Background: Many of the UK overseas territories (UKOTs) are small with limited microbiological diagnostic capacity for pathogens and antimicrobial resistance detection. The COVID-19 pandemic highlighted the vulnerability of these territories for the emergence of novel infections and antimicrobial resistance. Objective: To describe the process and clinical implications of implementing rapid automated syndromic molecular diagnostics (RASM) in the UKOTs, evaluating the outcome in enhancing individual patient management, communicable disease control, and antimicrobial stewardship. Methods: The UKOT program with its territory partners implemented RASM in March-May 2023, aiming to improve diagnostic capacity. Local laboratory staff were trained in the use of the diagnostics, and guidance was provided to clinicians for requesting tests. Syndromic diagnoses included enteric, respiratory, bloodstream, neurological infection, and antibiotic resistance mechanisms. Data on diagnostic capacity, turnaround times, and clinical impact were collected from records before and after the implementation of RASM. Results: Turnaround time for results went from an average of 14 days to 1 day, and often much shorter (1 hour). The range of enteric, respiratory, and neurological pathogens was extended. Antibiotic resistance mechanisms could be detected for the first time. Previously undiagnosed conditions could now be identified rapidly at the microbiological level in the territory, allowing appropriate specific clinical management, infection prevention, improved antimicrobial stewardship, and rapid public health response. Conclusion: Rapid microbiological diagnosis on-site transformed patient management, the timely investigation and management of outbreaks and clusters, accurate surveillance, and antimicrobial stewardship. Targeted RASM is likely to be cost-effective, reducing the requirement for highly trained scientific staff and expensive logistics around rapid transport to reference laboratories. Further cost analyses would be useful. This technology is simple to operate and maintain with little scope for user error. The speed of microbiological diagnosis for patient management and public health intervention was greatly enhanced.
Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE mediated food allergy characterized by delayed gastrointestinal symptoms, often misdiagnosed due to its overlap with infectious and other allergic conditions. In this case symptoms occurred within one hour of exposure on two separate occasions and resolved within twenty-four hours with supportive care. Skin prick testing with both commercial egg extract and fresh egg yielded negative results, effectively excluding IgE-mediated mechanisms. Based on clinical history, timing of the symptoms, recurrence on re-exposure and resolution with dietary exclusion, a diagnosis of acute FPIES to egg was made. The patient was managed on strict egg exclusion, provision of an emergency action plan and counseling regarding the natural history of the condition and the likelihood of outgrowing it, with future oral food challenge planned to assess tolerance. This case highlights the importance of recognizing FPIES as a distinct form of food allergy, especially in the Caribbean where awareness is low and epidemiological data is lacking. Early diagnosis and guideline based management is crucial to avoid misdiagnosis as sepsis or gastroenteritis, ensure parents education and prevent unnecessary interventions.
Primary cardiac angiosarcoma is a type of rare malignant cardiac neoplasm. These patients usually have a poor prognosis as primary angiosarcomas are associated with early metastasis. Currently, there are no guidelines or effective treatment methods available. Therefore, management relies on previous experience and case reports. We are interested in reporting this case to contribute to the existing knowledge on the topic. Our report highlights the case of a 22-year-old woman with a right atrial sarcoma who initially presented with severe pericardial effusion with impending Cardiac Tamponade. The patient's critical condition was stabilized with emergency pericardiocentesis. However, due to the extensive progression of the lesion, surgical resection was the only feasible treatment option.
Background: Most of the Small Island Developing States (SIDS) face a ‘triple burden’ of malnutrition, in which persistent levels of micronutrition and undernutrition deficiencies coincide with the increasing prevalence of overweight and obesity. Curaçao is classified as a SIDS and is recorded to have a persistently high rate of obesity over the last 30 years. Objective: This research aims to contribute to the United Nations’ established Sustainable Development Goal of one-third reduction in premature mortality from non-communicable diseases (NCDs) and suicide before 2030 in Small Island Developing States. This research provides insights into sociopsychological and environmental factors of obesity for women in Curaçao, to provide contextualised recommendations for future weight management programmes. Methods: A mixed methods explanatory sequential was employed with 17 previous obstetric patients who have a cardiovascular risk profile from Curaçao Medical Center. Data were collected via electronic patient records, a structured questionnaire and semi-structured follow-up questions. Results: The barriers to weight management behaviours are largely rooted within the obesogenic environment of Curaçao. Sociopsychological factors, such as the challenges associated with new motherhood, have a significant impact on participants’ lifestyle choices. Conclusion: To ensure a lasting impact, future weight management programmes in Curaçao should prioritise enhancing participants' self-efficacy and establishing multi-level support systems. These programmes must include education on obesity and its associated comorbidities to build a foundational understanding of health risks. Additionally, interventions should deliver culturally contextualised guidance on healthy lifestyle behaviours, considering the local obstetric environment and ensuring recommendations are realistic and sustainable for individuals to integrate into their daily lives.
