Evaluation of Clinical, Demographic, and Biochemical Profiles of Trinidadian Patients Undergoing Coronary Angiography

Background: Trinidad and Tobago ranks number 45 in the world for total deaths due to coronary heart disease. Predictive tests for coronary angiographic results set the basis for earlier monitoring of the disease before additional complications become obvious. Aims and Methods?This study aimed to evaluate the anthropometric and biochemical parameters of 124 patients with suspected coronary artery disease (CAD) in Trinidad and how these parameters correlate to the findings at angiography. Results?The biochemical parameters showed statistically significant correlations with CAD severity by Spearman's rank-order correlation. Two clinical parameters showed significant associations with CAD severity—ethnicity (?2 (4)?=?12.925, p?=?0.012) and presence of type 2 diabetes at baseline (?2 (4)?=?21.483, p?<?0.001). Conclusion?Biochemical parameters such as fasting blood sugar, N-terminal pro B-type natriuretic peptide, creatinine, and hemoglobin A1c were well correlated and well associated with the severity of CAD after diagnosis by the process of coronary angiography. Hence, these factors can be taken into consideration to predict the severity of CAD.

Brittle cornea syndrome: A tale of three brothers

Brittle cornea syndrome (BCS) is a genetic connective tissue disorder with discernible ocular features such as blue scleral and thin cornea that predominantly presents in younger children. We herein describe cases of three siblings with BCS, two of whom presented to us with open globe injuries following trivial trauma. Clinical examination of the other eye in both showed diffusely thin corneas and blue sclera. A systemic evaluation revealed sensorineural hearing loss and hyperextensible joints. The third sibling was screened and found to have features concurrent with BCS. This report highlights the challenges faced in the management of ocular injuries and consecutive complications in these patient

Congenital corneal anesthesia: A case series

Congenital corneal anesthesia (CCA) is an extremely rare condition where the cornea is affected in isolation or as a part of congenital syndrome, or can be associated with systemic anomalies. This case series of 12 eyes provides an overview of various clinical presentations and their final treatment outcomes. The average age of presentation was 3.2 years with a female preponderance (75%). Fifty percent of the patients had bilateral involvement and 50% had corneal ulcers at presentation. Two eyes required therapeutic keratoplasty for corneal perforation. All patients had isolated CCA except for one who had an associated hereditary and sensory autonomic neuropathy.

Coronavirus Disease 2019 (COVID-19) Vaccination for Children: Position Statement of Indian Academy of Pediatrics Advisory Committee on Vaccination and Immunization Practices

Justification: Data generated after the first wave has revealed that some children with coronavirus 19 (COVID-19) can become seriously ill. Multi-inflammatory syndrome in children (MIS-C) and long COVID cause significant morbidity in children. Prolonged school closures and quarantine have played havoc with the psychosocial health of children. Many countries in the world have issued emergency use authorisation (EUA) of selected COVID-19 vaccines for use in children. In India, a Subject Expert Committee (SEC) has recommended the use of Covaxin (Bharat Biotech) for children from the ages of 2-18 years. The recommendation has been given to the Drugs Controller General of India (DCGI) for final approval. Objective: To provide an evidence-based document to guide the pediatricians on the recommendation to administer COVID vaccines to children, as and when they are available for use. Process: Formulation of key questions was done by the committee, followed by review of literature on epidemiology and burden of COVID-19 in children, review of the studies on COVID vaccines in children, and the IAP stand on COVID-19 vaccination in children. The available data was discussed in the ACVIP focused WhatsApp group followed by an online meeting on 24 October, 2021, wherein the document was discussed in detail and finalized. Recommendations: The IAP supports the Government of India’s decision to extend the COVID-19 vaccination program to children between 2-18 years of age. Children with high-risk conditions may be immunized on a priority basis. The IAP and its members should be a partner with the Government of India, in the implementation of this program and the surveillance that is necessary following the roll-out.

