DNA Barcoding Analysis of Trinidad Haemagogus Mosquitoes Reveals Evidence for Putative New Species

Background: Haemagogus janthinomys is a primary sylvan vector of yellow fever virus and the emerging Mayaro virus. However, despite its medical importance, there is a dearth of data on the molecular taxonomy of this mosquito species. Methods: In this study, DNA barcoding analysis was performed on 64 adult female mosquitoes from Trinidad morphologically identified as Hg. janthinomys. The mitochondrial cytochrome c oxidase I (COI) gene and ribosomal DNA internal transcribed spacer 2 (ITS2) region of the mosquitoes were PCR amplified and sequenced, and molecular phylogenies inferred. Results: The BLASTN analysis showed that only 20% (n = 13/66) of COI sequences had high similarity (>99% identity) to Hg. janthinomys and the remaining sequences had low similarity (<90% identity) to reference GenBank sequences. Phylogenetic analysis of COI sequences revealed the presence of four strongly supported groups, with one distinct clade that did not align with any reference sequences. Corresponding ITS2 sequences for samples in this distinct COI group clustered into three clades. Conclusions: These molecular findings suggest the existence of a putative new Haemagogus mosquito species and underscore the need for further, more in-depth investigations into the taxonomy and classification of the Haemagogus genus.

Hematological profile of healthy Thoroughbred foals from birth to one month of age in Trinidad, West Indies

OBJECTIVE

This study aimed to develop a sound database for the hematological reference intervals of thoroughbred foals in Trinidad, West Indies from birth to 1 month of age.

ANIMALS

89 foals.

METHODS

Whole blood samples were taken from 89 foals throughout Trinidad at approximately 1 day, 1 week, and 1 month of age. These foals were examined to be classified as healthy or free from disease. Complete blood count (CBC), microscopic analysis of blood smears, and conventional PCR for Theileria equi and Babesia caballi were performed.

RESULTS

Of the 89 foals, 67 were deemed healthy and suitable for establishing reference intervals. Foals in this study had lower mean hemoglobin and hematocrit values for all 3 times of sampling when compared to their North American counterparts. Age had a significant effect on hemoglobin, hematocrit, white blood cell (WBC), neutrophil, and platelet counts of the foals from birth to 1 month of age.

CLINICAL RELEVANCE

Variations in reference intervals can occur due to differences in demographic, physiological, and environmental factors such as age, gender, breed, and geographical location. Given the changes in the hematological values over time, this study provides clinicians with valuable information that can be used to monitor the health status of newborn foals and detect disease conditions.

Anatomical variations in the circle of Willis on magnetic resonance angiography in a south Trinidad population

Objectives

This article seeks to determine the prevalence of a complete circle of Willis (CoW) and its common morphological variations in a south Trinidad population, while also investigating the influence of gender, age, and ethnicity on CoW morphology.

Methods

A prospective, descriptive, cross-sectional study was done on the magnetic resonance images for consecutive patients who had a brain MRI/magnetic resonance angiography at a tertiary health institution in south Trinidad between October 2019 and September 2020. Patients with significant cerebrovascular disease and/or a history of prior neurosurgical intervention were excluded.

Results

A complete CoW was seen in 24.3%, with more complete circles observed in younger participants (≤45 years) and Afro-Trinidadians. No gender predilection for a complete CoW was demonstrated. The most common variations in the anterior and posterior parts of the circle were a hypoplastic anterior communicating artery (8.6%, n = 13) and bilateral aplastic posterior communicating arteries (18.4%, n = 28), respectively.

Conclusions

Significant variations exist in the CoW of a south Trinidad population with a frequency of complete in 24.3%, and more complete circles in younger patients and Afro-Trinidadians. Gender did not influence CoW morphology.

Advances in knowledge

Structural abnormalities in the CoW may be linked to future incidence of cerebrovascular diseases and should therefore be communicated to the referring physician in the written radiology report. Knowledge of variant anatomy and its frequency for a particular populations is also required by neurosurgeons and neuro-interventional radiologists to help with preprocedural planning and to minimize complications.

Comparative evaluation of estrus synchronization protocols on reproductive performance and estrus behavior in Barbados Black Belly sheep

Background and Aim

Estrus synchronization of ewes has been accomplished using several protocols with various degrees of success in improving reproductive efficiency and obtaining the most effective protocol used in sheep farming. This study aimed to compare the effectiveness of three treatment protocols and to record the intensity and duration of estrus signs and pregnancy rate in Barbados Black Belly (BBB) sheep.

Materials and Methods

Thirty-two primipara BBB ewes aged 18-24 months were equally divided into three treatment groups. T1: the ewes were injected intramuscularly with 2 mL Lutalyse (PGF2α) (10 mg) on days 0 and 10. T2: 1 mL Fertiline (50 μg; Gonadorelin acetate) on day 0 and 2 mL lutalyse (10 mg) on day 7. T3: 1 mL fertiline (50 μg) on day 0, 2 mL lutalyse (10 mg) on day 7, and 1 mL Fertiline (50 μg) on day 9. Estrus response was assessed using naturally mating rams and ewes. Pregnancy was determined using ultrasonography between 55 and 80 days after the last hormonal injection. The following estrus signs were noted: Swollen vulva, mucus discharge, sniffing, excitement, loss of appetite, mounting, and rapid tail movement.

Results

Of the expressed signs, swollen vulva was most frequent, whereas loss of appetite and mucus discharge were the least overt signs recorded. The estrus response (%), onset (%), and duration (h) in ewe synchronization of the three treatment protocols were 100%, 58.3 ± 23.4%, and 48.0 ± 18.2 h (T1), 100%, 61.7 ± 41.2%, and 45.0 ± 27.0 h (T2), and 37.5%, 32.1 ± 1.7%, and 29.2 ± 1.25 h (T3), respectively. The pregnancy rates were 87.5%, 87.5%, 37.5%, and 50.0% in T1, T2, T3, and T4, respectively.

Conclusion

Prostaglandin F2α+PGF2α and GnRH+PGF2α synchronization protocols were more effective in the fertilization of BBB ewes with better expression of estrus signs compared with the GnRH+PGF2α+GnRH (OVS) protocol.

Are primary care consultations in Trinidad patient-centered? A cross-sectional study of patients with non-communicable diseases

BACKGROUND

The aim of this study was to measure the patient's perception of patient centeredness in their consultations for non-communicable diseases (NCDs). We also measured consultation length and patient enablement.

METHOD

A cross-sectional study was conducted over 2 months at four primary care clinics at the St. Joseph cluster of the North Central Regional Health Authority (NCRHA) in Trinidad and Tobago. Interviewers timed the consultation and completed post-consultation questionnaires using the Patient Perception of Patient-Centeredness (PPPC) questionnaire and the Patient Enablement Index (PEI). The PPPC is a 14-item (each scored 1-4) Likert-scaled instrument. The total score is averaged and a PPPC score of 4 is the maximum. The PEI measures the ability of the patient to cope with life and their disease. The PEI consists of 6 questions scored 0-2, with a maximum score of 12.

RESULTS

There were 180 respondents (response rate = 82.5%). Participants were female (75.6%), aged over 65 years (50.6%), married (51.1%), Indo-Trinidadian (52.2%), and Christian (60.6%). Half achieved a primary school education, and 37.2% secondary. The consultation length ranged between 1.32 and 31.22 min. The average, median and mode of the consultation length were 8.5, 7.74 and 10 min, respectively. The average, median and mode of the measures of patient-centeredness were PPPC (3.67, 3.86 and 4) and PEI score (5.93, 6 and 6). The PPPC average was lower in patients with a stroke (p = 0.022), and higher among those with more than 2 consultation interruptions (p = 0.015) and those who knew the doctor very well (p = 0.015). The PEI score was lower in patients with heart disease (p = 0.022). The consultation length was longer in those with tertiary education (p = 0.044) and those with two consultation interruptions (p = 0.032). PPPC Average and PEI Score correlated well (ρ = 0.408, p < 0.001). The consultation length correlated with the PPPC Average (ρ = 0.168,p = 0.025).

CONCLUSION

Primary Care consultations in this cluster of health centres in NCRHA in Trinidad were often patient centered. The consultation length, patient-centeredness, measured with the PPPC instrument, and patient enablement scores, measured with the PEI instrument, in consultations for NCDs in Trinidad compare favourably with international reports.

The preconception health status of nongravid women aged 18 to 45 years in Arima, Trinidad: a cross-sectional study

BACKGROUND

Preconception care (PCC) is the term used for activities and interventions designed to address and prevent problems related to pregnancy, the neonatal period and childhood. This study assessed maternal health status prior to conception in Trinidad by means of a screening tool, physical measurements, and laboratory samples.

METHODS

A cross-sectional study was conducted among women aged 18-45 years at a primary care centre in Arima, Trinidad. A de novo PCC screening tool was used to assess 13 domains of high-risk pregnancy in participants. These domains included dietary details, gynaecological and obstetric histories, and genetic and vaccination histories, among others. Blood pressure, weight, height, and waist circumference were recorded, and a capillary blood sample was used to determine random blood glucose and HbA1c levels. All data were coded and entered into SPSS ver. 21.

