Eric Williams Medical Sciences Complex Research Articles

Correlation of RETINAL Artery Diameter with Coronary Artery Disease: The RETINA CAD Pilot Study-Are the Eyes the Windows to the Heart?

This study aimed to determine whether there was any correlation between coronary artery disease (CAD) and retinal artery diameter at an academic tertiary medical center in Trinidad and Tobago. This prospective study evaluated patients (n = 77) with recent invasive coronary angiography (CAG) and the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score who subsequently underwent optical coherence tomography-angiography (OCT-A) at the Eric Williams Medical Sciences Complex (EWMSC) from January 2021 to March 2021. Routine medical history and cardiovascular medications were also recorded. Spearman's rank correlation coefficient and Mann-Whitney U-tests were used to compare correlations and medians between groups. The average patient age was 57.8years old, with the majority being male [n = 55 (71.4%)] and of South Asian ethnicity [n = 53 (68.8%)]. Retinal artery diameter was negatively correlated with the SYNTAX score (-0.332 for the right eye, p=0.003 and -0.237 for the left eye, p=0.038). A statistically significant relationship was also demonstrated in females and diabetic patients. There were no serious adverse events (SAEs). A significantly negative correlation was observed between retinal artery diameter and SYNTAX score. This study alludes to the practical use of optical coherence tomography-angiography (OCT-A) as a noninvasive diagnostic modality for patients with cardiovascular disease (CVD). Further large-scale, multicentric studies are required to confirm these exploratory findings. NCT04233619.

Tissue Yields for Epidermal Growth Factor Receptor Analysis in Non-Small Cell Lung Cancer Patients in Trinidad and Tobago.

IntroductionPatients with unresectable non-small cell lung cancer (NSCLC) may benefit from chemotherapy, tyrosine kinase inhibitor (TKI) therapy, or both. TKI therapy may be administered to the subset of patients who harbor the epidermal growth factor receptor (EGFR) mutation. EGFR mutation testing now plays a vital role in the diagnostic work-up of advanced NSCLC patients to determine which patients are more likely to benefit from TKI therapy. The role of surgery in these patients is mostly limited to obtaining an adequate biopsy for histological, immunohistochemical, and EGFR analysis using the least invasive methods possible. It is thought that larger volume samples, such as those obtained from traditional surgical lung biopsies (SLBs), have better yield than small volume samples, such as those obtained from transthoracic needle lung biopsies (TTNLBs), for EGFR analysis.AimThe aim of this was to determine which biopsy procedures provide superior yield for EGFR mutation analysis among primary NSCLC patients at the Eric Williams Medical Sciences Complex (EWMSC) and whether these tissue yields are in keeping with international recommendations.MethodsThis is a retrospective, observational study using patient data obtained from the Lung Malignancy Unit, which is based at the EWMSC. The study population was limited to primary NSCLC patients presenting to the EWMSC from January 2014 to June 2017 whose biopsy samples were sent for EGFR testing. Relevant patient data were entered onto a spreadsheet using Microsoft Excel. Patients were classified as having had either an SLB, bronchial biopsy (BB), TTNLB, or some other biopsy procedure. All samples were sent for histological analysis, followed by immunohistochemistry and finally EGFR testing. All EGFR mutation analysis was performed at a single laboratory in the USA. A minimum of 200 tumor cells or 10% tumor content defined an adequate sample for EGFR mutation analysis. Samples that yielded a positive or negative result were considered adequate samples in this study. The number of adequate and inadequate samples for each procedure group was tabulated and the yield was determined as the percentage of adequate samples obtained for each procedure group.ResultsSLBs had superior yield (95.6%) compared to BBs (88.5%) and TTNLB (85%) in obtaining adequate samples for EGFR analysis.ConclusionSLBs demonstrated superior yield in attaining adequate tissue samples for EGFR mutation analysis compared to BBs and TTNLBs.