Background: Empirical utilisation of antimicrobials has become standard practice in healthcare, but ultimately it may be associated with drug resistance. This study serves to determine the prevalence of antibiotic use at a secondary care hospital in east Trinidad and Tobago. Methods: A cross-sectional study was conducted at the Sangre Grande Hospital. The World Health Organization’s Methodology for Point Prevalence Survey on Antibiotic Use in Hospitals and the Global Point Prevalence Survey of Antimicrobial Consumption and Resistance were adapted for a simple prevalence study involving inpatient and outpatient accident and emergency settings. Researchers reviewed medical records of all patients present at the hospital for the preceding 24 hours for inpatients and 4 hours for patient records reviewed in the accident and emergency department. Information collected included antibiotic class, dosages, frequency, course duration, indication and microbiology data. Data was stored in an Excel spreadsheet. It was analysed using IBM SPSS Statistics for Windows, Version 29.0.2.0 Armonk, NY: IBM Corp, as descriptive statistics. Clinical and Laboratory Standards Institute M100, Version 33, was used to interpret susceptibility data. Results: There were 543 total patients sampled with 218 (40.1%) prescribed antibiotics. The most frequently prescribed classes included cephalosporins (31.4%), penicillins (31.1%) and nitroimidazoles (17.1%). Among the cephalosporins, 56 (54%) were third generation. The most common route of administration was parenteral. Antibiotics were most frequently administered as medical prophylaxis (63.9%). The surgical department was the service with the highest use of antibiotics (31.19%) followed by the emergency medicine department (27.52%). The most frequent systemic indications for antibiotic use were skin and soft tissue infections (32%), obstetric and gynaecological conditions (18%) and sepsis (13%). Out of 218 patients receiving antibiotics, only 9 (4%) cultures were identified as taken. Four species of bacteria were identified and treated based on susceptibility reports. Conclusion: There was greater utilisation of broad-spectrum antibiotics. Microbiology culture reports were not utilised by most services. This report provides an opportunity for improvement of antibiotic stewardship.
Objective: To determine the interest of undergraduate physiotherapy students in Jamaica in providing physiotherapy services to older adults upon graduation. Understanding such interest in this student population becomes necessary as the older Jamaican adult population is growing rapidly (Statistical Institute of Jamaica, STATIN), and such interest has never been investigated. This study also explores the differences between students’ interest and some personal characteristics. Methods: The data used to produce this paper were part of a larger data set for a larger cross-sectional study, which had not previously been published. Ethical approval was granted by the Mona Campus Research Ethics Committee (MCREC). Convenience sampling was used in this census survey to recruit students for this study. All students registered in the physiotherapy undergraduate programme, were invited to participate in the study. Those accepting the invitation gave written consent and completed the data collection instruments. Those on leave of absence would not have been registered for any course in the programme of study and were therefore excluded. Results: 110 out of 129 students participated. The response rate was 85%. Of the 110 students, 46% (n=51) expressed an interest in providing physiotherapy services to older adults once they qualified as a physiotherapist. The interest in providing physiotherapy services to older adults after graduation was more likely to be seen among students who had not yet completed their gerontology course content (p = .005), who had completed fewer placements (p = 0.04), and who had not provided physiotherapy treatment to infirmed older adults (p = 0.021). There was insignificant evidence of a difference in interest between males and females (p = 0.71). Conclusion: Many students expressed interest in providing physiotherapy services post-graduation. Completing the gerontology course and exposure to infirmed older adults while on clinical placement, appear negatively to influence such interest for these Jamaican-trained physiotherapy students. The implications of these findings were discussed in relation to the Jamaican-trained physiotherapy students.