RESULTS

A total of 400 nongravid participants were recruited, of whom 366 were included in the final analysis. Most (96.7%) had one or more risk factors for adverse pregnancy outcomes. These included overweight (27%), obesity (35%), central obesity (69.4%), and impaired glucose tolerance/diabetes mellitus (IGT/DM) (26.2%). Additionally, a sedentary lifestyle and diet high in processed food/fats were self-reported by 74.9% and 88.8% of participants, respectively. Only 13.1% had planned to conceive, and of those who had no immediate plans to conceive, 76.4% were currently sexually active, and many (60.7%) did not use birth control techniques. More than half (57.1%) had never had a pap smear. On the other hand, 86.3% knew their HIV status. Self-reported percentages for vaccination were as follows: MMR (100%), tetanus (17.5%), hepatitis B (11.5%) and influenza (2.7%). The majority (82.8%) of participants had not visited the dentist in the past year, with 35.9% of these individuals reporting symptoms of periodontitis. Segments of the population had multiple risk factors; for example, 23.7% of participants were overweight or obese and had an elevated HbA1c level.

CONCLUSIONS

Unexpectedly, most participants had a risk factor for an adverse pregnancy outcome, and many had multiple risk factors. There is a strong case for enhanced preconception care for women in Trinidad.

Comparative Analysis of Health- and Vision-Related Quality of Life Measures among Trinidadians with Low Vision and Normal Vision-A Cross-Sectional Matched Sample Study

This cross-sectional study investigated the health-related and vision-related quality of life measures of adults with low vision compared to healthy individuals in Trinidad and Tobago. The health-related quality of life (HRQOL-14) and the National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25) were administered to 20 participants with low vision caused by diabetic retinopathy, retinitis pigmentosa, glaucoma, and macular degeneration, as well as 20 participants with no visual problems (control). Participants were recruited from the University Eye Clinic in Trinidad and Tobago. Compared to the controls, more participants in the low-vision group had lower age-adjusted NEI-VFQ-25 scores (48.3% vs. 95.1%; p < 0.001), had poor general (47.5% vs. 10%, p = 0.004) and mental (100% vs. 10%, p < 0.042) health, experienced greater activity limitation due to impairment or health problems (85% vs. 20%, p < 0.001), needed help with personal care (27.5% vs. 0%, p < 0.009) and daily routine (67.5% vs. 0%, p < 0.001), and experienced sleep problems (97.5% vs. 65%, p < 0.001) and symptoms of anxiety (100% vs. 90%, p = 0.042). All the diabetic retinopathy participants (100%, p = 0.028) had two or more impairments or vision problems compared to none in the other low-vision participants. In summary, the HRQOL-14 and NEI-VFQ-25 scores were significantly reduced in low-vision participants, who also demonstrated a greater vulnerability to poor quality of life in the presence of diabetes retinopathy. These findings have important clinical implications regarding offering appropriate support and interventions to improve quality of life outcomes in individuals with low vision.

The incidence of histoplasmosis and cryptococcal antigenemia among patients attending a large HIV clinic in Trinidad

Our aim was to determine the incidence disseminated histoplasmosis and cryptococcal antigenemia among 280 patients with a CD4<350 cells/mm³ attending a large HIV clinic in Trinidad over the period November 2021-June 2022. Sera were screened for cryptococcal antigen (CrAg) using the Immy CrAg Immunoassay (EIA) and the Immy CrAg lateral flow assay (LFA). Urine was screened for Histoplasma antigen using the Immy EIA and the Optimum Imaging Diagnostics (OIDx) LFA. For the purposes of analysis, it was assumed, that all patients with positive urine Histoplasma antigen tests by both EIA and LFA and those with a single positive urine Histoplasma antigen test and clinical features of disseminated histoplasmosis were true positives. The incidence of probable disseminated histoplasmosis and cryptococcal antigenemia were 6.4% (18/280) and 2.5% (7/280) respectively. The sensitivity and specificity of the Immy Histoplasma EIA were 100% (95% CI, 81.5%-100%) and 98.5% (95% CI, 96.1% - 99.6%) respectively as compared to the OIDx Histoplasma LFA of 88.9% (95% CI, 65.3% - 98.6%) and 93.9% (95% CI, 90.3% - 96.5%) respectively, with substantial agreement between the 2 test kits (Kappa value = 0.763; 95% CI 0.685, 0.841). Testing for disseminated histoplasmosis in HIV patients is important in endemic areas.

Estimations of future reservoir volumes under different climate scenarios for a tropical reservoir in a small Caribbean Island, Trinidad

Freshwater resources supply has always presented challenges and considering a changing climate quantifying the available water in the future is important. In the Caribbean, based on projections it is likely that the island of Trinidad would receive less intense rainfall, experience more dry days, become drier and warmer, and the water resources be decreased. In this study, the impact of a changing climate on the Navet Reservoir in Trinidad was investigated and reservoir volumes were quantified for the period 2011-2099. This period was subdivided into three time periods, 2011-2040, 2041-2070, and 2071-2099, and evaluated under the representative concentration pathways (RCPs): RCPs 2.6, 4.5, 6.0, and 8.5. Utilizing a calibrated/validated Soil Water Assessment Tool (SWAT) model for the Navet Reservoir together with projections from five general circulation models (GCMs), future monthly and seasonal reservoir volumes were estimated. The GCM precipitation and temperature data were bias-corrected using linear scaling and variance scaling methods. It was found that reservoir volumes are likely to be the lowest during the period 2041-2070 at the Navet Reservoir. Additionally, the projected reservoir volumes are reliable, resilient, and not vulnerable. These results may be used by water managers in the adaptation and mitigation of the impacts of a changing climate, thus, building resilience in the water sector.

Knowledge, attitude and perception of optometrists in Trinidad and Tobago towards teleoptometry

Background

The limited accessibility of in-person optometry services during the coronavirus disease 2019 highlighted the need for teleoptometry but no data exists to substantiate the foregoing in Trinidad & Tobago (T&T). The study assessed the knowledge, attitude and perception (KAP) of optometrists toward teleoptometry in T&T.

Methods

This cross-sectional study utilized a convenient sampling technique to administer a structured, web-based survey to all registered optometrists in T&T between March and June 2021. Information on demographics and KAP of teleoptometry were collected. Descriptive statistics (mean, percentages, and standard deviations) were used to describe the characteristics of respondents. The mean scores for the main outcomes (KAP) were compared between the categorical groups of the demographic variables, using a one-way analysis of variance. A P-value of less than 0.05 was considered statistically significant.

Results

Of the 116 registered optometrists in T&T, 63 responded to the survey (response rate, 54.3%), and were mostly women (44, 69.8%), aged 21-30 years (42, 66.7%), worked in urban regions (41, 65.1%), and half of them (32, 50.8%) had practiced optometry for five or more years. More than two-thirds of the optometrists (76.4%) reported that they had never provided teleoptometry services, and only a few (2, 3.2%) had training on teleoptometry. The percentage mean scores for knowledge were significantly lower than attitude (38.5 ± 17.9% vs 78.2 ± 29.9%; P = 0.002) and perception (46.2 ± 11.4%; P < 0.001) scores, all of which were significantly lower among self-employed than employed optometrists (P < 0.02, for all three variables). While men and non-professional computer users had higher mean scores for attitude than women (3.03 [95%CI: 2.14, 3.93] vs 2.31 [95%CI: 1.41, 3.21], P = 0.037) and professional users (3.15 [95%CI: 2.07, 4.24] vs 2.18 [95%CI: 1.12, 3.24], P = 0.001), knowledge and perception scores varied significantly with practitioners' years of experience (P = 0.042) and age (P = 0.041), respectively.

Conclusion

The findings of the study suggest that although there was limited knowledge of teleoptometry among the participants, particularly the self-employed and the less experienced optometrists, most of them had good attitudes and perceptions toward teleoptometry. To fill the identified knowledge gap, there is a need for teleoptometry training among optometrists in T&T.

COVID-19 Vaccine Uptake, Acceptance, and Reasons for Vaccine Hesitancy: A Cross-Sectional Study Among Pregnant Women in Trinidad, West Indies

Purpose

Pregnant women are at greater risk for severe COVID-19 disease and are a priority group for vaccination. Trinidad and Tobago (TTO) introduced COVID-19 vaccination for pregnancy in August 2021, however uptake is presumed to be low. The objective was to determine the COVID-19 vaccine acceptance and uptake rates among pregnant women in TTO and reasons for vaccine hesitancy.

Patients and Methods

This was a cross-sectional study on 448 pregnant women conducted at specialized antenatal clinics within the largest Regional Health Authority in TTO, and at one private institution from February 1 to May 6, 2022. Participants completed an adapted WHO questionnaire on reasons for COVID-19 vaccine hesitancy. Logistic regression was used to assess factors affecting vaccination decisions.

Results

The vaccine acceptance and uptake rates in pregnancy were 26.4% and 23.6%, respectively. The main reason for vaccine hesitancy was lack of research on the COVID-19 vaccine in pregnancy (70.2%), where 75.5% of women believed the vaccine would harm their babies and 71.2% believed there was not enough data. Women seeking care in the private sector (OR: 5.24, 95% CI: 1.41-19.43) and who had comorbidities (OR: 3.72, 95% CI: 11.57-8.83) were more likely to take the vaccine, while Venezuelan non-nationals (OR: 0.09, 95% CI: 0.01-0.71) were less likely to take the vaccine. Older women (OR: 1.80, 95% CI: 1.12-2.89), women with tertiary education (OR: 1.99, 95% CI: 1.25-3.19), and women seeking care in the private sector (OR: 9.45, 95% CI: 4.36-20.48) were more likely to accept the vaccine.