Identifying dispensing errors in pharmacies in a medical science school in Trinidad and Tobago

BackgroundA dispensing error can be defined as an inconsistency between the drug prescribed and drug dispensed to a patient. These errors can lead to ineffective and sometimes unwanted pharmaceutical outcomes. Dispensing errors can be harmful or even fatal to patients.Case presentationThe objective to this study was (a) to determine the types and frequency of dispensing errors at the Eric Williams Medical Sciences Complex (EWMSC), (b) to explore the reasons for the occurrence of dispensing errors, and (c) to make suitable recommendations for their prevention. An observational study for a period of 2 weeks was carried out at various in- and outpatient departments of the EWMSC. The observations were carried out during 7:00 am to 3:00 pm. Dispensing errors identified during this period were recorded and analyzed.ResultsSixty-eight errors were identified in the adult outpatient pharmacy of the EWMSC; 19 errors in the pediatric outpatient pharmacy, whereas 22 errors were found in inpatient pharmacy. The most common plausible causes for the dispensing errors include high workload, failure to verify patient information, incorrect data in the pharmacy’s record system, inadequate notes made by pharmacists during prior patient visit, and in a few cases, uncomfortable working conditions.ConclusionDispensing errors were encountered in 2.1% of all the prescriptions filled at the EWMSC pharmacies. The factors which influenced these dispensing errors include but are not limited to a heavy workload, distractions, failure to verify patient information, and uncomfortable working conditions.

P1.13-39 Epidermal Growth Factor Receptor Mutation Among Non-Small Cell Lung Cancer Patients in Trinidad and Tobago: Frequency and Trends

Almost 70% of non-small cell lung cancer (NSCLC) patients present with unresectable disease and may benefit from chemotherapy or biologic therapy. Mutation testing now plays a vital role in their diagnostic work-up to determine which patients are more likely to receive benefit from biologic therapies. The rate of epidermal growth factor receptor (EGFR) mutations varies significantly across geographic regions and ethnicities, ranging from 13% to 64% in some areas. Several subgroups such as females, East Asians, never-smokers and those with adenocarcinoma histology have the highest reported rates of EGFR mutations. Regionally, the French West Indies reports an EGFR mutation rate of 36%. The frequency of the EGFR mutation among NSCLC patients in Trinidad and Tobago has not been previously reported in the literature. An observational, retrospective study was done using data obtained from the Lung Malignancy Unit (LMU) based at the Eric Williams Medical Sciences Complex (EWMSC). The EWMSC is the sole referral centre in Trinidad and Tobago for lung cancer and the LMU is responsible for co-ordinating clinical and educational services regarding lung cancer nationwide.The study population was limited to primary NSCLC patients presenting to the EWMSC from January 2014 to June 2017 whose biopsy samples were sent for EGFR testing and received either a positive or negative result. Patients’ clinical data was entered onto a spreadsheet and analysed using Microsoft Excel. The data for 94 patients with NSCLC were analysed. 68 of these patients were male, while 58 admitted to a history of smoking. EGFR mutations were present in 39.4% of this study population. Females demonstrated a significantly higher EGFR mutation rate than males (73.1% vs 26.5%, p < 0.0001). Smoking status was found to be significantly associated with differences in EGFR mutation status (p < 0.01). The mean age of presentation was similar despite of EGFR mutation status. Although a larger number of EGFR positive patients compared to EGFR negative patients had adenocarcinoma histology (97.3% vs. 89.5%), this was not found to be statistically significant (p = 0.29). The frequency of EGFR mutations in this study population (39.4%) was higher than most regions of the world but similar to that reported in the French Antilles. Sex and smoking status were significantly associated with differences in EGFR mutation status.

A Comparative Survey of Pacemaker Implantation in Trinidad and Tobago in 2005 and 2009.

The indications for permanent pacemaker implantations in Trinidad have expanded from initially symptomatic bradycardia to now include complex devices. A retrospective review of the available data was conducted to better understand the evolving trends in device implantation in Trinidad and Tobago. Data were collated from the two major implanting teams in Trinidad for the years 2005 and 2009. The two implanting centres were the Advanced Cardiovascular Institute (ACI) at Westshore Medical Centre and the Catheterization Laboratory of the Eric Williams Medical Sciences Complex (EWMSC). Data were based on retrospective collation using the implantation records. The implantation rate for new devices increased from 39 per million to 103 per million population. The most common indications for new device implants in 2009 were high degree atrioventricular (AV) block (53%) and sick sinus syndrome (22%) with the notable appearance of congestive cardiomyopathy (13%) which was not present in the earlier cohort. Of particular note, 23 high-end devices were implanted in 2009. These were five cardiac-resynchronization therapy (CRT-P) devices, 14 automatic implantable cardio-defibrillator (AICD) devices and four combined cardiac-resynchronization therapy with defibrillator (CRT-D) devices versus none in 2005. In summary, over the period 2005 to 2009, a substantial increase in device implantation rates has occurred which now include high-end, complex devices. Absolute rates, however, remain far below that of developed countries, indicating that the true need remains underserved. Furthermore, adjustment for gross domestic product suggests that the relatively buoyant economy of Trinidad and Tobago is capable of servicing a greater proportion of this need than is currently met.