ABSTRACT Objective: This study sought to determine the prevalence and epidemiology of self-reported injuries from recreational sport and exercise participation in the general adult population of Trinidad and Tobago. Methods: A cross-sectional survey was conducted via structured telephone interviews. Quota random sampling was done using the Regional Health Authorities' geographical distribution. Phone numbers were randomly selected from the 2019 print telephone directory using computer-generated random numbers that were matched to the names counting from the top of the page for each zone. Persons 18-years and older from each household, who met the inclusion criteria, were invited to participate. Data on self-reported injuries from July to December 2019 was captured. Results: A total of 1035 persons (58% males, 42% females) completed the study. The mean age was 45.0 years ± 19.8 years. Major ethnic groups were represented, namely Indian, African, and Mixed. Fourteen percent of the sample had sustained an injury from participating in sport or exercise during the time of interest. The estimated probability of sustaining an injury during recreational sport and exercise was 0.27% or 27 injuries per 10,000 occurrences of exercise activity. Injuries were more prevalent in younger persons, males and those with a higher level of education. Most were engaged in weights/resistance training at the time of injury. Conclusion: The pattern of injury from participation in recreational sport and exercise was similar to that of other countries, with prevalence being highest among young males and those with higher education levels. These injuries should be a public health concern and consideration should be given to employing sports medicine specialists at primary care facilities and driving injury prevention campaigns alongside physical activity ones. Keywords: physical activity, recreational injuries, overuse syndromes, traumatic injuries
Inguinoscrotal hernias commonly contain the bowel and omentum and very rarely contain the stomach - a distant, fixed organ. Diagnosis can be challenging as presentation ranges from asymptomatic, to gastric outlet obstruction and in extremis. Management can vary from conservative to surgical. We report the case of a large bilateral inguinoscrotal hernia containing the stomach and presenting with recurrent gastric outlet obstruction during the COVID-19 pandemic in a Caribbean island. We precluded perioperative morbidity by doing an initial combined conservative approach for the underlying reactive gastropathy followed by a single-stage, elective, bilateral inguinal hernia repair.
There is a vast amount of literature on complications related to dialysis catheters, particularly with regards to catheter related sepsis, stenosis, thrombosis and occlusion. There is an equally large number of corresponding radiological descriptions of the above complications. Fibrin sheaths though common1, are an under-recognised complication of dialysis catheters. We report a case of a patient with a fibrin sheath that was detected on computed tomography and interpreted as a catheter remnant which potentially could have led to the inappropriate investigations and management of this patient.
ABSTRACT Objective: This study aimed to perform a preliminary assessment of early childhood caries (ECC) in infants and toddlers accessing medical care at various community health centres in Trinidad, to identify any risk factors (nutritional or hygiene factors) that may be associated with early childhood caries, to determine oral health knowledge of parents or caregivers of children within this age group and to utilise this information to promote the early implementation of dental care programmes to diminish the impact of dental caries in children. Methods: A cross-sectional study was conducted involving 215 toddlers under three years of age attending immunisation clinics at health centres in north Trinidad. Data was collected using a structured questionnaire administered through an interview with attending mothers and clinical examination was performed using a mirror and blunt probe by calibrated examiners. Data analysis was performed using SPSS with statistical significance set at p<0.05. Results: The prevalence of ECC was found to be 12.5% for cavitated lesions and 25.1% if both cavitated and non-cavitated lesions were considered. Maternal level of education, bottle feeding practices and the use of fluoridated toothpaste were contributory to ECC in this age group. Conclusion: ECC is a disease that significantly affects this age group in Trinidad and Tobago. Early presentation to the dental setting for preventive care advice, as well as large scale public health education campaigns can help reduce the experience of ECC and its associated comorbidities in this population.
Objective: Community quarantine has been one of the public health management strategies used to control the spread of COVID-19 in Jamaica. This paper sought to understand COVID-19 related community lockdown experiences reported by residents in two communities in Jamaica. Methods: Forty-three in-depth interviews were completed in two communities that experienced COVID-related ‘community lock-down’. Using qualitative content analysis, themes and subthemes were identified and further categorized as pros and cons. Excerpts from the voices of participants were then utilized to further illuminate their feelings and experiences. Results: Females constituted the majority (53%) of participants and the mean age of participants was 44.1 years (SD =20). ‘Pros’ and ‘Cons’ as broad categories embodied nuances held by participants about their lockdown experiences. ‘Time to Bond’, Attention to Social Needs’ and ‘Staying Informed’ emerged as ‘Pro’ themes, while ‘Communication Pains’, ‘Nuff Discrimination [a lot of discrimination]’ and ‘Unmet Needs’ were the ‘Con’ themes emerging from participants’ experiences. Conclusion: The study highlights important issues related to communities and their lockdown experiences and the relevance of these to health promotion efforts. Heightened interest in health related information and education are opportunities for increased health promotion. Implementation of community lockdowns should not be an ad hoc process, but one with forethought, taking into account communication, social realities, political dynamics and health promotion.
The importance of a well-equipped and efficiently organised code cart cannot be overstated in the context of providing optimised emergency care for children. In addition to quality improvement initiatives addressing appropriate maintenance of code cart supplies, there is the global need to focus on efficient and intuitive paediatric code cart design to manage this unique population separately from adults.