Conclusion

Lack of confidence in the vaccine was the main reason for hesitancy, which may reflect paucity of research, lack of knowledge or misinformation of the vaccine in pregnancy. This highlights the need for more targeted public education campaigns and promotion of the vaccine by health institutions. The knowledge, attitudes, and beliefs of pregnant women obtained from this study can guide the development of vaccination programs in pregnancy.

Factors Affecting COVID-19 Vaccination Intentions among Patients Attending a Large HIV Treatment Clinic in Trinidad Using Constructs of the Health Belief Model

Persons living with HIV are particularly vulnerable to COVID-19 and understanding the factors influencing their decision to take the COVID-19 vaccine are crucial. Using the Health Belief Model (HBM), our study examined the role of psychological factors in predicting vaccine intention in patients with HIV. The underlying concept of the HBM is that behaviour is determined by personal beliefs about a disease, and access to strategies to decrease its occurrence. A cross-sectional survey using a structured questionnaire was conducted between August and September 2021 at an HIV clinic in Trinidad. Data on the HBM constructs, namely patient's beliefs about the perceived severity and susceptibility to COVID-19, their perceived benefits of taking the vaccine, and external cues to action, i.e., factors that may motivate them to take the vaccine, were collected. Univariate and multivariable logistic regression analyses were used to examine associations and whether the HBM components were predictors of vaccination intention. In this study, 59.9% of patients indicated their intentions to take the vaccine. Females (OR 0.49, 95% CI 0.30-0.81) were less inclined to take the COVID-19 vaccine compared to males, while Indo-Trinidadian patients with HIV (OR 4.40, 95% CI 1.26-15.3) were more inclined to take the vaccine compared to Afro-Trinidadians. Health beliefs such as having confidence in the vaccine (p = 0.001) and believing in its perceived benefits (p = 0.001) were significant predictors of vaccination intention. Patients who were confident about the vaccine were six times more likely to take the vaccine (OR 6.45, 95% CI 2.13-19.5) than persons who were not confident in it. Having adequate information about the vaccine or the knowledge of others who received the vaccine (OR 1.48, 95% CI 1.03-2.11) were significant cues to action influencing their decision. Guided by the HBM, understanding patient's health beliefs is important in the design of tailored interventions to improve vaccine outcomes. The HBM may also be useful in the design of approaches to increase the uptake of critical HIV prevention, and treatment services.

Assessment of natural radioactivity level before and after a mud-volcano eruption: A study from Piparo mud-volcano, Trinidad and Tobago

The present study was conducted in the Piparo mud-volcano, which is situated in the central part of the island of Trinidad, is geologically connected with the Central Fault Range Zone (CFRZ). This fault zone is a neotectonic (active) strike-slip fault system and an extension of the Andes Mountain chain. This study was aimed at detecting the possible gamma radiation level in Piparo MV after its eruption in September 2019 and finding the change in the ambient radiation level after that eruption. To achieve this aim, gamma radiation data were collected for 6 months (three times at 3 months interval) after this eruption. As a pilot study, gamma radiation measurements were measured with the help of a portable Geiger Muller counter from 32 locations. Radiation levels were nearly 2 times higher than the average background levels in the country indicating Piparo mud-volcano could have controlled the elevated radiation levels in the area. Good correlations were also found between elevated radiation in the northern and western sides of the main crater and presence of auxiliary craters in the same sides. Previous studies reported that the northern side of the crater was more active, and the present study also supported their observation. Good correlation (with coefficient >0.9) indicates that these radioactivity values might be syngenetic. Continuous release and slow reduction of radiation levels (only 13% over 6 months) may indicate a continuous activity in Piparo mud-volcano and may support CRFZ as a creep fault.

Well-being among older persons with disabilities in Trinidad

Given the expected increase in the proportion of older persons and evidence of poverty among persons with disabilities in general, well-being among older persons with disabilities is an important issue. Using Sen's capability approach, this article examines well-being among older persons with disabilities in Trinidad. A multiphase mixed-methods design with three phases was employed. In the initial exploratory phase, functionings which are things people value doing or being were identified via 11 interviews. These functionings were used in the subsequent phase to develop an instrument with both closed- and open-ended questions. The instrument was then administered in the third phase to measure well-being and to identify its hindering factors. Responses from 31 participants revealed moderate-to-severe deprivations among older persons with disabilities in Trinidad including for functionings related to food, healthcare, information and transportation. The integrated findings suggested changes to social care and healthcare systems to promote well-being among older persons with disabilities in Trinidad, as well as the need to develop community interactions and public services regarding transportation, supportive devices, and therapy.

Online e-learning during the COVID-19 lockdown in Trinidad and Tobago: prevalence and associated factors with ocular complaints among schoolchildren aged 11-19 years

Background

The increase in online learning during the pandemic has been linked to various ocular complaints. This study determined the prevalence and factors associated with ocular complaints among schoolchildren aged 12-19 years during the COVID-19 lockdown in Trinidad and Tobago (T&T).

Methods

A cross-sectional study was conducted between January and May 2021, during the COVID-19 lockdown in T&T among secondary school students studying remotely. A two-stage cluster sampling method was employed. A modified web-based Computer Vision Syndrome questionnaire was administered to students. Data on demography, duration of digital device use, and ocular complaints were collected, and multilevel logistic regression was used to determine factors associated with ocular complaints among school children, 12-19 years of age in T&T.

Results

A total of 435 schoolchildren (mean age, standard deviation, 15.2 ± 1.9 years range 12-19 years) responded to the questionnaire. The prevalence of self-reported symptoms of headache, blurred vision, dry eyes, itchy eyes, and double vision were 75.0%, 65.1%; 56.8%; 46.4%; and 33.5%, respectively. Schoolchildren aged 18-19 years, those that used spectacles for correction of their refractive errors, and spent more than 6 h on average on digital devices, reported a high prevalence of any ocular complaints. Analysis also revealed that age (14-15 years) was associated with dry eyes, blurred vision, and headaches, while gender (more prevalently females) was associated with blurred vision and headache. Those that had an eye examination in the last year and schoolchildren that took action to resolve ocular complaints were more likely to experience nearly all ocular complaints.

Conclusions

During the COVID-19 lockdown, over three in four students in T&T reported ocular complaints from digital devices for online learning. Tailored interventional messages to reduce all forms of ocular complaints should target older students, particularly females, those who laid down when learning online via their devices and people who regularly examine their eyes.

'You don't just do it because someone else said so': Menstrual practices and women's agency in the Hindu diaspora of Trinidad

Meanings of menstruation are deeply embedded in culture and religion. The current dominant narrative presents menstrual practices as restrictions and often describes Hindu women as 'subjected to' these practices, characterising them as the oppressed victims of their religion. This article seeks to complicate this oversimplified narrative by exploring women's motivations, choices and decisions related to menstrual practices in a small-scale study based on semi-structured interviews and focus groups with women in the Hindu-Trinidadian diaspora. Our findings indicate that the women we interviewed exercise agency in the cognitive, emotional, religious and socio-cultural spheres. Many of them accept the ritual 'impurity' but overwhelmingly restrict this label to the spiritual sphere and separate it from their menstruating bodies. Many reject the idea that the practices are restrictive or stigmatising. They do not understand religion as the source of menstrual stigma but instead value or accept menstrual practices as part of what it means to be a Hindu woman-motivated by religious observance and/or the desire to be part of a community that upholds tradition. These varied manifestations of women's agency challenge the understanding of menstrual practices as necessarily-and-always oppressive and call for acknowledging the nuance and complexity of women's lives.

A Comparison of Peripheral Blood Smears, Autologous Cell Cultures, and Reverse Line Blot Hybridisation in Screening for Anaplasma/Ehrlichia in Roaming Dogs and Symptomatic Dogs in Trinidad

This study compared two methods to detect cases of canine ehrlichiosis in a field setting. One method was a polymerase chain reaction for the 16S rRNA gene followed by reverse line blot hybridisation with genera and species-specific probes for Anaplasma/Ehrlichia. The second method was an autologous cell culture of peripheral leucocytes isolated from heparinised blood and maintained in a homologous canine serum in Dulbecco's Modified Eagle medium without antibiotics. The cultures were examined under light microscopy for inclusion bodies after 48 h. Leucocytes were successfully propagated for 20 of the 34 samples submitted for autologous cell culture. Inclusion bodies were observed after cell culture in leucocytes of eight dogs. Two dogs were positive to the Anaplasma/Ehrlichia genera probe and six dogs were positive to the E. canis probe after reverse line blot hybridisation. There was acceptable agreement between reverse line blot hybridisation and cell culture results. Both reverse line blot hybridisation and autologous cell cultures can be used to detect E. canis in subclinical and clinical cases of disease. A definitive diagnosis of E. canis is best achieved by a combination of clinical signs, positive autologous cell culture, and reverse line blot hybridisation results.