Polypharmacy and the Risk of Malnutrition among Independently-living Elderly Persons in Trinidad.

In this study, we evaluated the association of polypharmacy and nutritional status among independently-living elderly persons attending the outpatient clinics at the Eric Williams Medical Sciences Complex (EWMSC). Participants were recruited at the outpatient pharmacy at EWMSC. Face-to-face interviews were conducted using a questionnaire consisting of sociodemographic, health and nutritional status items. Anthropometry was taken using standard procedures. Participants gave oral and written consent prior to enrolment in the study. Participation was voluntary. The study wasapproved by the Ethics Committee, EWMSC. One hundred and three persons - polypharmacy (≥ 6 medications) = 57; non-polypharmacy (< 6 medications) = 46 persons) - participated in the study. There was no significant difference in the age, gender, weight, height, body mass index (BMI), mid-arm circumference, calf circumference, highest educational level achieved and marital status between the groups. The number of medications prescribed was significantly positively associated with the number of ailments (r = 0.56; p < 0.001) and the risk of malnutrition (r = 0.30; p = 0.006). Persons with polypharmacy were significantly more likely than their non-polypharmacy counterparts to be at increased risk for malnutrition (OR = 3.94, 95% CI: 1.52, 10.13; p = 0.004). This finding remained highly significant after simultaneous adjustment for age, gender, ethnicity, highest educational level achieved, marital status and number of diseases (p = 0.03). Among participants, polypharmacy and number of ailments were positively associated with an increased risk of malnutrition. Nonetheless, the mechanisms underlying these associations remain unclear.

Utility of the Tono-Pen in Measuring Intraocular Pressure in Trinidad: A Cross-sectional Study.

To determine the sensitivity and specificity of the Reichert™ Tono-Pen AVIA® when used by novice medical students in an ethnically diverse population in Trinidad. Participants were residents of Trinidad between the ages of 20 and 90 years attending the Ophthalmology Clinic at the Eric Williams Medical Sciences Complex (EWMSC). Intraocular pressure (IOP) was measured using the Goldmann applanation tonometer (the gold standard) for ophthalmology clinic patients as part of their routine care. Intraocular pressure measurements were then taken using the Tono-Pen. One hundred persons participated, consisting of Indo-Trinidadians (55%), Afro-Trinidadians (36%), Mixed (8%) and 1% of Caucasian descent. Fourteen per cent reported a diagnosis of glaucoma, with 70.6% of these being of African descent. One hundred and ninety-eight readings of IOP were taken. At a cut-off point of 21 mmHg, there were nine true positives, four false positives, seven false negatives and 178 true negatives. The sensitivity and specificity were found to be 56.3% (95% CI 33.2, 76.9) and 97.8% (95% CI 94.5, 99.1), respectively. The positive predictive value was calculated as 69.2% (95% CI 42.4, 87.3) while the negative predictive value was 96.2% (95% CI 92.4, 98.2). The prevalence of elevated IOP in this population was 8.1% (95% CI 4.8, 13.0). The likelihood ratio of a positive result was calculated to be 25.6 (95% CI 8.6, 73.9). The high specificity and negative predictive value suggests that the Tono-Pen can be used with minimal training, and can prove beneficial at the primary care level in the exclusion of increased IOP in an ethnically diverse high-risk Caribbean population.

The prevalence of depressive symptoms in a Trinidadian cardiac population.

