Demographic and socioeconomic barriers and treatment seeking behaviors of patients with infectious keratitis requiring therapeutic penetrating keratoplasty

Purpose: To understand demographic and socioeconomic barriers and treatment-seeking behaviors of patients with infectious keratitis requiring therapeutic penetrating keratoplasty (TPK) in a developing country. Methods: This prospective non-comparative questionnaire- based study included all patients presenting to Aravind Eye Hospital, Madurai with infectious keratitis that eventuated to TPK between November 2015 and October 2016. A structured questionnaire was administered on post-operative day 3 to collect data on the demographic details, predisposing factors, prior treatment received, and treatment expenditures. Results: In total, 227 patients underwent TPK between November 2015 and October 2016 for infectious keratitis. The majority of patients were males (n = 132, 58.1%), illiterate (n = 129, 56.8%), and had a family monthly income of less than INR 6000 (n = 142, 62.5%). Most of the patients (n = 163, 71.8%) had prior treatment with an ophthalmologist before presenting to our hospital. The mean distance travelled to reach our centre was 269.2 ± 298.5 km. The mean duration of disease before the presentation was 20.3 ± 21.1 days. Corneal smear was positive for fungus in 163 (88.1%) and Aspergillus was the most commonly isolated fungi in 55 (41.3%) cultures. The mean total cost of treatment was INR 8752.87 ± 7615.39 per patient. There was a positive correlation between the duration of the disease (rho 0.19, P = 0.0034) and the costs of treatment (rho 0.2, P = 0.0024) with the distance travelled by the patient. Conclusion: Patients who travelled a farther distance had a delayed onset of presentation and spent significantly more than their respective counterparts.

Drug utilization patterns in pregnant women: a case study at the Mount Hope Women's Hospital in Trinidad, West Indies / Patrones de utilización de medicamentos en las mujeres embarazadas: un caso de estudio en el Hospital de Mujeres Mount Hope en Trinidad, West Indies

OBJECTIVE: To explore drug (prescription, over-the-counter and herbal) utilization in pregnant women attending a public sector tertiary healthcare institution. METHODS: This was a cross-sectional case study in women attending antenatal clinics at the Mount Hope Women's Hospital. Women (506) who consecutively presented for routine care at the antenatal clinic were interviewed on the medication they took. Descriptive statistics and logistic regression for predictors of drug use were done using SPSS 16. RESULTS: There were 200 (39.5%) primigravidae, 306 (60.5%) multigravidae and 299 (59%) women were in the third trimester of pregnancy. Most women (69.8%) were between 20-35 years of age. Women took an average of 1.32, 1.22 and 0.94 prescribed drugs in each trimester, respectively. Multivitamins (59.8%) and iron/folic acid (54.2%) were the most frequently prescribed drugs. Regardless of trimester, only 20% of women took supplemental calcium. Very few women (2.4%) took herbal medications. Paracetamol was the most common over-the-counter (OTC) medication in all trimesters. Women with secondary level education were most likely to use OTC iron/folic acid (p = 0.02), paracetamol and histamine2 receptor antagonists [H2RAs] (p = 0.001). More primigravidae took non-steroidal anti-inflammatory drugs (p = 0.02) and more women in the first trimester used antiemetics (p = 0.001). Age group (p = 0.048), marital status (p = 0.001) and the trimester of pregnancy (p = 0.001) were predictors of drug utilization. CONCLUSION: Overall, women in tertiary healthcare institutions took medication as prescribed particularly multivitamins and iron/folic acid. More women with higher education took OTC paracetamol, iron/folic acid and vitamin supplements. Herbal supplements were rarely used. Research on drug utilization in primary care facilities is recommended.