Operation notes in orthopaedics: Beliefs and practices in a developing country

Maintaining accurate and complete operation notes is an essential metric of the quality of surgical care. While developed countries have implemented electronic health records to improve documentation, financial constraints prevent this realisation in the Caribbean. Somewhat paradoxically, previous studies in this area have focussed on 'process' while neglecting the key role of the surgeon. We conducted a 25-item Knowledge, Attitudes and Practices survey of orthopaedic doctors to identify any culturally unique health-related behaviours. Our results indicate that while most doctors understand the importance of operation notes, many are unaware of international note-keeping recommendations. Legibility was identified as a significant issue by 92% of doctors. A disturbing and previously unreported finding from the study revealed that 72% of surgeons would occasionally write the operation notes, although they were not scrubbed in for the procedure. We suggest that future studies examine this peculiar behaviour in greater detail.

Characterization of Salmonella Isolates Recovered from Stages of the Processing Lines at Four Broiler Processing Plants in Trinidad and Tobago

This cross-sectional study determined the prevalence, characteristics, and risk factors for contamination of chicken with Salmonella at four operating broiler processing plants in Trinidad. Standard methods were used to isolate and characterize the Salmonella isolates. The overall prevalence of Salmonella at the four processing plants was 27.0% (107/396). The whole carcass enrichment (WCE) method yielded a statistically significantly (p = 0.0014) higher frequency of isolation (53.9%; 97/180) than the whole carcass rinse (35.0%; 63/180) and neck skin methods (42.2%; 38/90). S. enterica serotypes Enteritidis, Javiana, and Infantis were the predominant serotypes isolated accounting for 20.8%, 16.7% and 12.5%, respectively, of the serotyped isolates. Risk factors included the use of over 100 contract farmers (OR 4.4), pre-chiller (OR 2.3), addition of chlorine to chiller (OR 3.2), slaughtering sick broilers (OR 4.4), and flocks with >50% mortality. Multi-drug resistance was detected in 12.3% (14/114) of the isolates of Salmonella. Resistance was high to kanamycin (85.7%) and doxycycline (74.6%) but low to amoxicillin-clavulanic acid (2.4%) and sulphamethoxazole-trimethoprim (0.8%). The occurrence of resistant Salmonella in chickens processed at commercial broiler processing plants has implications for salmonellosis and therapeutic failure in consumers of improperly cooked contaminated chickens from these plants in the country.

Living in the end of days: risk, anxiety, subjectivity and the devil in a Trinidadian village

Drawing on ethnographic fieldwork in Trinidad, this paper examines how the framing of a particular apocalyptic future provided a moral commentary and model for wellbeing in contemporary everyday life. Changing social, political, and economic circumstances and relations had brought a range of new risks and anxieties into daily life. These more recent problems originating from beyond the village (such as climate change, criminality, inequality, pollution, neglect by the State) could not be resolved through working with obeah spirits as might have been used previously for more local issues, or through the long-established Catholic and Anglican churches. Instead evangelical Christian cosmology and practices gave a means of making sense of such issues and for protecting oneself. The development of a strong individual relationship with God connected individuals to a greater power and a global community, framing such problems not only as the work of the Devil but as evidence of the coming of the End of Days. Political protest or attempts at wider change were futile therefore; individuals should focus on their own practices to develop a strong relationship with God. Health and wellbeing relied on an individualised and deep relationship with the Holy Spirit. This was developed through practices that both drew on, and helped create, a type of neoliberal logic and global subjectivity to understand and live within current times, evangelical Christianity promoting ways of living without anxiety in the present through understandings of an apocalyptic future.

Serological Evidence for Henipa-like and Filo-like Viruses in Trinidad Bats

Bat-borne zoonotic pathogens belonging to the family Paramxyoviridae, including Nipah and Hendra viruses, and the family Filoviridae, including Ebola and Marburg viruses, can cause severe disease and high mortality rates on spillover into human populations. Surveillance efforts for henipaviruses and filoviruses have been largely restricted to the Old World; however, recent studies suggest a potentially broader distribution for henipaviruses and filoviruses than previously recognized. In the current study, we screened for henipaviruses and filoviruses in New World bats collected across 4 locations in Trinidad near the coast of Venezuela. Bat tissue samples were screened using previously established reverse-transcription polymerase chain reaction assays. Serum were screened using a multiplex immunoassay to detect antibodies reactive with the envelope glycoprotein of viruses in the genus Henipavirus and the family Filoviridae. Serum samples were also screened by means of enzyme-linked immunosorbent assay for antibodies reactive with Nipah G and F glycoproteins. Of 84 serum samples, 28 were reactive with ≥1 henipavirus glycoprotein by ≥1 serological method, and 6 serum samples were reactive against ≥1 filovirus glycoproteins. These data provide evidence of potential circulation of viruses related to the henipaviruses and filoviruses in New World bats.

Notes on Trochila (Ascomycota, Leotiomycetes), with new species and combinations

Studies of Trochila (Leotiomycetes, Helotiales, Cenangiaceae) are scarce. Here, we describe two new species based on molecular phylogenetic data and morphology. Trochilabostonensis was collected at the Boston Harbor Islands National Recreation Area, Massachusetts. It was found on the stem of Asclepiassyriaca, representing the first report of any Trochila species from a plant host in the family Apocynaceae. Trochilaurediniophila is associated with the uredinia of the rust fungus Ceroteliumfici. It was discovered during a survey for rust hyperparasites conducted at the Arthur Fungarium, in a single sample from 1912 collected in Trinidad. Macro- and micromorphological descriptions, illustrations, and molecular phylogenetic analyses are presented. The two new species are placed in Trochila with high support in both our six-locus (SSU, ITS, LSU, rpb1, rpb2, tef1) and two-locus (ITS, LSU) phylogenetic reconstructions. In addition, two species are combined in Trochila: Trochilacolensoi (formerly placed in Pseudopeziza) and T.xishuangbanna (originally described as the only species in Calycellinopsis). This study reveals new host plant families, a new ecological strategy, and a new country record for the genus Trochila. Finally, our work emphasizes the importance of specimens deposited in biological collections such as fungaria.

Occurrence of Virulence and Resistance Genes in Salmonella in Cloacae of Slaughtered Chickens and Ducks at Pluck Shops in Trinidad

ABSTRACT

The study used PCR to determine the molecular basis of the antibiotic resistance and virulence profiles of isolates of Salmonella by targeting genes encoding for carriage and persistence in the poultry. Of a total 1,503 cecal samples collected from poultry, 91 (6.1%) were positive for Salmonella. Ten different serotypes were detected from Salmonella isolates. The study was also conducted to determine the occurrence of 13 virulence and 12 resistance genes in isolates of Salmonella. All 46 isolates of Salmonella tested were positive for one or more of the 12 virulence genes detected, ranging from 0.0% (viaB) to 100.0% (invA, mgtB, pipA, and spi4D) (P < 0.05). Occurrence of virulence genes varied significantly (P < 0.05) by serotype but not by animal species. Only 4 (33.3%) of 12 resistance genes assayed were detected: strA, ampC, cmy2, and qnrB. Overall, the occurrence of detected resistance genes was 71.7% (33 of 46), and 87.1 and 40.0% of the isolates from chickens and ducks, respectively, were positive (P = 0.0009). The occurrence of resistance genes ranged from 2.2% (cmy2) to 50.0% (qnrB) in isolates positive for resistance gene. The findings provide evidence that poultry from "pluck shops" are colonized by Salmonella pathogens that harbor virulence and antimicrobial resistance genes; this may have clinical and therapeutic consequences, if the genes detected are expressed. Although there is a need for prudent use of antimicrobial agents in poultry production systems, there should be constant monitoring for the prevalence of resistance in Salmonella isolates using phenotypic methods. The importance of monitoring the occurrence of resistance genes in the pathogens in Trinidad cannot be ignored.

HIGHLIGHTS

Peptidomic Analysis of Skin Secretions of the Caribbean Frogs Leptodactylus insularum and Leptodactylus nesiotus (Leptodactylidae) Identifies an Ocellatin with Broad Spectrum Antimicrobial Activity

Ocellatins are peptides produced in the skins of frogs belonging to the genus Leptodactylus that generally display weak antimicrobial activity against Gram-negative bacteria only. Peptidomic analysis of norepinephrine-stimulated skin secretions from Leptodactylus insularum Barbour 1906 and Leptodactylus nesiotus Heyer 1994, collected in the Icacos Peninsula, Trinidad, led to the purification and structural characterization of five ocellatin-related peptides from L. insularum (ocellatin-1I together with its (1–16) fragment, ocellatin-2I and its (1–16) fragment, and ocellatin-3I) and four ocellatins from L. nesiotus (ocellatin-1N, -2N, -3N, and -4N). While ocellatins-1I, -2I, and -1N showed a typically low antimicrobial potency against Gram-negative bacteria, ocellatin-3N (GIFDVLKNLAKGVITSLAS.NH₂) was active against an antibiotic-resistant strain of Klebsiella pneumoniae and reference strains of Escherichia coli, K. pneumoniae, Pseudomonas aeruginosa, and Salmonella typhimurium (minimum inhibitory concentrations (MICs) in the range 31.25–62.5 μM), and was the only peptide active against Gram-positive Staphylococcus aureus (MIC = 31.25 μM) and Enterococcus faecium (MIC = 62.5 μM). The therapeutic potential of ocellatin-3N is limited by its moderate hemolytic activity (LC₅₀ = 98 μM) against mouse erythrocytes. The peptide represents a template for the design of long-acting, non-toxic, and broad-spectrum antimicrobial agents for targeting multidrug-resistant pathogens.