The current study investigated the prevalence of depressive symptoms in persons with self-reported cardiovascular disease and the interactions of depressive symptoms, reported cardiovascular disease and gender in a Trinidadian population. Between June 2009 and August 2009, 425 participants were recruited from the Eric Williams Medical Sciences Complex (EWMSC) Heart Clinic and all the participants completed the Center for Epidemiologic Studies Depression Scale. Clinical and demographic variables were obtained from the sociodemographic questionnaire. Forty-seven per cent of the self-reported cardiovascular disease participants were identified as having high depressive symptoms as compared to 32% of those who did not report having a cardiovascular illness. The odds ratio indicated that high depressive symptoms are more likely to occur in individuals with reported cardiovascular disease. The Mann-Whitney test revealed females had significantly higher levels of depressive symptoms than males. Previous studies suggest that depression is a risk factor for adverse prognosis in a cardiac population, therefore future research examining the link between depression and cardiovascular disease is warranted.

Neurodevelopmental Outcome of Childhood Cancer Survivors Treated at the Eric Williams Medical Sciences Complex.

To investigate the neurodevelopmental outcome of childhood cancer survivors treated at the Eric Williams Medical Sciences Complex (EWMSC). Study participants were children treated at EWMSC from January 2003 to March 31, 2012 for various childhood cancers. All had completed treatment and were in remission. The McCarthy Scales of Children's Abilities (MSCA) was administered. The study was conducted from December 2011 to March 31, 2012. Twenty-six children were evaluated, a response rate of 74%. There were 12 males and 14 females. Ages ranged from 3.25 to 9.00 years. Four (15.4%) children scored a general cognitive index (GCI) < 68. One child (3.8%) scored a GCI > 132. The children's mean estimated mental age was found to be significantly lower than their mean actual age (p = 0.0086). Children treated for solid tumours had the least difference between their actual ages and estimated mental ages (p = 0.0301). The mean GCI for the genders was 97.4 for females and 81.0 for males; this difference was statistically significant (p = 0.0302). Age at diagnosis, type and length of treatment were not found to significantly affect development. The paediatric cancer survivors in this survey were found to have delays in their development. This group of children should have their development closely monitored. This would ensure that any delays in development can be discovered early and appropriate interventions instituted, so that childhood cancer survivors are adequately prepared for adult life beyond cancer.

The prevalence of Type D personality in a Trinidadian cardiac population.

The current study investigated the prevalence of Type D personality in persons with self-reported cardiovascular disease and the interactions of Type D personality, reported cardiovascular disease and gender in a Trinidadian cardiac population. Between June 2009 and August 2009, 425 participants were recruited from the Eric Williams Medical Sciences Complex (EWMSC) Heart Clinic and all the participants completed the Type D Scale. Clinical and demographic variables were obtained from the sociodemographic questionnaire. Forty-two per cent of participants with self-reported cardiovascular disease were identified as Type D as compared to 26% of participants who did not report having a cardiovascular illness. The odds ratio indicated individuals identified with Type D personality are 2.0 times more likely to report having cardiovascular disease and females with cardiac disease are 1.6 times more likely to be identified with Type D personality as compared to males. Previous studies suggest Type D personality is a risk factor for adverse prognosis in the cardiac population, therefore future research examining the link between Type D personality and cardiovascular disease is warranted.

Parent Perceptions of Paediatric Oncology Services at the Eric Williams Medical Sciences Complex, Trinidad and Tobago

To assess the perceptions of parents of children with cancer and to determine level of satisfaction with the paediatric oncology services at the Eric Williams Medical Sciences Complex (EWMSC). Parents of children with cancer were surveyed during the period 12-27 October 2009 as part of a wider needs assessment project using a questionnaire designed to obtain information on their perception of medical, physical and psychosocial resources during the family encounter at the EWMSC. Overall, parents expressed a high level of satisfaction with the quality of delivery of medical and pharmaceutical services which were at no direct cost to the patient. Issues of concern included a lack of a structured clinic appointment system, inadequate patient care assistance on the ward for very young patients and the housing of non-oncology patients in the oncology specialty unit. Apart from their child's illness, fear of job and income loss was a major stressor for parents. Medical needs of patients were perceived to be well met, but there was need to address the psychosocial, physical and educational needs of parents.