Dengue is endemic to the Caribbean. Neurological complications that occur in severe dengue are extremely rare. Severe central nervous system involvement is a dangerous complication of dengue associated with a high mortality. No definite medical versus surgical management consensus exists as studies have highlighted varying outcomes for severe dengue with intracranial hemorrhage (ICH). Our case highlights a patient presenting with severe dengue complicated by an ICH and subsequent diabetes insipidus postoperatively further emphasizing this controversy.
The competition for general surgery specialisation remains high and while the United Kingdom route of training is a well-established avenue, the University of the West Indies (UWI) graduate has alternative options with the United States general surgery residency. The aim of this article to outline the numerous steps that one must take to apply to general surgery residency and the pathway and requirements of the general surgery residency itself.
Objective: To describe the incidence of confirmed COVID-19 cases and deaths in Jamaica and assess the country’s vaccination and prevention efforts. Methods: This study analyzed the daily number of new confirmed COVID-19 cases and deaths in Jamaica from March 2020 to February 2023 and showed how different factors influenced rate of new cases and deaths across the island. It also assessed Jamaica’s vaccination and prevention efforts from April 2021 to February 2023. Results: In this descriptive ecological study, two variables: the daily number of new confirmed cases and deaths were analyzed to describe the incidence of COVID-19 in Jamaica during the pandemic. Changes in COVID-19 policies by the Jamaican government as well as the characteristics of different COVID-19 variants corresponded to an increased number of new daily COVID-19 cases and deaths among the Jamaican population. Currently, only 29.97% of the Jamaican population has completed the initial COVID-19 vaccination protocol which ranks Jamaica 32 out of 33 countries in Latin America and the Caribbean as of February 10, 2023, when looking at the number of COVID-19 vaccination doses per 100 population. Conclusion: During the COVID-19 pandemic in Jamaica, the daily number of new confirmed cases and deaths corresponded to changes in COVID-19 policies and the characteristics of different COVID-19 variants. Jamaica needs to implement more strategies to increase the vaccination rate across the country.
Objectives: To present key data accumulated from the first six years of a publicly funded Palliative Care Unit (PCU) in Trinidad and Tobago. Methods: This was an observational, descriptive, retrospective study. Data was sampled from five (5) service areas: admissions to the PCU, out-patient clinic, hospital consultations, family meetings and telephone calls. Demographic data, reason for referral, diagnosis, time to consultation and outcome data were collected. Results: The Palliative Care Unit was accessed by 2579 patients between 2014 – 2020. Ages ranged from 3-103 years. There were 1004 unique in-patient admissions, most of whom fell in the age range 62-82 years. 83% had a documented cancer diagnosis. 90% of patients spent less than 30 days at the PCU. Discharge rate was 25%. Most out-patient clinic referrals were for symptom management – 90.8% of these had cancer. Median time from palliative care review at out-patient clinic to death was 34 days (Interquartile range (IQR) 12-107 days). For the hospital consultation service, 82.8% had a cancer diagnosis. Median time from palliative care review to death was 11 days, Interquartile range (IQR) 4-39 days. Conclusion: The Caura PCU meets the needs of a small proportion of palliative patients in Trinidad and Tobago. The service is accessed mostly by patients with cancer, and referrals are frequently made late in the disease trajectory. This service needs to be expanded to include a community/home-based service and a paediatric service. Palliative care needs to become integrated throughout the health service in Trinidad and Tobago.
Conjoined twins are very rare and some obstetricians may go through their career without ever managing a case. This case describes a thoraco-omphalopagus whereby the twins were joined at the chest and abdomen. Management of conjoined twins largely depends on the degree of conjoining and the availability of resources. In this case, the severity of the conjoining and lack of specialized resources resulted in managing via termination of the pregnancy. This is the first published case of conjoined twins from Trinidad and Tobago. The aim of this case report is to share our findings and management in a setting with limited resources.
Transcatheter aortic valve implantation (TAVI) has provided patients who have been deemed high risk, or inoperable by conventional surgical valve replacement, with another method of having an aortic valve replacement without the need for major open-heart surgery. We report in this case a TAVI via a transaortic approach on a 75-year-old woman who had no amenable peripheral vascular access for a transfemoral approach. Therefore, a transaortic approach was deemed appropriate. This was the first performance of a TAVI via transaortic approach reported in Trinidad and Tobago and it illustrated a safe and effective strategy for TAVI in high-risk patients without eligible femoral access and severe aortic stenosis.
Stroke mimics (SM) such as Todd’s paralysis pose a major diagnostic challenge and may be difficult to distinguish from Transient Ischemic Attacks (TIA). The aim of this case presentation was to highlight a case where the presentation made it difficult to ascertain the true cause of patients' quadriplegia.