A Chart Review Study of Sexually Transmitted Infections Among Persons Living with HIV Attending an STI Clinic in Trinidad

A chart review study of the sexually transmitted infection (STI) prevalence among persons living with HIV (PLHIV) was conducted among STI clinic attendees in Trinidad between January 2012 and December 2012. Data were abstracted from client records to obtain the clinical and the laboratory diagnoses of STIs. Descriptive and bivariate analyses were conducted, and factors significantly associated with the presence of a STI were assessed using multiple logistic regression. During this period, 385 PLHIV were seen; 104 (27.0%) were newly HIV diagnosed and 281 (73.0%) had a known history of HIV infection; 135 (35.1%) were diagnosed with a STI. Patients with known HIV infection were more likely to be diagnosed with a STI than those who were newly diagnosed (odds ratios: 6.99; 95% confidence interval: 3.79-12.89). The STI prevalence was high among PLHIV in Trinidad, identifying them as a critical target group for public health interventions to prevent the spread of HIV and STIs.

Distribution and health risk assessment of heavy metals in road dust from an industrial estate in Trinidad, West Indies

Road dust from the Point Lisas Industrial Estate in Trinidad, West Indies was investigated to determine its heavy metal content and the associated health risks. The average concentrations of Cd, Cr, Cu, Mn, Ni, Pb and Zn were 3.44, 37.69, 58.16, 770.69, 35.61, 68.50 and 342.53 μg/g, respectively. The health risks due to exposure to heavy metals in road dust were assessed based on the US EPA's Health Risk Assessment Model for both carcinogenic and non-carcinogenic effects. The health risk assessment indicated that the ingestion pathway was the main exposure route to heavy metals from road dust; however, HI values suggested no potential health risks to both children and adults. The cancer risks for Cd, Cr and Ni were less than 10^-6 and the resulting exposure was therefore considered low.

Bachelor of pharmacy graduates' perceptions of the pharmacy administration curriculum in Trinidad and Tobago

INTRODUCTION

As the profession of pharmacy has evolved, pharmacy education has developed to include competencies and skills related to pharmacy administration services. Competencies taught in pharmacy administration courses are expected to provide graduates with skills to effectively undertake administrative functions. Our study aimed to assess perceptions about knowledge and skills gained by the pharmacists during the Pharmacy Administration course at the School of Pharmacy, the University of the West Indies (UWI), Trinidad and Tobago.

METHODS

A cross-sectional survey was carried out among pharmacists working in hospitals and community pharmacies in Trinidad using non-probability convenience sampling. A structured questionnaire was distributed to 262 pharmacists who completed the Pharmacy Administration course. Two-hundred eighteen (83%) usable responses were included for analysis.

RESULTS

Many (45.4%) respondents agreed that the course provided them with the knowledge of running a business, 78% said they were able to apply the skills in their practice, and 80% mentioned that the course should be mandatory. Pharmacists found that the course on business management enhanced their knowledge in the fields of managing human resources, conflict management, marketing, project management, corporate turnaround, inventory, and financial management.

CONCLUSIONS

The Pharmacy Administration course in the bachelor of science degree in pharmacy programme at the School of Pharmacy, UWI remains relevant in the areas of marketing, human resource management, and inventory management. The programme can be extended to a full time masters course to interested pharmacy graduates.

The Serological Prevalence of Rabies Virus-Neutralizing Antibodies in the Bat Population on the Caribbean Island of Trinidad

: Rabies virus (RABV) is the only lyssavirus known to be present within the Caribbean. The island of Trinidad, is richly diverse in chiropteran fauna and endemic for bat-transmitted rabies with low RABV isolation rates observed in this population. We aimed to determine the seroprevalence of rabies virus neutralizing antibodies (RVNA) in light of spatio-temporal and bat demographic factors to infer the extent of natural exposure to RABV in the Trinidadian bat population. RVNA titers were determined by the RABV micro-neutralization test on 383 bat samples representing 21 species, comprising 30.9% of local bat diversity, from 31 locations across the island over 5 years. RVNA was positively detected in 33 samples (8.6%) representing 6 bat species (mainly frugivorous) with titers ranging from 0.1 to 19 IU/mL (mean 1.66 IU/mL). The analyses based on a multivariable binomial generalised linear mixed-effects model showed that bat age and year of capture were significant predictors of seropositivity. Thus, juvenile bats were more likely to be seropositive when compared to adults (estimate 1.13; p = 0.04) which may suggest early exposure to the RABV with possible implications for viral amplification in this population. Temporal variation in rabies seropositivity, 2012-2014 versus 2015-2017 (estimate 1.07; p = 0.03) may have been related to the prevailing rabies epizootic situation. Regarding other factors investigated, RVNA was found in bats from both rural and non-rural areas, as well as in both hematophagous and non-hematophagous bat species. The most common seropositive species, Artibeusjamaicensisplanirostris is ubiquitous throughout the island which may potentially facilitate human exposure. The findings of this study should be factored into public health assessments on the potential for rabies transmission by non-hematophagous bats in Trinidad.

Unmet needs of patients with cancer in their last year of life as described by caregivers in a developing world setting: a qualitative study

BACKGROUND

Palliative care is in its infancy in most of the developing world. We set out to explore the lived experiences of families and caregivers of recently deceased cancer patients in Trinidad and Tobago and to determine the unmet needs of the patients and what recommendations could be derived to improve the current services.

METHODS

A phenomenological approach with purposeful sampling was used. Participants were referred by key health professionals. Face-to-face interviews were conducted. Interviews were transcribed verbatim, with analysis and data collection occurring concurrently. Thematic content analysis was used to determine common domains, themes and sub-themes.

RESULTS

Interviews were completed with 15 caregivers. All were spouses or children of the deceased. Ages of the deceased ranged from 43 to 93, the average being 65.5 years. The deceased experienced a variety of cancers including lung, colorectal and oesophageal. Unmet needs were identified under 4 domains of institutions, community, the family unit and the wider society. Institutional unmet needs were delayed diagnosis and treatment and poor inter-institution coordination. Medical and nursing care failed in the areas of health care providers' attitudes, pain management and communication. The family unit lacked physical and psychosocial support for the caregiver and financial aid for the family unit. Societal needs were for public education to address myths and cultural beliefs around cancer.

CONCLUSION

There is need for systemic interventions to improve the care of those dying from cancer in Trinidad and Tobago. Stakeholders need to commit to palliative care as a public health priority, implementing education, planning services and mobilizing community resources.

Changing patterns in the distribution of the Mayaro virus vector Haemagogus species in Trinidad, West Indies

The Mayaro virus disease (MAYVD) is an emerging mosquito borne zoonosis that was first reported on the island of Trinidad in 1954. The viral agent for this disease is known to presently be endemic to Central and South America. The enzootic cycle of the Mayaro virus (MAYV) is not fully characterized, though primates are thought to be the main reservoir with Haemagogus species of mosquitoes as the primary vector. This virus has been responsible for several sporadic cases of infections and limited outbreaks, but it is postulated that the MAYVD will become a major epidemic in the future, following in the steps of the recent pandemics caused by Chikungunya and Zika viruses. Mitigating possible major outbreaks of MAYVD in the future would require effective strategies for vector control, for which knowledge on the ecology and distribution of the Haemagogus mosquitoes would be vitally important. In Trinidad, Haemagogus species have only been reported in the northwestern peninsula of the island based on studies up to 1995. However, no recent investigations have been completed to determine the status of this important vector on the island. The aim of this study was to investigate the current spatial distribution of Haemagogus species in the island of Trinidad, West Indies. Adult Haemagogus (Hag.) mosquitoes and larvae were surveyed during a twenty-month period using human bait trapping and ovitraps in major forested areas on the island. Mosquito species were identified using classical taxonomic keys. Haemagogus species were widespread and found in all forest types surveyed. Hag. janthinomys (85.7%) was the most widely distributed and dominant species on the island. Lower levels of Hag. leucocelaneus (7.3%), Hag. equinus (6.4%) and Hag. celeste (0.6%) were also collected. Overall, the proportion of mosquitoes collected in the wet season (June-December) was 3.5 times more than in the dry season (January-May). Mangroves, young secondary forests, semi-evergreen and evergreen forest types had relatively high mean abundance levels of Haemagogus species as compared to deciduous and montane forests. Proximity analysis suggests that population settlements within a 1 km buffer of the forest peripherals may be at risk for any emerging arboviral disease associated with these mosquito vectors. Haemagogus species showed a much wider distribution in Trinidad as compared to previous reports from up to 20 years ago and were prevalent in areas with no known presence of non-human primates. Since the MAYV has been previously implicated in causing infections in vertebrate hosts like rodents, birds and small mammals, the findings of this study suggest that there may be alternative hosts and reservoirs of this virus in the sylvatic cycle in Trinidad, other than primates. This has significant epidemiological implications for mosquito-borne viral infections in the region.

