Challenges for eGFR equations in the developing world.

The populations in countries that have the highest number of individuals with chronic kidney disease (CKD) are the low and middle-income countries which are ethnically diverse. The regional and international data highlighting the need for continuous monitoring of renal function warrants that such countries use equations that give the best estimates of glomerular filtration rate for their settings. While chronic disease conditions such as diabetes and hypertension are the main conditions associated with CKD in adult populations and complicated urinary tract infections and congenital anomalies in the kidney and the urinary tract in the young, the management of patients with CKD at any age can be impacted by medical and non-biological factors.

Contraceptives Are Also Drugs.

We report a patient who stated that contraceptives are not drugs. She presented with distressing symptoms of UTI following sexual activity and denied using any medication. Her physician prescribed co-amoxiclav based on her urine culture and sensitivity report, and the patient returned three days later with complete relief of symptoms but complained of vaginal bleeding.

Early COVID-19 response in two small island developing states: Maldives and Trinidad and Tobago.

Problem: Coronavirus disease 2019 (COVID-19) was declared a pandemic on 11 March 2020. Severe illness requires intensive care facilities, which are limited in smaller, resource-constrained settings.

Context: Maldives and Trinidad and Tobago are small island developing states with comparable climates.

Targeting insulin resistance with selected antidiabetic agents prevents menopausal associated central obesity, dysglycemia, and cardiometabolic risk.

Menopause consequent to reduced circulating estrogen is associated with diminished insulin receptor sensitivity and fat redistribution, particularly central adiposity and increased waist circumference. Peri and menopausal women are at risk of hyperglycemia, prediabetes and attendant metabolic disturbances. Hormone replacement therapy increases insulin receptor sensitivity, but may precipitate an increased cardiovascular risk, depending on the route, if not commenced within the proposed period denoted by the 'timing hypothesis'.

Efficacy of Levofloxacin Loaded Nonionic Surfactant Vesicles (Niosomes) in a Model of Infected Sprague Dawley Rats.

This study examined the effectiveness of niosomes loaded with levofloxacin in treating (American Type Culture Collection-ATCC 27853) infections in Sprague Dawley rats since these infections are becoming more common and resistant to treatment. Levofloxacin entrapped in niosomes was prepared using the thin-film hydration method and was assessed for in vitro release and stability. Three groups of six (6) animals were infected with a lethal dose of via the intraperitoneal (Ip) route.

Risk factors for poor asthma control and impaired quality of life in a Caribbean population.

Objective: Asthma, a major cause of disability and reduced quality of life, has a high global prevalence and burden of death. Despite the propitious guidelines, a substantial portion of asthmatics reportedly have poorly controlled disease. In the current study, we have examined risk factors for uncontrolled asthma in specialty clinics and its association with impaired quality of life.

Sodium-glucose cotransporter 2 inhibition as a potential treatment for idiopathic oedema.

Idiopathic oedema is a syndrome affecting primarily women that is characterized by frustrating intermittent fluid retention, with hallmarks of obesity, periodic oedema, anxiety, and a susceptibility to develop type 2 diabetes. Management is typically reassurance and weight control, with no known drug class proven to provide consistent relief. We hypothesise that sodium-glucose cotransporter 2 inhibition is a logical intervention in the treatment of idiopathic oedema, having effects on obesity, blood pressure, impaired glucose tolerance, sympathetic overdrive, and reduction in swelling - the most common and distressing complaint.

Reality and understanding of asthma control.

The aim of this study was to describe the level and perception of control in severe asthma in Trinidad after the introduction of revised guidelines for asthma management. Adult asthmatics (N = 329) at Trinidad's chest clinics were cross-sectionally examined for guideline-defined disease control. Patients' mean (SD) age was 54.

Prevalence of self-reported diabetes, hypertension and heart disease in individuals seeking State funding in Trinidad and Tobago, West Indies.

Objective: Diabetes, hypertension and heart disease inflict a heavy health burden on the Caribbean Republic of Trinidad and Tobago. This study assessed the prevalence of self- reported diabetes, hypertension and heart disease in lower socioeconomically placed individuals accessing welfare grants.

Method: Data collected between July 2008 and June 2009 were analyzed from 14,793 responses.

Restrictive pulmonary deficit is associated with inflammation in sub-optimally controlled obese diabetics.

Caribbean data linking inflammation, pulmonary dysfunction and diabetes is unavailable. Spirometry, acanthosis nigricans, hs-CRP were assessed in 109 type 2 diabetics (43% males) mean age=55.6 years, BMI=29.

Clinical features of a paediatric asthma population in Trinidad.

Aim: Clinical features and management of paediatric asthma, highly prevalent in the Caribbean, was explored in Trinidadian children.

Materials: Children (2-16 years) with acute [visiting Accident and Emergency (A&E) in the past 12 months (50.2%, 120)] or stable asthma [controlled during the previous 3 months (49.