Investigating risk factors for developing autism, cerebral palsy and down syndrome in a Trinidadian population

Background: Autism, Cerebral Palsy and Down Syndrome are three lifelong, non-curable common developmental disorders that affect approximately 1 in 59, 1 in 323, and 1 in 700 children respectively. This research is to study the effects of prenatal, perinatal, and postnatal factors on the development of Autism, Cerebral Palsy (CP) and Down Syndrome (DS) in a Trinidadian population.Methods: This was a descriptive case-control study comprised 75 subjects, with 25 cases from each of the three disorders investigated, i.e. autism, CP and DS.Results: The highest risk of autism was associated with mothers having high stress levels (p=0.002), high blood pressure (0.042), and low iron levels (p=0.012) during the pregnancy, as well as having a family history of autism (p=0.002) and residing in an air polluted area (p=0.034). The highest risk of cerebral palsy was associated with a child being born preterm (case 24%, control 0; p=0.009), experiencing postnatal complications (case 80%, control 4%, p=0.000), having a birth weight less than 2500 g (p=0.002), having an abnormal appearance at birth (p=0.045), specifically the prevalence of blue baby (case 20%, control 0) and abnormal appearance (case 12%, control 4%), a case father having a low educational level (p=0.002), a case of mother having gestational diabetes during the pregnancy (p=0.037) and having older mothers (p=0.033) and fathers (p=0.033) than the controls. The highest risk of down syndrome was associated with mothers having high stress (p=0.017) and blood pressure (p=0.021) during pregnancy.Conclusions: The findings of our research confirm that autism, CP and DS are multi-factorial developmental disorders. A combination of environmental conditions, genetics, prenatal and postnatal factors are associated with an increased risk of developing autism, cerebral and down syndrome.

Quality of life of patients with head and neck cancer: A mixed method study

Aim of the Study: The current research was conducted with the aim of determining the quality of life of head and neck cancer (HNC) patients using mixed method approach. Methods: A mixed method triangulation design (QUAN + QUAL) was adopted in the study. Quantitative data were collected among 54 and qualitative data were collected till data saturation using nested sampling technique. Data were collected from seven oncological wards of two tertiary care hospitals during the 4th week of radiation therapy. Quantitative data were collected through functional assessment of cancer therapy: head and neck, and a semi-structured interview schedule was adopted to elicit their experiences. Quantitative and qualitative data were compared during the analysis phase. Both qualitative and quantitative data were depicted in meta-matrices. Results: Results showed that the most affected domains were functional well-being followed by HNC subscale. Similar findings were observed in narrative description of participants. Most focused experience was pain, and difficulty in eating and swallowing was experienced due to pain. Their verbal communication was inefficacious due to loss of voice and tone. Moreover, communication was difficult owing to changes in the oral mucous membrane and pathology. Conclusion: Patients with HNC suffer from varying degrees of psychosocial problems, and it is important to identify the psychosocial adjustment of the patients since the symptoms are sufficient to lay heavy burden

Prevalence of Shukra vega dharana in an Indian population: A cross sectional survey protocol

Background: Despite being an important aspect of health and quality of life, individuals tend to suppressnatural sexual urge (‘Shukra vega’) due to a variety of factors. Unless managed appropriately throughself-regulatory mechanisms, suppressed sexual urge (‘Shukra vega dharana’, SVD) not only causes psychological suffering but may also put other basic needs at risk. Adult, married, males who are eitherliving away from their spouse for long durations or separated or divorced are at a considerably higherrisk of developing SVD as compared to others. Considering the recent rise of sexual diseases and sexualviolence, it is critical to understand the extent and epidemiology of SVD in this sub-population of India.Objective: The study was attempted to understand the extent and epidemiology of SVD in this subpopulation of India.Materials and methods: To determine the prevalence of SVD in adult married, male individuals located inNashik, Ahmadnagar and Thane cities of India who are either living away from their spouse or separatedor divorced, a crosssectional, anonymous survey will be conducted among a sample of male individualsmeeting eligibility criteria. A multi-stage sampling approach will be used to identify cities/organizations(where the study will be conducted) and participants for the study. Post informed consent, eligible individuals will respond to a survey questionnaire. Responses will be populated in a spreadsheet, analyzedand reported. Understanding extent and epidemiology of SVD in an Indian sub-population will not onlyfacilitate design of future research studies but will also inform health, social and educational policyassociated with sex education (training individuals in the appropriate management of sexual urge).© 2018 Transdisciplinary University, Bangalore and World Ayurveda Foundation. Publishing Services byElsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Indian Academy of Pediatrics (IAP) Advisory Committee on Vaccines and Immunization Practices (ACVIP) Recommended Immunization Schedule (2018-19) and Update on Immunization for Children Aged 0 Through 18 Years