Detection of a novel reassortant epizootic hemorrhagic disease virus serotype 6 in cattle in Trinidad, West Indies, containing nine RNA segments derived from exotic EHDV strains with an Australian origin

Epizootic hemorrhagic disease virus (EHDV) is a Culicoides-transmitted orbivirus that infects domestic and wild ruminants in many parts of the world. Of the eight proposed serotypes, only EHDV-1, 2 and 6 have been reported to be present in the Americas. Following the identification of a virulent EHD-6 reasssortant virus in the USA in 2007 (EHDV-6 Indiana), with outer coat protein segments derived from an Australian strain of EHDV and all remaining segments derived from a locally circulating EHDV-2 strain, questions have remained about the origin of the Australian parent strain and how it may have arrived in the USA. When EHDV-6 was identified in asymptomatic cattle imported into the Caribbean island of Trinidad in 2013, full genome sequencing was carried out to further characterise the virus. The EHDV-6 Trinidad was a reassortant virus, with 8 of its 10 segments, being derived from the same exotic Australian EHDV-6 strain as the VP2 and VP5 present in the EHDV-6 Indiana strain from the USA. Analyses of the two remaining segments revealed that segment 8 showed the highest nucleotide identity (90.4%) with a USA New Jersey strain of EHDV-1, whereas segment 4 had the highest nucleotide identity (96.5%) with an Australian EHDV-2 strain. This data strongly suggests that the Trinidad EHDV-6 has an Australian origin, receiving its segment 4 from a reassortment event with an EHDV-2 also from Australia. This reassortant virus likely came to the Americas, where it received its segment 8 from a locally-circulating (as yet unknown) EHDV strain. This virus then may have gained entry into the USA, where it further reassorted with a known locally-circulating EHDV-2, the resulting strain being EHDV-6 Indiana. This study therefore identifies, for the first time, the likely minor parent virus of the EHDV-6 currently circulating in the USA.

NOVEL POXVIRAL INFECTION IN THREE FINCH SPECIES ILLEGALLY IMPORTED INTO TRINIDAD, WEST INDIES, WITH IMPLICATIONS FOR NATIVE BIRDS

Oryzoborus angolensis (Lesser Seed-Finch), Oryzoborus crassirostris (Large-billed Seed-Finch), and Sporophila intermedia (Grey Seedeater) are finch species native to the Caribbean island of Trinidad. These species are locally trapped and kept for their song, but with declining native populations, enthusiasts have turned to illegally importing birds from the South American mainland. The smuggling of wild birds from South America poses significant disease risks to the native bird species of Trinidad. Herein we describe the first case of poxviral infection in these illegally imported birds in Trinidad and partial genome sequence of the causative agent. Phylogenetic analysis of the 4b core protein sequence indicated that the avian poxvirus identified was most closely related to a 2012 avian pox sequence from Brazil, with 96.2% and 98.1% identity at the nucleotide and amino acid level.

Single incision laparoscopic surgery from a caribbean perspective

Conventional laparoscopy with multiple ports has recently gained a strong foothold in the Caribbean, but single incision laparoscopic surgery (SILS) has lagged behind. In this paper, we compare the data on SILS and conventional multi-port laparoscopy in the English-speaking Caribbean.

Phylogenetic analysis of Theileria equi and Babesia caballi sequences from thoroughbred mares and foals in Trinidad

The agents of equine piroplasmosis, Theileria equi and Babesia caballi, are endemic in Trinidad, West Indies. While transmission is mainly by ixodid ticks, transplacental transmission of T. equi has also been reported. This disease has contributed to foetal losses as well as morbidity and mortality of neonatal foals and adult horses. Previous 18S rRNA-based phylogenetic studies indicated a noticeable degree of variation within and among B. caballi and T. equi isolates from different geographical regions. The objective of this study was to evaluate the diversity of T. equi and B. caballi obtained from horses in Trinidad by amplifying a region of the 18S rRNA gene. The phylogenetic trees for T. equi sequences obtained from horses in 2006 and 2011-2013 revealed that Trinidad sequences were of genotype A. Additionally, all of the B. caballi sequences from Trinidad were grouped together with other B. caballi sequences of genotype A. However, T. equi sequences from horses in Saint Kitts and Nevis clustered with sequences of genotype C. This study also identified two genotypes of T. equi in the equine population of Brazil. All of the T. equi and B. caballi sequences obtained from horses in Trinidad belong to genotype A and were similar to T. equi and B. caballi sequences of the same genotype that were submitted to GenBank™ databases. Countries in close proximity to Trinidad have T. equi sequences belonging to genotype C; therefore, movement of horses between these countries can introduce a new genotype of T. equi into the equid population of Trinidad.

Identification and characterization of epizootic hemorrhagic disease virus serotype 6 in cattle co-infected with bluetongue virus in Trinidad, West Indies

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Epizootic haemorrhagic disease virus serotype 6 (EHDV-6) is circulating in Trinidad.

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EHDV is infecting cattle at a slower rate than BTV.

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EHDV appears to have a faster viral evolution rate than BTV.

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The EHDV-6 Trinidad strain (VP-2) falls within the eastern topotype clade that is likely to have originated from Australia.

Epizootic hemorrhagic disease virus (EHDV) is an economically important virus that can cause severe clinical disease in deer and to a lesser extent cattle. This study set out to determine and characterize which EHDV serotypes were circulating in Trinidad. Serum and whole blood samples were collected monthly for six months from a cohort of cattle imported to Trinidad from the USA. Results revealed that all the cattle seroconverted to EHDV within six months of their arrival, with EHDV RNA being detected in the samples just prior to antibodies, as expected. Serotyping assays revealed that a single serotype (EHDV-6) was circulating in the cattle. Sequencing of the surface viral protein (VP2) of EHDV-6, followed by phylogenetic analysis, revealed that the Trinidad EHDV-6 strain was closely related to EHDV-6 viruses found in Guadeloupe (2010), Martinique (2010) and USA (2006), with 96–97.2% nucleotide identity. The Trinidad EHDV-6 VP-2 shared 97.2% identity with the Australian EHDV-6 prototype strain, classifying it within the eastern topotype clade. Bayesian coalescent analysis support Australia as the most probable source for the EHDV-6 VP2 sequences in the Americas and Caribbean region and suggests that the they diverged from the Australian prototype strain around 1966 (95% HPD 1941–1979).

Antimicrobial Resistance of Salmonella Isolates Recovered from Chickens Sold at Retail Outlets in Trinidad

This study determined the frequency of resistance of 135 isolates of Salmonella, including 15 serotypes recovered from chickens purchased from retail outlets (cottage processors and supermarkets) across Trinidad. Resistance to 16 antimicrobial agents was determined by using the disk diffusion method. Resistance among the isolates was related to the type of retail outlet, location of outlets, type of sample, and isolate serotype. Overall, all isolates exhibited resistance to one or more of the 16 antimicrobial agents tested. All isolates were sensitive to cefoxitin and norfloxacin, with the overall frequency of resistance ranging from 1.1% (sulfamethoxazole-trimethoprim) to 100.0% (ceftiofur and doxycycline). The frequency of resistance to tetracycline, ampicillin, ceftriaxone, amoxycillin-clavulanic acid, and chloramphenicol was significantly ( P < 0.05) higher in isolates recovered from cottage processor outlets compared with those from supermarkets. The frequency of resistance to antimicrobial agents was significantly different only to kanamycin ( P = 0.046) and enrofloxacin ( P = 0.000) across seven counties in Trinidad). Regarding sample presentation (whole versus parts), the frequency of resistance was only significantly higher to gentamicin ( P = 0.039) for chicken part isolates from cottage processor and to only tetracycline ( P = 0.034) for isolates from whole carcasses from supermarkets. All the 135 Salmonella isolates exhibited multidrug resistance patterns. The high frequency of resistance to seven antimicrobial agents (erythromycin, streptomycin, ceftiofur, doxycycline, kanamycin, tetracycline, and ampicillin), some used in the poultry industry, coupled with the occurrence of multidrug resistance, may have potential therapeutic implications for broiler farmers in Trinidad.

The National Alcohol Survey of Households in Trinidad and Tobago (NASHTT): willingness to support changes in policy, laws and regulations

Background

Over 60% of households (HHs) in Trinidad and Tobago (T&T) consume alcohol. These HHs were more likely to report illnesses, relationship problems, and behavioral problems with children. This study set out to determine what proportion of HHs were willing to support changes in specific policies, laws and regulations in a national alcohol campaign.

Methods

A cross-sectional convenience sample of HHs were surveyed from a random sample of enumeration districts (ED) in T&T. An interviewer-applied, field pre-tested de novo questionnaire had 5 domains and was developed over 1 1/2 years after an extensive literature review and consultation. Many of the WHO ‘best buys’ recommendations were included.

