Port of Spain General Hospital

Sodium-glucose co-transporter 2 (SGLT2) inhibitors, initially developed to treat type 2 diabetes mellitus, work by blocking SGLT2 proteins in the proximal convoluted tubules of the nephrons, thereby preventing glucose reabsorption into the bloodstream. Subsequently, its mechanism reveals additional cardiovascular and renal benefits, necessitating further investigation into its effects on heart failure. This condition affects millions and leads to diminished quality of life, frequent hospitalizations, and high mortality rates. This review aims to evaluate several large randomized controlled trials (RCTs) investigating the favourable outcomes of SGLT2 inhibitors on heart failure and its related variables, including hospitalizations secondary to the condition, mortality rate, kidney function, and left ventricular ejection fraction (LVEF). Nine RCTs were reviewed systematically and meta-analyzed to assess the effectiveness of SGLT2 inhibitors. A pooled risk ratio was calculated under a random-effects model, along with heterogeneity analysis, to summarize the overall effect across studies. The studies analyzed two primary clinical outcomes of mortality and rehospitalization due to heart failure. SGLT2 inhibitors were associated with a 20% relative reduction in mortality (risk ratio (RR) = 0.80) and a 24% relative risk reduction of rehospitalization due to heart failure (RR = 0.76). These findings support the cardioprotective effects of SGLT2 inhibitors, as well as significant reductions in hospitalization and mortality. The efficacy of SGLT2 inhibitors was observed across diverse demographic and clinical subgroups, supporting their role as a valuable therapeutic option for managing heart failure.

Self-Verification, (SV) is a systematic process used for verifying effective implementation of requirements not limited to those from regulatory, statutory, internal company systems, and client-operator organizations. An effective Self-Verification process promotes a safety-first culture, helps minimize external audits/inspections, and ensures efficient operations compliant with all necessary rules and regulations. The intended outcomes of an effective Self-Verification Process include: Enhanced Safety Performance: lower incident rates and negative impacts at the frontline.Safety and Risk Management: verification of effectiveness of existing controls.Regulatory and Statutory Compliance: verification that applicable requirements have been met.Demonstration of Leadership and Commitment: participation from various levels of organizational leadership.Health, Safety, and Environment (HSE) Learning: improved HSE learning cultureContinuous Improvement: support to the continuous improvement cycle. Based on the above, Tucker Energy Services, (TES) has implemented a risk-based Self-Verification Process through a bespoke software Application (APP).

The predicted advantages of better survivorship and function from metal-on-metal (MoM) total hip arthroplasty (THA) systems introduced in the early 2000s did not materialise. Instead, national registry data indicated high failure rates, and these devices were quickly withdrawn from the market. With over 1 million MoM articulations implanted worldwide, there is a need for close follow-up and surveillance of the at-risk population. A 54-year-old woman presented with a painful right MoM hip arthroplasty. Serial radiographs demonstrated progressive migration of the acetabular shell with extensive osteolysis. After medical clearance, the patient underwent a successful isolated acetabular revision. The bone defects were filled with bone substitute, and the acetabulum was reconstructed using a metal cage and a cemented all-polyethylene cup. MoM THA is associated with a high failure rate and the need for early revision. An unverified number of these implants were used in Trinidad in 2009, leaving patients at risk for premature failure. In the Caribbean, the medical devices industry is largely under-regulated, exposing the patient to unnecessary risks. The formation of a national joint registry administered through the Caribbean Association of Orthopedic Surgeons could provide outcome data, identify early implant failures, and improve patient safety.

Immunology and microbiology research in the West Indies has witnessed remarkable growth and innovation, playing a pivotal role in advancing our understanding of immune mechanisms, disease pathogenesis, and therapeutic interventions. This manuscript presents a comprehensive exploration of key areas in West Indian immunology research, spanning from the utilization of bacterial proteins as antibody reagents to the intricate realms of clinical immunology and disease management. The utilization of bacterial immunoglobulin-binding proteins (IBPs), including protein A (SpA), protein G (SpG), and protein L (SpL), has revolutionised serological diagnostics in the region. promise in early disease detection and precision medicine. Microbiological studies in the Caribbean region have shed light on antimicrobial resistance patterns, particularly the emergence of extended-spectrum beta-lactamases (ESBLs), guiding antimicrobial stewardship programs and informing therapeutic strategies. Clinical immunology research has elucidated the molecular pathways underlying immune-mediated disorders, leading to tailored management strategies for conditions such as severe combined immunodeficiency (SCID), neuropsychiatric lupus erythematosus (NPLE), and others. In summary, West Indian immunology and microbiology research has made significant contributions to global healthcare, fostering collaboration, innovation, and improved patient outcomes.

