98; or prior ADT (P = .37) and the adjusted odds of risk-group upshifts. MRI findings resulted in treatment plan modification for 39 of 79 (49.4%) men overall. CONCLUSION Prostate MRI should be considered for patients in high-risk populations prior to EBRT because upstaging from MR image assessment may have implications for modification of treatment.Keywords: MR-Imaging, Prostate, Radiation Therapy© RSNA, 2020See the commentary by Davenport and Shankar in this issue.
Collapse
|
21
|
Clement Y, Singh S, Motilal S, Maharaj R, Nunez-Smith M. A Protocol for the Study of Polymorphisms and Response to Metformin in Patients with Type 2 Diabetes in Trinidad. Ethn Dis 2020; 30:211-216. [PMID: 32269463 DOI: 10.18865/ed.30.s1.211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Background Metformin is the drug of first choice in people newly diagnosed with type 2 diabetes. Most patients respond to metformin monotherapy, but many others remain uncontrolled even at maximal doses. Although non-adherence is a major contributor to non-response, genetic polymorphisms of organic cation transporters play an important role in clinical response. We hypothesize that genetic variants are partly responsible for non-response. Objective This study aims to determine the allele and genotype frequencies of three single nucleotide polymorphisms (SNPs; ATM rs11212617, SLC22A1 rs594709 and SLC47A1 rs2289669) most commonly associated with failure to respond to metformin. Setting Ten primary health care facilities in the North Central Regional Health Authority region of Trinidad. Patients The study population will include 216 patients with diabetes adherent to metformin monotherapy for at least three months. Methods Following a 12-hour overnight fast, blood samples will be taken to measure fasting insulin and HbA1c. DNA would be isolated and PCR will be used to determine the allele and genotype frequencies of these three SNPs in adherent diabetic patients. DNA samples will be stored for future sequencing of these three genes to determine whether other, possibly novel, mutations are associated with poor metformin response in Trinidad. Clinical Significance This study will highlight the prevalence of these polymorphisms in our population. Should an association be found between the polymorphisms tested and glycemic control in adherent patients on metformin monotherapy, this will have implications for further research on medication initiation in newly diagnosed patients with diabetes in Trinidad.
Collapse
Affiliation(s)
- Yuri Clement
- Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Shamjeet Singh
- Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Shastri Motilal
- Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Rohan Maharaj
- Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | | |
Collapse
|
22
|
Seecheran N, Seebalack V, Seecheran R, Maharaj A, Boodhai B, Seecheran V, Persad S, Motilal S, Tello-Montoliu A, Schneider D. TRimetazidine as an Agent to affeCt clopidogrEl Response: The TRACER Study. Cardiol Ther 2019; 8:229-237. [PMID: 31292901 PMCID: PMC6828882 DOI: 10.1007/s40119-019-0139-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION This prospective study aimed to determine whether trimetazidine (TMZ) alters the pharmacodynamic (PD) effects of clopidogrel. METHODS Patients with stable coronary artery disease (SCAD) (n = 24) who were actively treated with dual antiplatelet therapy (DAPT) of aspirin 81 mg daily and clopidogrel 75 mg daily were recruited. Platelet function was measured with the VerifyNow P2Y12 assay (Accriva Diagnostics, San Diego, CA, USA) and assessed before the initiation of and after 14 days of treatment with TMZ. Results were compared using a paired t test. RESULTS Almost 80% of the study population were of South Asian descent and had diabetes mellitus (DM). P2Y12 reaction units (PRUs) were higher in patients on TMZ (204 ± 56 compared with 174 ± 71 before TMZ, p = 0.005). The average increase in PRU score was 29 (95% confidence interval 8.8-49.7). Before TMZ, the proportion of patients with high on-treatment platelet reactivity (PRU > 208 units) was 25%, which increased to 42% for patients on TMZ. CONCLUSION Higher platelet reactivity was seen in patients on TMZ, suggesting that TMZ attenuated the PD effects of clopidogrel in this study of a predominantly South Asian diabetic subpopulation. Alternative therapies should be considered and further research is warranted. TRIAL REGISTRATION ClinicalTrials.gov number, NCT03603249.