Results

One thousand six hundred ninety-five HHs (from 53 ED) responded from a total of 1837 HHs approached (response rate 92%). In a national campaign the following proportions of HHs would support: setting the legal age for drinking at 21 years (82.4%); restricting or banning alcohol advertising on TV and other media (73.1% and 54.4% respectively); banning all alcohol advertising at sports and cultural events (64.8%); banning radio stations playing songs with reference to alcohol use (71.3%); holding sellers of alcohol responsible for the amount of alcohol sold (79.5%); advocating that proof of age to be shown by persons buying alcohol (87.4%); placing more prominent warning labels on products displaying alcohol content (87.2%); placing more prominent warning labels on products showing harmful effects (88.5%); increasing taxes on alcohol sales (87.7%). Less than 50% of HH supported restrictions in density of outlets and reduction in opening times for alcohol outlets.

Conclusions

Many HHs in T&T are willing to support changes in policies around alcohol, including many of the policies shown by the WHO to be effective in reducing the harmful consumption of alcohol.

Prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in broilers and workers at 'pluck shops' in Trinidad

Livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) is a cause of zoonotic infections in many countries. People with occupational contact with food animal production are at risk of colonization. The aim of this study was to determine the prevalence of MRSA and their frequency of resistance to other antimicrobial agents from broilers and workers at the 'pluck shops' in Trinidad. For isolation of MRSA, choanal, cloacal and pharyngeal swabs taken from broilers and nasal swabs from humans were enriched then plated on CHROMagar MRSA and Brilliance MRSA. MRSA was confirmed using the PBP2a test kit, resistance to oxacillin and cefoxitin and polymerase chain reaction (PCR) for the mecA gene. Antimicrobial resistance of the MRSA isolates to 16 antimicrobial agents was determined using the disc diffusion method. Of the 287 broilers and 47 humans sampled, MRSA was isolated at a frequency of 2 (0.7%) and 0 (0.0%) respectively. All the MRSA isolates exhibited resistance to one or more of the 16 antimicrobial agents. The study demonstrated that broilers at 'pluck shops' in Trinidad harbor MRSA. This is the first isolation of MRSA from poultry in Trinidad, West Indies, and this finding is of public health significance since occupational exposure of humans can lead to increased risk of acquiring MRSA infections.

Religion and Life Satisfaction: A Correlational Study of Undergraduate Students in Trinidad

Religious behaviour tends to correlate positively with life satisfaction. The predictive power of this relationship is associated with various socio-demographic factors such as age, gender and religious affiliation. We investigated the relationship between religious involvement and life satisfaction in a multi-religious population of undergraduate medical students of the University of the West Indies. We used a cross-sectional design to assess 228 undergraduates (50 males and 178 females) on religiosity, religious well-being and life satisfaction using the Religious Orientation Test, Religious Well-Being subscale and the Satisfaction with Life Scale, respectively. Respondents also provided socio-demographic information such as age, gender and religious affiliation. "How religious one considers oneself" was the religiosity construct most significantly associated with life satisfaction while "frequency of prayer" was the least. Christians registered higher religiosity and religious well-being but non-Christians reported significantly higher life satisfaction. Muslim and Hindu scores on religiosity, religious well-being and life satisfaction were not statistically different. Females scored higher than males on religiosity (borderline significant, p = .054) and significantly higher on religious well-being (p < .01); however, there was no significant difference between males and females on life satisfaction. The "religious affiliation" group scored significantly higher on religiosity and religious well-being compared with the "no religious affiliation" group but there was no difference between these two groups on life satisfaction. Religiosity and religious well-being were overall significantly and positively associated with life satisfaction. However, in demographic groups where there was higher religiosity, for example females, Christians, people affiliated with a religion and older people, it was not associated with greater life satisfaction.

Gradients in predation risk in a tropical river system

The importance of predation risk as a key driver of evolutionary change is exemplified by the Northern Range in Trinidad, where research on guppies living in multiple parallel streams has provided invaluable insights into the process of evolution by natural selection. Although Trinidadian guppies are now a textbook example of evolution in action, studies have generally categorized predation as a dichotomous variable, representing high or low risk. Yet, ecologists appreciate that community structure and the attendant predation risk vary substantially over space and time. Here, we use data from a longitudinal study of fish assemblages at 16 different sites in the Northern Range to quantify temporal and spatial variation in predation risk. Specifically we ask: 1) Is there evidence for a gradient in predation risk? 2) Does the ranking of sites (by risk) change with the definition of the predator community (in terms of species composition and abundance currency), and 3) Are site rankings consistent over time? We find compelling evidence that sites lie along a continuum of risk. However, site rankings along this gradient depend on how predation is quantified in terms of the species considered to be predators and the abundance currency is used. Nonetheless, for a given categorization and currency, rankings are relatively consistent over time. Our study suggests that consideration of predation gradients will lead to a more nuanced understanding of the role of predation risk in behavioral and evolutionary ecology. It also emphasizes the need to justify and report the definition of predation risk being used.

Phylogeography of Burkholderia pseudomallei Isolates, Western Hemisphere

The bacterium Burkholderia pseudomallei causes melioidosis, which is mainly associated with tropical areas. We analyzed single-nucleotide polymorphisms (SNPs) among genome sequences from isolates of B. pseudomallei that originated in the Western Hemisphere by comparing them with genome sequences of isolates that originated in the Eastern Hemisphere. Analysis indicated that isolates from the Western Hemisphere form a distinct clade, which supports the hypothesis that these isolates were derived from a constricted seeding event from Africa. Subclades have been resolved that are associated with specific regions within the Western Hemisphere and suggest that isolates might be correlated geographically with cases of melioidosis. One isolate associated with a former World War II prisoner of war was believed to represent illness 62 years after exposure in Southeast Asia. However, analysis suggested the isolate originated in Central or South America.

Molecular Identification of Eimeria Species in Broiler Chickens in Trinidad, West Indies

Coccidiosis is an intestinal disease of chickens of major economic importance to broiler industries worldwide. Species of coccidia found in chickens include Eimeria acervulina, Eimeria brunetti, Eimeria maxima, Eimeria mitis, Eimeria necatrix, Eimeria praecox, and Eimeria tenella. In recent years, polymerase chain reaction (PCR) has been developed to provide accurate and rapid identification of the seven known Eimeria species of chickens. The aim of this study was to use species-specific real-time PCR (qPCR) to identify which of the seven Eimeria species are present in Trinidad poultry. Seventeen pooled fecal samples were collected from 6 broiler farms (2–5 pens per farm) across Trinidad. Feces were also collected from birds showing clinical signs of coccidiosis in two live bird markets (pluck shops). qPCR revealed the presence of five species of Eimeria (E. acervulina, E. maxima, E. mitis, E. necatrix, and E. tenella), but not E. brunetti or E. praecox. Mixed infections were detected on all broiler farms, and DNA of two highly pathogenic Eimeria species (E. tenella and E.necatrix) was detected in feces taken from clinically sick birds sampled from the two pluck shops.

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

Background

The relative importance of coronary artery disease (CAD) risk varies globally. The aim of this study was to determine CAD risk factors for acute myocardial infarction (AMI) among patients in public health care institutions in Trinidad using a case–control type study design.

Methods

The sample comprised 251 AMI patients hospitalized between March 1, 2011 and April 30, 2012 and 464 age- and sex-matched non-AMI patients with no terminal or life-threatening illness and who did not undergo treatment for CAD. SPSS version 19 was used for data analysis that included chi-square tests, unadjusted and adjusted odds ratios (OR) and conditional multiple binary logistic regression.

Results

There was no difference in age between AMI and non-AMI patients (p = 0.551). Chi-square test revealed that clinical and lifestyle variables including stressful life, diabetes, hypertension, hypercholesterolaemia, ischaemic heart disease (IHD), a family history of IHD (p ≤ 0.001), smoking (p = 0.007) and alcohol consumption (p = 0.013) were associated with AMI; sex (p = 0.441), ethnicity (p = 0.366), age group (p = 0.826) and renal failure (p = 0.487) were not.

Both unadjusted and adjusted (for age) ORs showed that the odds of hypertension, IHD and alcohol consumption were greater among AMI patients than among non-AMI patients for males; diabetes and IHD for females; and that the odds of a stressful life was greater among non-AMI patients and were the same for both groups with respect to sex, age > 45 years, hypercholesterolemia, renal insufficiency, and family history of IHD.

Conditional multiple logistic regression showed that smoking [OR: 0.274, p ≤ 0.001, 95% CI for OR (0.140, 0.537)], a stressful life [OR: 2.697, p ≤ 0.001, 95% CI for OR (1.585, 4.587)], diabetes [OR: 0.530, p = 0.020, 95% CI for OR (0.310, 0.905)], hypertension [OR: 0.48, p = 0.10. 95% CI for OR (0.275, 0.837)] and IHD [OR: 0.111, p ≤ 0.001, 95% CI for OR (0.057, 0.218)] were the only useful AMI predictors.

Conclusions

Smoking, diabetes, hypertension, IHD and decrease stress are useful AMI predictors.

The evaluation of total mercury and arsenic in skin bleaching creams commonly used in Trinidad and Tobago and their potential risk to the people of the Caribbean

Background. Skin lightening is very popular among women and some men of the Caribbean, and its popularity appears to be growing. The lightening of skin colour is done to produce a lighter complexion which is believed to increase attractiveness, social standing and improves one’s potential of being successful.

Design and Methods. Fifteen (15) common skin lightening creams found in pharmacies and cosmetic retailers throughout Trinidad and Tobago were evaluated for Mercury by Cold Vapor Atomic Absorption Spectrophotometry (CVAAS) and Arsenic by Hydride Generation Atomic Absorption Spectrophotometry (HGAAS). The results obtained were compared to global standards and previous research.