Justification: There is a need to revise/review recommendations regarding existing vaccines in view of current developments invaccinology. Process: Advisory Committee on Vaccines and Immunization Practices (ACVIP) of Indian Academy of Pediatrics (IAP)reviewed the new evidence, had two meetings, and representatives of few vaccine manufacturers also presented their data. Therecommendations were finalized unanimously. Objectives: To revise and review the IAP recommendations for 2018-19 and issuerecommendations on existing and certain new vaccines. Recommendations. The major changes in the IAP 2018-19 ImmunizationTimetable include administration of hepatitis B vaccine within 24 hours of age, acceptance of four doses of hepatitis B vaccine if acombination pentavalent or hexavalent vaccine is used, administration of DTwP or DTaP in the primary series, and complete replacementof oral polio vaccine (OPV) by injectable polio vaccine (IPV) as early as possible. In case IPV is not available or feasible, the child shouldbe offered three doses of bivalent OPV. In such cases, the child should be advised to receive two fractional doses of IPV at aGovernment facility at 6 and 14 weeks or at least one dose of intramuscular IPV, either standalone or as a combination, at 14 weeks. Thefirst dose of monovalent Rotavirus vaccine (RV1) can be administered at 6 weeks and the second at 10 weeks of age in a two-doseschedule. Any of the available rotavirus vaccine may be administered. Inactivated influenza vaccine (either trivalent or quadrivalent) isrecommended annually to all children between 6 months to 5 years of age. Measles-containing vaccine (MMR/MR) should beadministered after 9 months of age. Additional dose of MR vaccine may be administered during MR campaign for children 9 months to 15years, irrespective of previous vaccination status. Single dose of Typhoid conjugate vaccine (TCV) is recommended from the age of 6months and beyond, and can be administered with MMR vaccine if administered at 9 months. Four-dose schedule of anti-rabies vaccinefor Post Exposure Prophylaxis as recommended by World Health Organization in 2018, is endorsed, and monoclonal rabies antibody canbe administered as an alternative to Rabies immunoglobulin for post-exposure prophylaxis.

Causes and Concerns of Diabetic Subjects with Lower Limb Amputation(s) in Trinidad

Aim:This study seeks to examine the major causative factors for lower extremities amputation (LEA) amongst a Trinidadian diabetic patients as well as to analyse the resulting concerns of said patients.Study Setting and Design: This study mainly comprised patients who were subject to or will be subject to lower limb amputations of differing degrees and were selected via a random stratified methodology. Questionnaire used was designed as to attain data on patient medical history as well as intrinsic and opinionated results.Methods:This study comprised 35 patients who were subject to LEAs of differing degrees and these patients were selected via a random stratified methodology. After obtaining informed consent questionnaire were used to attain subjective and objective data as it pertains to the cause and effects of lower limb amputations. Statistical analysis was done using SPSS to test for distribution and correlations. Results: A number of factors were taken into account and measured as it pertained to the cause of having an amputation. Our study noted that the major factors like diet, alcohol consumption and infection became the reason for amputation.Conclusions:The data of this study showed that the patients are to ensure better self-care and preventative lifestyle changes are to be implemented as to prevent the need for amputations.

Tiny Magnetic Resonance Imaging Black Spot - Presenting An Interesting Case Of Internuclear Ophthalmoplegia With Radioanatomical Correlation

Horizontal gaze palsy involves three different entities of similar imaging findings with subtle differences and a prominent difference in the clinical findings. A thorough knowledge of the anatomy of the pathway of horizontal gaze pathways is essential before coming to the correct diagnosis. Here, we report the case of a 42-year-old male patient presented with a history of impaired vision for 1 day. Through this case report, we will revisit these three entities with a brief discussion on the pathways involved in horizontal gaze palsies.