OBJETIVO: Explorar el uso de los medicamentos (con prescripción, sin receta médica, herbarios) en mujeres embarazadas que asisten a una institución terciaria de atención a la salud pública dentro del sector público. MÉTODOS: Se trató de un estudio transversal de mujeres que asisten a las clínicas prenatales en el Hospital de Mujeres Mount Hope. Las mujeres (506) que consecutivamente se presentaron para cuidados de rutina en la clínica prenatal, fueron entrevistadas acerca de la medicación que tomaban. Se hicieron estadísticas descriptivas y se hizo una regresión logística para los predictores del uso del medicamento usando SPSS 16. RESULTADOS: Había 200 (39.5%) primerizas, 306 (60.5%) multíparas, y 299 (59%) embarazadas en su tercer trimestre. La mayoría de las mujeres (69.8%) tenían entre 20-35 años de edad. Las mujeres tomaban un promedio de 1.32, 1.22 y 0.94 medicamentos prescritos en cada trimestre, respectivamente. Las multivitaminas (59.8%) y el hierro/ácido fólico (54.2%) fueron los medicamentos más frecuentemente prescritos. Con independencia del trimestre, sólo 20% de las mujeres tomaron suplemento de calcio. Muy pocas mujeres (2.4%) tomaban medicaciones herbarias. El paracetamol fue el medicamento sin receta más común en todos los trimestres. Las mujeres con nivel de educación secundaria presentaban una mayor probabilidad de usar hierro/ácido fólico (p = 0.02), el paracetamol y los antagonistas de los receptores de la histamina-2- [H2RAs] (p = 0.001). Un mayor número de primerizas tomaron medicamentos anti-inflamatorios no esteroideos (p = 0.02) y más mujeres en el primer trimestre usaron anti-eméticos (p = 0.001). El grupo etario (p = 0.048), el estado matrimonial (p = 0.001) y el trimestre de embarazo (p = 0.001) fueron predictores de la utilización de medicamentos. CONCLUSIÓN: En general, las mujeres en las instituciones terciarias de atención a la salud tomaron la medicación como fue prescrita, en particular las multivitaminas y el hierro/ácido fólico. Más mujeres con mayor escolaridad tomaron medicamentos sin recetas: paracetamol, hierro/ácido fólico y suplementos de vitamina. Raramente se usaron suplementos herbarios. Se recomienda la investigación del uso de medicamentos en centros de atención primaria.

Congenital toxoplasmosis in two health institutions in Trinidad / Toxoplasmosis congénita en dos centros de salud de Trinidad

Toxoplasmosis is the most widespread zoonosis and an important human disease particularly in children where it could cause visual and neurological impairment and mental retardation. This study was conducted to determine the prevalence of toxoplasmosis, especially congenital toxoplasmosis in patients at two health institutions in Trinidad A total of 504 cord blood samples of newborn babies were collected: 174 from a women's hospital and 330 from a general hospital. In order to elicit aternal and prenatal risk factors for toxoplasmosis, mothers of the newborns completed a questionnaire. Enzyme-immuno assay (EIA) was used to detect IgG and IgM to Toxoplasma gondii. Overall, of 504 serum samples tested, 220 (43.7%) were seropositive for IgG while the prevalence of congenital toxoplasmosis as reflected by IgM was 0.4%. The prevalence of IgG and IgM by health institutions was not significantly different (p > 0.05; chi-square). The prevalence of toxoplasmosis using IgG was highest in neonates of mothers who were of East Indian descent (54.1%), had four children (52.9%), kept cats in households (47.7%), practised outdoor gardening (50.8%), consumed raw meat (66.7%), had experienced miscarriage(s) (47.3%), stillbirths (66.7%), or who had eye problem(s) (52.9%) and mental retardation (50.0%). The study prevalence of congenital toxoplasmosis revealed a high seroprevalence oftoxoplasmosis in neonates but there was 0.4% serological evidence of congenital disease. It indicates a need for sensitization of the population and healthcare workers and for follow-up of infected children for clinical evidence of the disease. This would be necessary to fully appreciate the impact of toxoplasmosis in Trinidad and Tobago. The differences from comparison groups were however not statistically significant (p > 0.05; chi-square).