Results. Fourteen (14) of the fifteen samples analysed contained Mercury in the range of 0.473 μg/g to 0.766 μg/g. One sample had a Mercury content of 14,507.74±490.75 μg/g which was over 14,000 times higher than the USFDA limit for mercury in cosmetics of 1 μg/g. All samples contained Arsenic in the range 1.016 μg/g to 6.612 μg/g, which exceeds the EU limit for cosmetics of 0 μg/g.

Conclusions. All the samples analysed contained significant amounts of Mercury and Arsenic and none of them can be considered safe for prolonged human use. The samples that contained Mercury levels which were lower than the USFDA limit contained Arsenic levels which exceeded the EU standard of 0 μg/g in cosmetics. The popularity of these skin lightening creams in the Caribbean region places the population at elevated risk of chronic Mercury and Arsenic poisoning and possibly acute Mercury Poisoning.

A preliminary assessment of heavy metals in sediments from the Cipero and South Oropouche Rivers in Trinidad, West Indies

The increasing urbanization and industrial processes in Trinidad within recent years could pose a possible contamination threat to the aquatic environment. The southwestern part of the island houses numerous industrial activities, and the recent sightings of schools of dead fish and other marine organisms in that locality is cause for concern prompting research into this occurrence. Sediment and surface water samples from the Cipero and South Oropouche Rivers in South Trinidad were analyzed for their heavy metal content (Cd, Cr, Cu, Mn, Ni, Pb, and Zn). Another watercourse, the Moruga River, was selected as a control, based on its location away from significant anthropogenic sources, and the levels of heavy metals obtained for this location were considered as background concentrations for both surface waters and sediments. Cadmium, Ni, and Pb were not detected in surface water samples of both rivers. The corresponding order of metals in the Cipero River was Mn > Cr > Zn > Cu, while for the South Oropouche River, the order was Mn > Cr > Cu > Zn. The individual concentrations of metals in sediments found in the Cipero and South Oropouche Rivers varied according to the following orders: Mn > Zn > Cu > Pb > Ni > Cr > Cd and Mn > Zn > Pb > Cu > Ni > Cr > Cd, respectively. Assessments of the pollution status in sediments revealed that the Cipero River was considered polluted with a moderate degree of ecological pollution while the South Oropouche River was also deemed polluted; however, the degree of ecological pollution associated with that river was low. Principal component analysis (PCA) and cluster analysis (CA) confirmed that both anthropogenic and natural sources contributed to heavy metal contamination in sediments of both rivers.

Novel incidental finding of Hepatozoon canis infection in two dogs of the same household in Trinidad, West Indies

A five-year old mixed breed bitch was presented to the veterinary clinic in lateral recumbency with a history of anorexia and muscle hyperaesthesia. Examination of the blood smear of this animal revealed the presence of Hepatozoon spp. gamonts in the neutrophils and monocytes with a parasitaemia level of approximately 2%. Complete blood count (CBC) revealed a neutrophilia, and a normocytic normochromic non-regenerative anaemia which were consistent with Hepatozoon spp. infections. Diagnosis was confirmed by polymerase chain reaction (PCR) amplification of the 18S rRNA gene followed by DNA sequencing of the amplicon. Although the other dog in the household appeared asymptomatic, Hepatozoon canis infection was confirmed by both microscopic examination of blood smear and PCR. Both dogs were infested with Rhipicephalus sanguineus ticks. Phylogenetic analysis revealed that the H. canis sequences from these two dogs were similar to those from Venezuela and St Kitts but not Brazil. This is the first reported case of Hepatozoon canis infections in dogs in Trinidad that were confirmed by molecular techniques.

The History of Rabies in Trinidad: Epidemiology and Control Measures

Vampire bat-transmitted rabies was first recognized in Trinidad during a major outbreak reported in 1925. Trinidad is the only Caribbean island with vampire bat-transmitted rabies. We conducted a literature review to describe the changing epidemiology of rabies in Trinidad and give a historical perspective to rabies prevention and control measures on the island. The last human case of rabies occurred in 1937 and although no case of canine-transmitted rabies was reported since 1914, sporadic outbreaks of bat-transmitted rabies still occur in livestock to date. Over the last century, seven notable epidemics were recorded in Trinidad with the loss of over 3000 animals. During the 1950s, several measures were effectively adopted for the prevention and control of the disease which led to a significant reduction in the number of cases. These measures include: vampire bat population control, livestock vaccination, and animal surveillance. However, due to lapses in these measures over the years (e.g., periods of limited vampire control and incomplete herd vaccination), epidemics have occurred. In light of the significant negative impact of rabies on animal production and human health, rabies surveillance in Trinidad should be enhanced and cases evaluated towards the design and implementation of more evidence-based prevention and control programs.

A study in a hospital setting in Trinidad and Tobago, West Indies, on the psychological factors that cause road traffic collisions

The following research paper aims to examine the psychological factors that have led to road traffic collisions (RTCs) by conducting research on drivers who had been admitted to the Accident and Emergency department at four major hospitals in Trinidad as RTC cases. A cross-sectional survey was conducted in four major hospitals in Trinidad. Sample size was 900 participants admitted to the hospital as RTC cases, and the sample was selected using Daniel's formula. All 900 participants were drivers involved in an RTC and were mostly male, and majority of drivers involved in an RTC were within the age group of 30-39 years. The survey was conducted in a 3-month window between March and June 2013. The results of the survey indicated that there was a significant relationship between most of the factors and RTCs, that is, p<0.05. This indicated that the null hypotheses did not hold. Thus, there was an positive correlation. The study revealed that attitude of drivers, real driving practice and the driving knowledge possessed by the driver were associated factors for RTCs. The survey also established that factors such as stress, the lack of sleep and fatigue were also likely to be associated with RTC.

Supernatural versus medical: Responses to mental illness from undergraduate university students in Trinidad

Background/Introduction: Perceptions about the aetiology of mental illness are likely to influence help-seeking behaviour. Understanding help-seeking behaviour will improve service provision and access. Therefore, this is likely to improve treatment outcomes.

METHODS

We assessed the perceptions and help-seeking behaviours surrounding mental illness in a Trinidadian population of 158 tertiary-level students (136 female, 22 male; mean age 30) by analysing their responses to a questionnaire which asked for responses regarding a case vignette of a 25-year-old young woman exhibiting symptoms suggestive of schizophrenia.

RESULTS

Of the respondents, 32.3% attributed the symptoms to supernatural causes. Specifically, 27.8% to someone doing her bad and 24.1% to evil spirits. In all, 77.2% of respondents indicated that mental illness was caused by medical problems and 63.3% to work stress. A minimum of 9.5% of the students therefore have dual perceptions regarding causation (77.2 + 32.3 = 109.5) Those who perceived causation to be supernatural said they would seek help from both medical ( p = .000) and supernatural ( p = .000) modalities. This also applied significantly to those who said the causation was medical, that is, seeking both religious intervention ( p = .000) and medical intervention (.000) as the first path in the health-seeking pathway.

CONCLUSION

Dual help-seeking behaviour seems to be the functional result of an integration of religious and medical models of mental illness causation even in respondents who clearly identified only one of these as the likely cause of the illness behaviour.

Impact of a medical university on laparoscopic surgery in a service-oriented public hospital in the Caribbean

INTRODUCTION

The Caribbean lags behind global trends for volume and complexity of laparoscopic operations. In an attempt to promote laparoscopy at a single facility, a partnership was formed between the University of the West Indies (UWI) and the Port of Spain General Hospital in Trinidad and Tobago. This study seeks to document the effect of this partnership on laparoscopic practice.

MATERIALS AND METHODS

In this partnership, the UWI took the bold step of volunteering to staff a surgical team if the Ministry of Health provided the necessary legislative changes. On August 1, 2013, a UWI team was introduced with a mandate to optimize teaching and promote laparoscopic surgery. The UWI team had a similar staff complement to the existing service-oriented teams. There was no immediate investment in equipment, hospital beds, ICU beds, or operating room space. Therefore, the new team was introduced with limited change in existing conditions, resources, and equipment.

RESULTS

There were 252 laparoscopic operations performed over the study period. After introduction of the UWI team, there was an increase in the mean number of unselected laparoscopic operations (3.17 vs 10.83 cases per month; P<0.001; 95% confidence interval [95% CI] -8.5 to -6.84; standard error of the difference [SED] 0.408), the mean number of basic laparoscopic operations (3.17 vs 6.94 cases per month; P<0.0001; 95% CI -4.096 to -3.444; SED 0.165), the mean number of advanced laparoscopic operations (0 vs 3.89; P<0.0001), the number of teams undertaking unselected laparoscopic operations (2 vs 5), and the number of teams independently performing advanced laparoscopic operations (0 vs 4).

CONCLUSION

At this facility, we have demonstrated a significant increase in laparoscopic case volume and complexity when partnerships were formed between the UWI and this service-oriented hospital. Continued cross-fertilization and distribution of skill sets across the surgical community can reasonably be expected. We also identified maneuvers that can be used as a template to build laparoscopic services in other service-oriented hospitals in developing nations.