Vaccination against the SARS-CoV2 virus has shown great promise in managing the spread and severity of Covid-19. While these vaccines were able to provide a favourable response in controlling the SARS-CoV2 infection, its use came with accompanying side effects. This systematic review aimed to determine the effectiveness of the different Covid-19 vaccine subtypes and discover the side effects associated with each vaccine elsewhere but specially in Trinidad and Tobago. For this systematic review, the keywords “Pfizer-BioNTech OR Moderna OR Oxford-AstraZeneca OR Janssen OR Sinopharm OR Novavax AND Covid-19 vaccine efficacy” and “Covid-19 vaccines AND Trinidad and Tobago” were researched under PubMed, MEDLINE and other internet sources through which other notable journals, and documents were discovered and searched similarly as outlined previously. In doing so, 65 relevant articles were included as part of this review. Of the studies examined, overall the vaccine with the greatest VE was found to be Pfizer-BioNTech (95%), followed by Moderna (94.1%), Novavax (89.7%), AstraZeneca (70.4%), Sinopharm (67%) and finally Janssen (66.9%). The use of Pfizer-BioNTech or Moderna was most efficacious in response to the different Covid-19 variants. Some side effects were common for all vaccine types however adverse effects were more commonly seen with vaccination by mRNA vaccines, Pfizer-BioNTech and Oxford-Astrazeneca. Researchers targeted individuals aged 18 and above residing in various geographical areas of TT, specifically focusing on those who had not received the COVID-19 vaccine and expressed hesitancy towards it. Convenience sampling was used to select the study participants, and formal in-depth virtual interviews were conducted on a one-to-one basis, employing a semi-structured questionnaire to guide the discussions. The interviews were meticulously recorded and transcribed, following the principles of reflexive thematic analysis, to distill key insights from the participants' responses. The study's findings, derived from the perspectives of 25 participants, illuminated a complex tapestry of reasons underlying vaccine hesitancy in Trinidad and Tobago. Notably, prominent themes emerged, including fear, doubts regarding vaccine efficacy, a perceived inadequacy of information, a sense of susceptibility to the virus, deep-seated mistrust, alternative herbal remedies, and religious reservations. Interestingly, the motivations expressed by these vaccine-hesitant individuals for potentially receiving the vaccine in the future were rooted in notions of necessity, an increased sense of susceptibility to the virus, a desire to reach a certain health benchmark, and a need for assurance regarding the vaccine's safety and effectiveness. This comprehensive exploration of vaccine hesitancy in TT provides valuable insights for public health officials and policymakers in crafting targeted strategies to address this critical issue within the local context. Conclusion: The findings of this study determined that vaccination against the SARS-CoV2 virus provided beneficial outcomes against infection, Covid-19 related hospitalizations, ICU admissions and mortality. While vaccination was deemed highly appropriate in managing the spread of the SARS-CoV2 virus and enhancing the outcomes in infected persons, the effectiveness of the different vaccine platforms indicated that certain vaccine platforms are preferential to others in different populations. In terms of vaccine efficacy, nucleic acid vaccines such as Pfizer-BioNTech and Moderna showed the greatest effectiveness while inactivated whole virus vaccines such as Sinopharm and viral vectors like Janssen had the least effectiveness. The side effects, joint/muscle soreness, pain at the injection site, shoulder pain, headaches, fever, chills, weakness, epistaxis, renal and certain cardiovascular events were common for all vaccine types. Adverse effects were more frequent and severe with the mRNA vaccines by Pfizer-BioNTech and Oxford-Astrazeneca than inactivated whole virus vaccines. The data collected in this research can be very useful to help individuals make a decision on which vaccine would be appropriate for them. More long-term studies are needed to better gauge the scope of side effects for each vaccine type.

Systemic lupus erythematosus (SLE) is an idiopathic chronic autoimmune disease that can affect any organ in the body, including the neurological system. Multiple factors, such as environmental (infections), genetic (many HLA alleles including DR2 and DR3, and genes including C4), and immunological influences on self-antigens, such as nuclear antigens, lead to the formation of multiple autoantibodies that cause deleterious damage to bodily tissues and organs. The production of autoantibodies, such as anti-dsDNA, anti-SS(A), anti-SS(B), anti-Smith, and anti-neuronal DNA are characteristic features of this disease. This autoimmune disease results from a failure of the mechanisms responsible for maintaining self-tolerance in T cells, B cells, or both. Immune complexes, circulating antibodies, cytokines, and autoreactive T lymphocytes are responsible for tissue injury in this autoimmune disease. The diagnosis of SLE is a rheumatological challenge despite the availability of clinical criteria. NPSLE was previously referred to as lupus cerebritis or lupus sclerosis. However, these terms are no longer recommended because there is no definitive pathological cause for the neuropsychiatric manifestations of SLE. Currently, the treatment options are primarily based on symptomatic presentations. These include the use of antipsychotics, antidepressants, and anxiolytic medications for the treatment of psychiatric and mood disorders. Antiepileptic drugs to treat seizures, and immunosuppressants (e.g., corticosteroids, azathioprine, and mycophenolate mofetil), are directed against inflammatory responses along with non-pharmacological interventions.