La toxoplasmosis es la zoonosis más extendida y una enfermedad humana importante, particularmente en niños, a quienes puede causar daño visual y neurológico, y retraso mental. Este estudio se llevó a cabo con el propósito de determinar la prevalencia de la toxoplasmosis, especialmente la toxoplasmosis congénita en pacientes de dos centros de salud en Trinidad. Se recogieron un total de 504 muestras de sangre de cordón umbilical de neonatos: 174 de mujeres en un hospital de mujeres y 330 en un hospital general. A fin de obtener información sobre los factores de riesgo maternos y prenatales en relación con la toxoplasmosis, las madres de los recién nacidos llenaron una encuesta. Un ensayo inmunoenzimático (EIE) fue usado para detectar anticuerpos IgG e IgM contra el Toxoplasma gondii. En general, de 504 muestras de suero examinadas, 220 (43.7%) resultaron seropositivas al IgG, mientras que la prevalencia de la toxoplasmosis congénita reflejada por el IgM fue 0.4%. La prevalencia de IgG e IgM por parte de las instituciones de salud no fue significativamente diferente (p > 0.05; chi-cuadrado). La prevalencia de la toxoplasmosis usando IgG fue más alta en los neonatos cuyas madres eran ascendencia indoriental (54.1%), tenían cuatro niños (52.9%), mantenían gatos en sus casas (47.7%), practicaban jardinería al aire libre (50.8%), consumían carne cruda (66.7%), habían tenido aborto(s) (47.3%), partos de feto muerto (66.7%), o tenían problema(s) de los ojos (52.9%) y retardo mental (50.0%). Este estudio de la toxoplasmosis congénita, reveló una alta seroprevalencia de toxoplasmosis en neonatos, pero hubo 0.4% de evidencia serológica de enfermedad congénita. Esto apunta a la necesidad de sensibilizar a la población y a los trabajadores del cuidado de la salud, e igualmente indica la necesidad de realizar seguimientos a los niños infectados, en busca de evidencia clínica de la enfermedad. Esto es necesario si se quiera valorar totalmente el impacto de la...

The oral contraceptive pill effectively permits cycle batching for an intermittent in vitro fertilization programme in Trinidad and Tobago / Las Píldoras Anticonceptivas Orales Permiten la Agrupación Eficaz de los Ciclos para un Programa Intermitente de FIV en Trinidad y Tobago

Assisted reproductive technology (ART) in small island states like Trinidad and Tobago is usually provided in batches so as to minimize the cost of providing the service. As a result, patients 'cycles have to be synchronized in order to coincide with the arrival of a visiting embryologist. This is a retrospective study which evaluates the experience of pre-treatment with an oral contraceptive pill (OCP) as a means of batching cycles for an intermittent ART programme. Seventy-four in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) cycles in which OCP usage was employed (Group A), were compared with 121 cycles which did not require pharmaceutical manipulation (Group B). In both groups more than 50 of women were older than 36-years. Two cycles were cancelled in Group A and seven in Group B, because of poor ovarian response. Although the pregnancy rate per treatment cycle was higher in Group A than in Group B (26.3 vs 17.3), this difference was not significant. More spontaneous miscarriages occurred in the non-OCP women and ovarian cyst formation was more common in these women. The authors experience indicates that the OCP is a simple, cheap and efficient means of batching patients for an intermittent ART programme and can be utilized in other small ART centres

