Barbados Community College

Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by progressive joint inflammation and structural damage. Two primary treatment strategies-step-up therapy and early aggressive DMARD therapy have been widely debated in clinical practice. The step-up approach begins with NSAIDs or corticosteroids, progressing to DMARDs based on disease severity, whereas early aggressive therapy prioritizes immediate DMARD initiation to prevent irreversible joint damage. This comprehensive review evaluates the effectiveness of these strategies by analyzing randomized controlled trials (RCTs), meta-analyses, and cohort studies assessing treatment outcomes, remission rates, and radiographic progression. A literature search was conducted across PubMed, Scopus, and Web of Science, including studies published between 2010 and 2024. Key clinical trials, including TICORA, COBRA, BeSt, and CAMERA, were critically analyzed to assess the comparative benefits and limitations of both treatment approaches. Evidence suggests that early aggressive therapy is associated with higher remission rates, reduced radiographic progression, and improved long-term physical function, whereas the step-up approach often leads to delayed disease control and cumulative joint damage. However, concerns related to treatment adherence, cost-effectiveness, and safety profiles necessitate further investigation. Future research should focus on biomarker-driven personalized treatment strategies, optimizing drug sequencing, and long-term comparative effectiveness studies to refine RA management.

This study highlights the superior performance of Bayesian Model Averaging (BMA) in credit risk modeling under IFRS 9, particularly during economic uncertainty, such as the COVID-19 pandemic. Using granular bank-level data from Malta, spanning 2017–2023, the analysis integrates macroeconomic scenarios and sector-specific transition matrices to assess credit risk dynamics. Key findings demonstrate BMA’s ability to outperform Single-Equation Models (SEM) in predictive accuracy, robustness, and adaptability. The results emphasize BMA’s resilience to structural economic changes, making it a critical tool for regulatory stress testing and provisioning in small open economies highly exposed to external shocks. This work underscores the importance of forward-looking, flexible frameworks for credit risk management and policy decisions.

This chapter explores food utilization in the region from the perspectives of food consumption and food safety. The Caribbean faces a double burden of undernourishment and obesity. The prevalence of obesity in adults has increased in all countries, with the highest levels (31.6%) observed in the Bahamas and the lowest (18.6%) in Trinidad and Tobago. Obesity is more prevalent in women, with significant disparities between sexes. The prevalence of overweight and obesity among children under 5 years old as well as in children and adolescents ages 5 to 19 is among the highest in the world. Obesity is linked to chronic non-communicable diseases (NCDs). Deaths caused by NCDs contribute to increased healthcare costs and economic burdens. Several factors contribute to the rising trend of obesity in the region, including high prices of healthy, locally produced food, limited availability of nutritious food, poor dietary choices, lack of nutritional education and the preponderance of ultra-processed foods. Natural disasters and supply chain challenges exacerbate the problem. At both regional and national levels, efforts are being made to address obesity through policies aimed at promoting healthy eating, reducing the consumption of unhealthy foods, nutrition education, implementing fiscal measures and supporting local food production. Regional frameworks such as the Port of Spain Declaration and the Declaration of St Ann emphasize the importance of multisectoral collaboration and policy coordination. In the area of food safety, the Caribbean faces challenges ranging from foodborne outbreaks exacerbated by climate change impacts and changing food systems. Strengthening food safety systems requires addressing institutional issues, fostering collaboration among agencies and adopting the One Health approach. Comprehensive and coordinated efforts are urgently needed to address the intertwined challenges of overweight, obesity and NCDs, considering their profound health and economic implications. Likewise, concerted actions are essential to enhance food safety, safeguard public health and support economic stability in the Caribbean region.

Per-oral endoscopic myotomy (POEM) is a minimally invasive procedure that is very effective in the treatment of achalasia, a rare esophageal motility disorder. POEM has become the first-line treatment for achalasia, with high success rates reported in the literature. However, a known complication of POEM is gastroesophageal reflux disease (GERD). The exact cause and risk factors of post-POEM GERD are not fully understood; however, a number of factors have played a role in its development. The management of post-POEM GERD is mainly by conservative measures, such as lifestyle changes and medications, like proton pump inhibitors (PPI), which are often the first-line method of treatment. However, surgical procedures, such as fundoplication, may be necessary in some patients. This literature review will discuss the effectiveness of the use of PPIs as a management strategy for post-POEM GERD, the factors that lead to PPI-resistant GERD, and other management strategies utilized in these cases.

Given the recent outbreaks of the Marburg (MARV) virus within the first quarter of the year 2023, interest in the MARV virus has been re-ignited given its shared phylogeny with the dreadful Ebola virus. This relation gives some insight into its virulence, associated morbidities, and mortality rates. The first outbreak of MARV recorded was in Germany, in 1967, of which seven died out of 31 reported cases. Ever since, subsequent cases have been reported all over Africa, a continent replete with failing healthcare systems. This reality impresses a need for a contemporary and concise revision of the MARV virus existing publications especially in the areas of vaccine research. A functional MARV vaccine will serve as a panacea to ailing communities within the African healthcare landscape. The objective of this scoping review is to provide pertinent information relating to MARV vaccine research beginning with an outline of MARV's pathology and pathogenesis in addition to the related morbidities, existing therapies, established outbreak protocols as well as areas of opportunities.

Intramedullary myxopapillary ependymomas are rare spinal cord tumors primarily affecting young adults. Grade 2 tumors are associated with a higher proliferative index and potentially more aggressive behavior compared to grade 1 tumors. We present a case of a 30-year-old male who presented with a three-month history of progressive unilateral lower back pain that was refractory to analgesics. Neurological examination revealed bilateral lower limb weakness and sensory impairments in the L2 region. MRI confirmed a well-defined, enhancing intramedullary lesion at the L2 level, causing cord enlargement and edema. Diagnosis of grade 2 intramedullary myxopapillary ependymoma was made. Complete surgical resection was performed, confirming a grade 2 myxopapillary ependymoma. Postoperatively, the patient demonstrated significant improvement in lower limb function and sensation, with no tumor recurrence during long-term follow-up. Rehabilitation therapy was initiated, while close monitoring for complications and tumor progression was maintained. This case explores the etiology and features of intramedullary myxopapillary ependymomas and underscores the importance of early recognition, accurate diagnosis, and aggressive surgical management.

ABSTRACTObjective.To examine multiple aspects of the medicines in CARICOM procurement markets, including manufacturer headquarters location, regulatory history, and type (innovator versus generic); the proportion of World Health Organization (WHO) essential medicines; and the most expensive medicines procured.Methods.An analysis of procurement information from selected CARICOM procurers. Four public sector procurement lists were obtained based on public availability or sharing of data from public sector procurers. Analyses were based on parameters available or deduced from these data.Results.The majority of products come from manufacturers headquartered in North America and Europe (63%–67%). The percentage of medicines procured from generic companies is 60%–87%; and 25%–50% of medicines procured are on the WHO Essential Medicines List. Wide price variations exist in the most expensive medicines purchased.Conclusions.The analysis identifies vulnerabilities and opportunities in the procurement situation of CARICOM states, particularly related to quality and rational use of medicines. This analysis represents a baseline that governments and other stakeholders can use in the future.