Hospital-based Surveillance of Invasive Pneumococcal Disease and Pneumonia in South Bangalore, India.

Objective: To estimate the incidence of invasive pneumococcal disease and pneumonia, distribution of pneumococcal serotypes, and antibiotic susceptibility in children aged 28 days to <60 months. Design: Hospital-based surveillance. Setting:; South Bangalore, India. Participants: 9950 children aged 28 days to <60 months with clinical suspicion of invasive pneumococcal disease or pneumonia. Results: The estimated at-risk population included 224,966 children <5 years of age. Forty cases of invasive pneumococcal disease were identified. Estimated invasive pneumococcal disease incidence was 17.8/100,000 with incidence being highest among children aged 6 months to <12 months (49.9/100,000). Clinical pneumonia syndrome was the most frequent diagnosis (12.5/100,000). Pneumococcal serotypes included: 6A (n=6, 16.7%); 14 (n=5, 13.9%); 5 (n=4, 11.1%); 6B (n=4, 11.1%); 1, 18C, and 19A (n=3 each, 8.3%); 9V (n=2, 5.6%); and 3, 4, 10C, 18A, 18F, and 19F (n=1 each, 2.8%). Serotypes 6A, 14, 6B, 1, 18C, 19A, 9V, 4, 10C, and 18A showed antibiotic resistance. Clinical pneumonia incidence was 2109/100,000, with incidence being highest among children aged 28 days to <6 months (5033/ 100,000). Chest radiograph-confirmed pneumonia incidence was 1114/100,000, with incidence being highest among children aged 28 days to <6 months (2413/100,000). Conclusion: Invasive pneumococcal disease and pneumonia were found to be common causes of morbidity in young children living in South Bangalore, India.

The association between indices of obesity and common clinical measures in adults with and without type 2 diabetes.

Background: The aim of this study was to determine the differences amongst the anthropometric measurements, lipid profile, blood pressure and body shape in diabetics as well as non-diabetics. Methods: This was a cross-sectional study comprised of 309 subjects with 91 males and 218 females. Of this, there were 217 diabetics and 92 non-diabetics. The sample was taken from three hospitals in Trinidad. Lipid profile and blood pressure were taken from each facility’s physician’s notes while anthropometric measurements were taken from the patients themselves. Results: The diabetic group had elevated body mass index and waist to hip ratios were significant (P <0.05) when compared to non-diabetics. There was no significant association of lipid profile, blood pressure, waist circumference and waist to height ratios between diabetics and non-diabetics. As age increased, the prevalence of type 2 diabetes mellitus was more common. Out of 217 diabetics, 173 were of East Indian descent. With regards to gender, more males were found to be diabetics resulting from having an android body shape as compared to females (gynoid body shape). Conclusion: It was found that of all the anthropometric measurements used, waist to hip ratio was found to be the most effective indicator of type 2 diabetes mellitus in Trinidadians, while body mass index was found to be the least effective indicator.

Nstemi “But” Stemi-De Winters Sign.

Anterior ST elevation myocardial infarction can present with a specific electrocardiographic (ECG) pattern without ST segment elevations, known as De Winter sign. Recognizing this ECG pattern is important since it is considered an equivalent to ST elevation myocardial infarction (STEMI), hence may require thrombolysis when primary PCI facilities are not available or delayed. We report a28 year old male who presented to us with de winters ecg pattern. Subsequent coronary angiogram showed Proxmial left anterior descending (LAD) artery occlusion.

Thoracic Aorta Aneurysm-Endovascular Aortic Repair.

Endovascular aortic repair (EVAR) is the treatment of choice for patients with descending thoracic aortic aneurysm who are unfit for open surgery. We report a 50-year-old Asian woman who presented with a saccular symptomatic thoracic aortic aneurysm and underwent EVAR with a covered stent with prompt relief of symptoms and no residual complications at 1 year of follow up.

Relationship of HS-CRP level in diabetic persons free from micro and macrovascular disease.