La tecnología de reproducción asistida (TRA) en los pequeños estados insulares como Trinidad y Tobago, usualmente se ofrece por tandas a fin de minimizar los costos del servicio brindado. En consecuencia, los ciclos de las pacientes tienen que ser sincronizados de modo que coincidan con la visita del embriólogo. Éste es un estudio retrospectivo que evalúa la experiencia del pretratamiento con píldoras anticonceptivas orales (PAO) como medio de agrupar los ciclos con el propósito de organizar un programa intermitente de TRA. Setenta y cuatro ciclos de fertilización in vitro (FIV) e inyección intracitoplasmática de esperma (ICSI) en los que se recurrió al uso de PAO (Grupo A), fueron comparados con 121 ciclos que no requirieron manipulación farmacéutica (Grupo B). En ambos grupos, > 50% de las mujeres tenían más de 36 años de edad. Dos ciclos fueron cancelados en el grupo A y siete en el grupo B, debido a una respuesta ovárica pobre. Aunque la tasa de embarazo por ciclo de tratamiento fue más alta en el grupo A que en el grupo B (26.3% vs. 17.3%), esta diferencia no fue significativa. El número de abortos espontáneos fue mayor y la formación de quistes ováricos más común, en las mujeres que tomaron PAO. La experiencia de los autores indica que la PAO es un medio simple, económico y eficaz de agrupar a los pacientes en un programa intermitente de TRA, y puede utilizarse en otros centros pequeños de TRA.

Initial experience with in-vitro fertilization technology in the English-speaking Caribbean

This audit documents the first experience with in-vitro Fertilization technology in the English-speaking Caribbean. From 1996 to 2000, 121 cycles have been performed in 99 couples utilizing these techniques. After ovarian stimulation, 1,103 oocytes were retrieved (average 9.1) and of these, 65 fertilized normally, with embryo transfer possible in 111 cycles. Twenty-one pregnancies were recorded (21.2 per patient and 18.9 per embryo transfer) and the live birth rate per patient was 12.1. The trend was for the success rate to be better in patients under age 36 years.

Missing intrauterine contraceptive device presenting with strings at the anus

The rare condition of strings of a missing intrauterine contraceptive device presenting at the anus is described. Partial removal was achieved via the rectum and this was followed by a normal uncomplicated pregnancy and delivery.

Another look at the effects of advanced maternal age

The reproductive performance of primigravidae aged 30 years and over was compared with that of a group of younger primigravidae. Other patients were at greater risk for antepartum complications such as pre-eclampsia and uterine fibroids. Induction of labour was undertaken more frequently, and the Caesarean Section rate was higher but there was no worsening of perinatal mortality.

Indications and risks of abdominal hysterectomy

A retrospective analysis of 602 consecutive abdominal histerectomies revealed that uterine fibroids servel as the principal indication for the procedure. Malignant disease accounted for only 4.5% cases. The main complciations encountered were at the abdominal wound and vaginal vault. The use of prophylactic antibiotics is supported, but routine cross-matching of blood for all patients is questioned

Sterization patterns in a maternity unit

An evaluation of the characteristics of 425 womwn on whom surgical sterilization were performed revealed that 40% were 35 years or older and 48% had 5 or more children. Thirty-five per cent were Roman Catholics, and there was an equal incidence among the two major ethnic groups of Trinidad. Parental desire was the chief indications for tubal ligation. Complications were few, regardless of the procedure. A plea is made for intensifying efforts in promoting postpartum sterilizations following vaginal delivery, particularly for mothers whose life circumstances would prohibit them from returning for interval sterilization

Re-evaluation of diagnostic uterine dilatation and curettage: a review of 203 patients

Two handred and three patients were reviewed to assess the efficacy of diagtnostic uterine dilatation and curettage. Thirteen (6.4%) had definitive pathological changes of the endometrium; of the 4 patients with endometrial carcinoma, 3 presented eith post-menopausal bleeding. Anaemia was present in 11/3% of those with menorrhagia. The complication rate was 3.4% and the mean hospital stay, 3 days. It is suggested that in pre-menopausal women with abnormal uterine bleeding, medical management and outpatient endometrial biopsy should be the preferred diagnostic approach. fora post-menopausal women, curettage under general anaethesia remains the diagnostic method of choice