Collapse
Affiliation(s)
- Naveen Seecheran
- Department of Clinical Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago.
| | - Victoria Seebalack
- Department of Clinical Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Rajeev Seecheran
- Department of Medicine, North Central Regional Health Authority, Port of Spain, Trinidad and Tobago
| | - Aarti Maharaj
- Department of Medicine, North Central Regional Health Authority, Port of Spain, Trinidad and Tobago
| | - Brent Boodhai
- Department of Medicine, North Central Regional Health Authority, Port of Spain, Trinidad and Tobago
| | - Valmiki Seecheran
- Department of Medicine, North Central Regional Health Authority, Port of Spain, Trinidad and Tobago
| | - Sangeeta Persad
- Department of Medicine, North Central Regional Health Authority, Port of Spain, Trinidad and Tobago
| | - Shastri Motilal
- Department of Clinical Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | | | - David Schneider
- Cardiovascular Research Institute of Vermont, Colchester, VT, USA
| |
Collapse
|
23
|
Seecheran NA, Maharaj A, Boodhai B, Seecheran R, Seecheran V, Persad S, Ramsaroop K, Sandy S, Giddings S, Sakhamuri S, Ali R, Motilal S, Teelucksingh S, Tello-Montoliu A. Prevalence of clOpidogrel 'resIstaNce' in a selected population of patients undergoing elective percutaneous coronary intervention at a tertiary cardiovascular centre in Trinidad: the POINT pilot study. Open Heart 2019; 6:e000841. [PMID: 30997117 PMCID: PMC6443217 DOI: 10.1136/openhrt-2018-000841] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 11/12/2018] [Accepted: 01/20/2019] [Indexed: 11/03/2022] Open
Abstract
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.).
Collapse
Affiliation(s)
- Naveen Anand Seecheran
- Clinical Medical Sciences, University of the West Indies at Saint Augustine Faculty of Medical Sciences, Saint Augustine, Trinidad and Tobago
| | - Aarti Maharaj
- Department of Medicine, North Central Regional Health Authority, Champ Fleurs, Trinidad and Tobago
| | - Brent Boodhai
- Department of Medicine, North Central Regional Health Authority, Champ Fleurs, Trinidad and Tobago
| | - Rajeev Seecheran
- Department of Medicine, North Central Regional Health Authority, Champ Fleurs, Trinidad and Tobago
| | - Valmiki Seecheran
- Department of Medicine, North Central Regional Health Authority, Champ Fleurs, Trinidad and Tobago
| | - Sangeeta Persad
- Department of Medicine, North Central Regional Health Authority, Champ Fleurs, Trinidad and Tobago
| | - Koomatie Ramsaroop
- Department of Medicine, North Central Regional Health Authority, Champ Fleurs, Trinidad and Tobago
| | - Sherry Sandy
- Clinical Medical Sciences, University of the West Indies at Saint Augustine Faculty of Medical Sciences, Saint Augustine, Trinidad and Tobago
| | - Stanley Giddings
- Clinical Medical Sciences, University of the West Indies at Saint Augustine Faculty of Medical Sciences, Saint Augustine, Trinidad and Tobago
| | - Sateesh Sakhamuri
- Clinical Medical Sciences, University of the West Indies at Saint Augustine Faculty of Medical Sciences, Saint Augustine, Trinidad and Tobago
| | - Ronan Ali
- Clinical Medical Sciences, University of the West Indies at Saint Augustine Faculty of Medical Sciences, Saint Augustine, Trinidad and Tobago
| | - Shastri Motilal
- Clinical Medical Sciences, University of the West Indies at Saint Augustine Faculty of Medical Sciences, Saint Augustine, Trinidad and Tobago
| | - Surujpal Teelucksingh
- Clinical Medical Sciences, University of the West Indies at Saint Augustine Faculty of Medical Sciences, Saint Augustine, Trinidad and Tobago
| | | |
Collapse
|
24
|
Abstract