C-reactive protein is considered as one of the most sensitive markers of systemic inflammation. Studies have found that increase in the levels of Creactive protein is associated with the vascular complications. Hence we aimed in finding the correlation of hs-crp with other risk factors like BMI, FBS and HbA1c in diabetic subjects who have still not developed any micro and macrovascular complications. 229 cases of type 2 diabetics and 205 healthy individuals were selected as per the criteria. BMI was calculated, FBS was estimated by glucose-oxidase peroxidase method. Hs-crp was estimated by immunoturbidometric technique. The group was divided into low risk and high risk group as per their hs-crp level. Correlation was seen with other factors like BMI, FBS and HbA1c. The level of Hs-crp was high in diabetic subjects when compared to normal individuals. Further when the diabetic subjects were divided into high risk and low risk groups, the difference between the groups were statistically significant. Hs-crp failed to show any correlation with BMI, FBS and HbA1c. Diabetes is considered as an inflammatory disease hence we observed an increase in the hs-crp level in diabetes than in the normal. Since the vascular complication was totally absent hs-crp failed to show any correlation with BMI, FBS and HbA1c.

Furosemide Infusion in Children with Dengue Fever and Hypoxemia.

Objectives: To study the role of furosemide infusion in the management of Acute respiratory distress syndrome (ARDS) associated with dengue fever. Methods: Children between the ages of 1 month to 18 years, who fulfilled the WHO clinical criteria for dengue infection and American European Consensus Criteria criteria for ARDS with Dengue IgM positivity, were evaluated. Patients were studied as group D (receiving diuretic therapy alone) and group B (both ventilation and diuretics), and compared to a historical control group V (ventilation alone). Furosemide infusion was administered at 0.05-0.1 mg/kg/hour for 48 hours, maintaining a urine output of 2-4 mL/kg/hour. Results: There was a significant difference in survival in the three groups. Significant difference was noted between pre- and postintervention arterial blood gases with respect to PCO2 (P=0.02), pO2 (P=0.003), PaO2/FaO2 ratio (P<0.001) and alveolar-arteriolar oxygen gradient (P=0.002). Conclusion: Diuretic infusion improves outcome in dengue with ARDS.

Evaluation of pulmonary dysfunction among persons with type 2 diabetes in Trinidad.

To determine the prevalence of pulmonary dysfunction among persons with type 2 diabetes mellitus (T2DM) using spirometry, and to determine the relationship between pulmonary dysfunction and duration of diabetes, glycaemic control (HbA1c), BMI, age, gender, ethnicity and associated systemic dysfunctions. Data was obtained from 93 persons with type 2 diabetes from various clinics in Trinidad via face to face spirometric testing and also by gathering data from their personal medical files. Variables measured include FEV1, FVC, FEV1/FVC, and FEF 25-75. The durations of diabetes of the 93 patients ranged from 0.4 years to 35 years. The majority of patients indicated diabetes duration within the ranges of 0-5 years and 5-10 years, and 3 had duration of 25 years or more. There were no significant differences between the means of the spirometry ratios (FEV1/FVC, FEV1, FVC, and FEF 25-75) for the five year interval ranges of diabetes duration. Approximately 60% (56) of the patients had normal pulmonary function and 40% (37) of the patients had pulmonary dysfunction. The majority of patients were found to have restrictive pulmonary dysfunction, and only 2% presented with obstruction. Within the BMI classes, 5% of the patients were underweight, 36% were normal, 33% were overweight and 26% were obese. There was a significant difference between the means of underweight and overweight patients for FEV1/FVC ratios at alpha level (p<0.05). The mean difference between underweight and overweight FEV1/FVC ratios was 11.20 with a standard error of 3.4634. At alpha level (p<0.05) there was no significant correlation between the spirometry variables and the duration of Diabetes or the BMI of the sample. Under one-half of persons with Type 2 Diabetes Mellitus display a restrictive spirometric profile and there are significant differences in FEV1/FVC ratios among underweight and overweight persons.

Niemann-Pick Disease Type A Presenting as Unilateral Tremors.

Niemann-Pick group of diseases are rare lysosomal storage disorders. The clinical phenotype is variable. We report a child who first time presented with tremors of tongue and tremors of one side of the body. On examination child had hemiparesis and hepatosplenomegaly. Bone marrow examination shows storage cells suggestive of Niemann-Pick cells and enzyme assay confirmed the diagnosis.