Does insulin resistance co-exist with glucocorticoid resistance in the metabolic syndrome? Studies comparing skin sensitivity to glucocorticoids in individuals with and without acanthosis nigricans.

Background: The metabolic syndrome is associated with increased risk for both diabetes and coronary artery disease, which insulin resistance alone does not satisfactorily explain. We propose an additional and complementary underlying mechanism of glucocorticoid resistance.

Results: Using acanthosis nigricans (AN) and skin vasoconstrictor (SVC) response to topically applied beclomethasone dipropionate as markers of insulin and glucocorticoid resistance, respectively, we compared anthropometric, biochemical, pro-inflammatory markers and the SVC response in subjects with AN in two studies: STUDY 1 was used to compare subjects with AN (Grade 4, n = 32), with those without AN (n = 68) while STUDY 2 compared these responses among a cross-section of diabetic patients (n = 109) with varying grades of AN (grade 0, n = 30; grade 1, n = 24; grade 2, n = 18; grade 3, n = 25; grade 4, n = 12).

Prevalence of chronic obstructive pulmonary disease among stable chronic disease subjects in primary care in Trinidad, West Indies.

The prevalence of COPD in the Caribbean is uncertain. Spirometric indices were assessed at chronic disease clinics in 353 subjects (African, 66; East Indian, 198; 109 male), mean age 56.51 years (non-COPD) vs 59.

Fish faddism causing low-level mercury poisoning in the Caribbean: two case reports.

Two otherwise healthy middle-aged males presented with persistent abdominal and lower- back pain, progressive weakness, paraesthesias, fatigue and weight loss over 8-12 months. Extensive work-up failed to localize organ pathology. Both men, strongly aware of the nutritional benefits of fish had a diet dedicated of canned and fresh fish.

Association of troponin T and altered lipid profile in patients admitted with acute myocardial infarction.

Objective: To determine whether elevated levels of troponin T are associated with altered lipid profile.

Methods: Data were collected from 205 patients each of whom presented elevated troponin T levels.

Results: 195 patients presented with suspected myocardial infarction, 10 patients did not.

Steroid-induced iatrogenic disease after treating for pseudothrombocytopenia.

Pseudothrombocytopenia, a spontaneous in vitro occurrence after the addition of anticoagulant to blood, causes clumping of platelets resulting in a spurious observation of low platelet counts (<10,000/μL) without any associated hemorrhagic manifestations. We describe a 46-year-old male patient who was diagnosed with immune thrombocytopenic purpura (ITP) based on a reported platelet count of 22,000/μL. He was prescribed high-dose glucocorticoid therapy, up to 60 mg of prednisolone daily for over a year.

Experimental evaluation of ethanolic extract of Carapa guianensis L. Leaf for its wound healing activity using three wound models.

The leaves of Carapa guianensis have been used to treat ulcers, skin parasites, and skin problems. The ethanolic extract of C. guianensis leaf was evaluated for its antibacterial and wound healing activity using excision, incision and dead space wound models in rats.

Distribution and seasonality of rhinovirus and other respiratory viruses in a cross-section of asthmatic children in Trinidad, West Indies.

Background: Childhood asthma in the Caribbean is advancing in prevalence and morbidity. Though viral respiratory tract infections are reported triggers for exacerbations, information on these infections with asthma is sparse in Caribbean territories. We examined the distribution of respiratory viruses and their association with seasons in acute and stable asthmatic children in Trinidad.

Do current standards of primary care of diabetes meet with guideline recommendations in Trinidad, West Indies?

Aims: Primary care management of diabetes was examined using the Caribbean Health Research Council (CHRC) guidelines.

Methods: We retrospectively examined a cross-section of 646 type 2 people with diabetics over 12 months with 1st visit between 1997 and 2005.

Results: There were more women (65.

Drugs in upper respiratory tract infections in paediatric patients in North Trinidad.

Objective: We explored the prescribing patterns of physicians in North Trinidad in treating upper respiratory tract infections (URTI) in paediatric patients and the appropriateness of drugs prescribed.

Methods: A retrospective observational study was conducted, with a sample size of 523 paediatric patients, diagnosed with an URTI during the period of June 2003 to 22 June 2005. The study was conducted at five Primary Health Care Facilities in North Trinidad.

Diminished Plasmodium falciparum sensitivity to quinine exposure in vitro and in a sequential multi-drug regimen: A preliminary investigation in Guyana, South America.

Objectives: This preliminary study sought to investigate the response of uncomplicated falciparum infections to semi-supervised drug administration with quinine and two adjunctive schizontocidal drugs in infected patients in Guyana. Quinine and chloroquine cross-sensitivity was also assessed in vitro.

Methods: Patients were treated with quinine 10mg/kg for 7 days followed by sulfadoxine/pyrimethamine 25mg/kg single dose (in children) or doxycycline 100mg daily for 7 days (in adults).