BACKGROUNDLaparoscopic colectomy is widely accepted as a safe operation for colorectal cancer, but we have experienced resistance to the introduction of the FreeHand® robotic camera holder to augment laparoscopic colorectal surgery.AIMTo compare the initial results between conventional and FreeHand® robot-assisted laparoscopic colectomy in Trinidad and Tobago.METHODSThis was a prospective study of outcomes from all laparoscopic colectomies performed for colorectal carcinoma from November 29, 2021 to May 30, 2022. The following data were recorded: Operating time, conversions, estimated blood loss, hospitalization, morbidity, surgical resection margins and number of nodes harvested. All data were entered into an excel database and the data were analyzed using SPSS ver 20.0.RESULTSThere were 23 patients undergoing colectomies for malignant disease: 8 (35%) FreeHand®-assisted and 15 (65%) conventional laparoscopic colectomies. There were no conversions. Operating time was significantly lower in patients undergoing robot-assisted laparoscopic colectomy (95.13 ± 9.22 vs 105.67 ± 11.48 min; P = 0.045). Otherwise, there was no difference in estimated blood loss, nodal harvest, hospitalization, morbidity or mortality.CONCLUSIONThe FreeHand® robot for colectomies is safe, provides some advantages over conventional laparoscopy and does not compromise oncologic standards in the resource-poor Caribbean setting.

There is a paucity of data regarding relationships between patient demographics and aneurysm characteristics in the West Indies. With this in mind, a retrospective cross-sectional review was conducted analyzing the computed tomography aortogram reports/images of 273 aortic aneurysms. Data were collected and analyzed on ethnicity, size, type, morphology, presence and maximum size of thrombus and aneurysm location, demographics, and clinical presentation with correlations. There were 273 patients with aortic aneurysms giving an incidence rate of 4.33 per 100,000 people per annum. Statistically significant associations were noted with age, gender, and ethnicity. All false aneurysms were male (p = 0.004). The average size of aortic aneurysms being 0.7 cm larger in males than females (p < 0.001). Females were more likely to present with rupture (p = 0.001). Thrombus was more likely in males, Black and mixed races, and in the 8th decade (p < 0.001). Mean age of presentation was the highest in East Indians at 78 than the other ethnicities (Chinese: 65, Black: 70, mixed: 71, White: 73). Aortic aneurysmal disease is increasing in Trinidad and the Caribbean. Infrarenal fusiform aneurysms are the most common types with many significant differences based on age, gender, and ethnicity in the Caribbean population.

Objective: It is current practice in our setting to not admit a partner in theatre during cesarean section (CS) even though this is becoming commonplace in various countries. This study is designed to determine the views of healthcare workers, postpartum mothers and their accompanying partners on having a partner present in the operating roon (OR) during an elective CS at Port of Spain General Hospital, Trinidad, West Indies.&#x0D; Materials and Methods: The study’s theoretical model was based on a constructionist, interpretivist framework as well as phenomenological research. A semi-structured interview was conducted and a thematic approach was used to develop codes. This was analyzed by Qualitative Data Analysis (QDA miner) software and the following themes emerged: ‘Maternal support’; ‘Fathers’ marginalization’; ‘Nurses’ perception of fathers’ role’; ‘Healthcare workers’ perception of litigation and ‘Limiting factors’.&#x0D; Results: 70% of respondents were in favor of a partner being present in the operating room for an elective CS and thought it would help to keep the mother at ease by allowing her to hold hands with the partner, talk to them and be accompanied by them to the recovery room. Healthcare workers did think that male partners might not have much of an impact in the operating room as they would not know what to do and may actually pose a security threat if things did not go exactly as planned.&#x0D; Conclusions: Healthcare professionals were neutral about partners being present in the operating room but had concerns regarding partner’s presence in the operating room. &#x0D; Key words: Anesthesia; Cesarean section; Health personnel; Parturients; Obstetric; Perception&#x0D; Citation: Ventour D, Gardiner K. The perception of obstetric healthcare workers to the partners’ presence in the operating room-a phenomenological study. Anaesth. pain intensive care 2023;27(4):528−534; DOI: 10.35975/apic.v27i4.2276&#x0D; Received: May 08, 2023; Reviewed: June 22, 2023; Accepted: June 28, 2023