Antimicrobial sensitivity pattern of aerobic bacteria blood isolates: experience at a university hospital in Trinidad

The morbidity and mortality associated with blood stream bacterial infections are increasing globally [1,2]. Bacterial resistance to the relatively inexpensive antimicrobials (e.g. ampicillin, tetracycline, co-trimoxazole) in developing countries have increased considerably both in hospitals [3] and the community [4] due to sales without a prescription at many pharmacies. This can lead to uncontrolled medication [4] and along with the indiscriminate use of antibiotics and absence of hospital antibiotic prescribing policies, may contribute to the emergence of resistant strains within the hospital environment. Relatively few studies on the levels of antibiotic resistance have been conducted in most Caribbean countries including Trinidad. This study was undertaken to evaluate and document the antimicrobial profile of the various pathogens isolated from blood cultures at a university teaching hospital in Trinidad. Between January and December 1998, 1002 consecutive blood specimens from 656 male and 346 female inpatients were received in the microbiology laboratory at the Eric Williams Medical Sciences Complex (EWMSC), Trinidad. Suspected positive cultures were identified using a non-radiometric assay Bactec (NR 600) and identified by using standard procedures [5]. Anaerobes were excluded. Antimicrobial susceptibility to several antibiotics used a diffusion technique and followed the guidelines of the National Committee for Clinical Laboratory Standards (NCCLS) [6]. From a total of 1002 blood specimens received in the laboratory for culture 348 (34.8%) grew bacteria (Table 1). Coagulase-negative staphylococci (CNS) were the most frequently isolated organisms (100, 28.7%), followed by Staphylococcus aureus and Pseudomonas aeruginosa (each, 48, 13.8%). There were 40 isolates of Escherichia coli (11.5%), 24 of Klebsiella pneumoniae (6.9%) and 20 Enterococcus faecalis (5.7%). Three hundred and thirty-six (96.5%) cultures grew a single organism while 12 (3.5%) grew more than one species. More than 90% of CNS and S. aureus were resistant to ampicillin and more than 70% were resistant to augmentin and tetracycline but highly sensitive ( 95%) to erythromycin. No methicillin-resistant staphylococci were isolated from blood. The prevalence of resistance of the other Gram-positive organisms to all the drugs tested was less and ranged from an average of 32% to fully sensitive (Table 2). P. aeruginosa was fully sensitive to the cephalosporins, imipenem and aztreonam, but highly resistant (\80%) to gentamicin. E. coli and K. pneumoniae showed multi-resistance to

Prevalence of tuberculin skin test reactivity among health care workers at a teaching hospital in Trinidad

The prevalence of tuberculosis is increasing worldwide. The World Health Organization estimated that 8 million new cases and 3 million deaths annually are directly attributable worldwide to the disease each year, comprising 6% of all deaths [1]. Bloom and Murray [2] have identified categories of persons that are at special risk within the general population, as well as in the hospital setting [3,4]. Published data documenting the current risk to health care workers (HCW) within the Caribbean region is scanty. In fact, lack of reliable data on yearly skin testing of hospital employees have been shown to hamper the evaluation of tuberculosis outbreaks in some centres [3,5]. In the USA in 1993, health care workers accounted for 3.2% of total cases of tuberculosis reported to the Centers for Disease Control and Prevention [6]. Subsequent to this report, the CDC issued guidelines designed to prevent spread of tuberculosis in health care facilities [7]. Persons latently infected with Mycobacterium tuberculosis may be identified by skin testing with purified protein derivatives (PPD) of the organism (e.g. Mantoux test) and it is a reliable method for monitoring the exposure of HCW to infected persons, and the best means for determining the efficacy of infection control efforts. There was no employee tuberculosis surveillance screening programme at the Eric Williams Medical Sciences Complex (EWMSC) prior to this study. This study was therefore conducted to define the prevalence of tuberculin reactivity among health care providers at the EWMSC before the transfer of patients and services from the National Chest Hospital at Caura and to provide ongoing monitoring with the development of specific infection control procedures. The study was conducted from October 1, 1996 to January 31, 1997 and came about because the Ministry of Health was contemplating transferring patients with tuberculosis and those suspected of being infected with the organism, from the National Chest Hospital (Caura Hospital) to the Eric Williams Medical Sciences Complex (EWMSC), in April 1997. The EWMSC is a 560-bed medical facility located in the northwestern part of Trinidad, and is one of four major governmentsponsored hospitals in Trinidad and Tobago. Trinidad is the larger of the twin island republic (Trinidad and Tobago) with