OBJECTIVES Current treatment strategies for painful diabetic neuropathy (PDN) include oral medications, which are costly and may have adverse effects. Topical therapies have been used for PDN with some benefit. Nutmeg has certain properties that may be effective in ameliorating neuropathic pain. The purpose of this study was to determine whether topical nutmeg extracts can reduce pain or improve the quality of life in PDN sufferers. DESIGN This study was a randomized, double-blind, placebo-controlled trial. SETTINGS/LOCATION It was conducted at a primary care center in Trinidad, Caribbean. SUBJECTS Seventy-four (74) diabetic subjects who met criteria for painful neuropathy were recruited. INTERVENTIONS Participants were randomized to receive either topical nutmeg extracts (NEMM; mace oil [2%], nutmeg oil [14%], methyl salicylate [6%], menthol [6%], and coconut oil) or placebo (MM; methyl salicylate [6%], menthol [6%], coconut oil, and alcohol). OUTCOME MEASURES Outcome measures of pain and quality of life were assessed using the Brief Pain Inventory for Diabetic Painful Neuropathy and Neuropathic Pain Symptom Inventory. RESULTS An intention-to-treat analysis was done for 24 male and 50 female subjects (30-85 years) with an average duration of diabetes of 11 years. Significant reductions in worst and average pain scores were seen within each group (p ≤ 0.001). Similarly significant reductions were also noted for interference with walking, sleep, and mood scores as well as burning, pins and needles, and tingling scores within each group (p<0.05). There were no statistically significant differences between both groups after 4 weeks for any outcome measure. CONCLUSIONS In this trial topical, nutmeg extracts did not add to the improvements observed in PDN symptoms during 4 weeks treatment with preparations containing menthol and methyl salicylate. Further research designed to test the individual components of the topical therapies used in this study may clarify their benefit.
Collapse
Affiliation(s)
- Shastri Motilal
- Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad, West Indies.
| | | |
Collapse
|
25
|
Bharath J, Mosodeen M, Motilal S, Sandy S, Sharma S, Tessaro T, Thomas K, Umamaheswaran M, Simeon D, Adesiyun AA. Microbial quality of domestic and imported brands of bottled water in Trinidad. Int J Food Microbiol 2003; 81:53-62. [PMID: 12423918 DOI: 10.1016/s0168-1605(02)00193-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A cross-sectional study was conducted to determine the microbial quality of domestic and imported brands of bottled water available in Trinidad, purchased from six geographical regions in Trinidad, and representing the whole island. A sample size of 344 bottles of water was determined by using a precision rate of 2% and a Type 1 error of 5%. The membrane filter technique was used with cultures grown on m-Endo agar and m-FC agar for total coliforms and thermotolerant coliforms, respectively. Aerobic plate count (APC) was determined on nutrient agar; Pseudomonas aeruginosa was detected on MacConkey agar, Escherichia coli was isolated on eosin methylene blue (EMB) and Salmonella spp. was assayed by using standard methods. Of the 344 water samples tested, 262 (76.2%) and 82 (23.8%) were domestic and imported brands, respectively. Eighteen (5.2%) of the 344 samples contained coliforms with a mean count of 0.88+/-6.38 coliforms per 100 ml, while 5 (1.5%) samples contained E. coli. The prevalence of total coliforms in domestic brands of bottled water was 6.9% (18 of 262) as compared with 0.0% (0 of 82) detected in imported brands. The difference was statistically significant (p=0.004). Similarly, the prevalence of aerobic bacteria in domestic brands of bottled water (33.6%) was significantly higher (p=0.001) than was found in imported brands (14.8%). Twenty-six (7.6%) of the total samples of water contained Pseudomonas species, but all were negative for thermotolerant coliforms and Salmonella spp. It was concluded that based on the recommended zero tolerance for coliforms in potable water, 5% of bottled water sold in Trinidad could be considered unfit for human consumption.
Collapse
Affiliation(s)
- J Bharath
- School of Medicine, Faculty of Medical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago
| | | | | | | | | | | | | | | | | | | |
Collapse
|