Potential biomarkers for dementia in Trinidad and Tobago.

Biomarkers that could possibly discriminate between healthy controls and patients with dementias of the Alzheimer's type (AD) and vascular dementia (VaD) were investigated. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition TR (DSM IV TR) was used to diagnose for dementia in Trinidad. Healthy seniors greater than 60 years old were controls. All participants were administered the Mini-Mental State Examination (MMSE) and had blood analyzed for levels of C-reactive protein (CRP), total homocysteine (tHcy) and microglial antibodies (MgAb). Plasma tHcy was determined on the Abbot AxSym, serum CRP concentrations were measured using the Tina-Quant sCRP (Latex) high sensitive immunoturbidimetric assay and serum MgAb were examined on frozen rat brain sections. The study was carried out on 29 patients that fulfilled the inclusion criteria and 46 controls. Of the patients 65.5% had AD and 34.5% had VaD. Significant differences were found between the mean MMSE scores of the different types of dementias and controls. MgAb presence as well as tHcy were able to distinguish between controls and dementia of the AD and VaD type, respectively. The MMSE is a good discriminative tool for dementias. Serum MgAbs are a possible biomarker for Alzheimer disease pathology and tHcy is elevated in patients with vascular dementia.

Factors affecting future choice of specialty among first-year medical students of the University of the West Indies, Trinidad.

BACKGROUND: This study was conducted to determine factors that influence career choice among 1st-year medical students. DESIGN AND METHODS: A cross-sectional survey of 170 1st-year medical students from the University of the West Indies, St Augustine Campus was undertaken with a questionnaire designed to assess their perceptions of careers in various specialties. Likert scales were used to quantify the reasons for their preferences. RESULTS: The response rate was 136/170 (80%). The age of respondents ranged from 16 to 36 years, mean 20.45, SD 2.88. Of the generic factors students considered important in their choice of a specialty, students ranked the ability to help patients the highest (rating of 1.44), along with the diagnosis and treatment of disease second (rating of 1.49); 38 (27.9%) cited medicine, 26 (19.1%) surgery, 13 (9.6%) paediatrics, 10 (7.4%) family practice and 4 (2.9%) psychiatry as their chosen career. Students begin their medical training with the view that a career in psychiatry is less attractive than other specialties surveyed. The average attractiveness was estimated as surgery 1.64, medicine, 1.81, paediatrics 1.95 and psychiatry 2.57. The differences between the averages were highly significant (F = 57.6, P < 0.001). CONCLUSION: The findings suggest that although 1st-year medical students rank the diagnosis and treatment of disease and the ability to help patients as the greatest influence in choosing a specialty, internal medicine was the most popular chosen career, while the surgical specialties were identified as the most attractive. Medical students have serious reservations about psychiatry as a career choice.

Schizophrenia in Trinidad

INTRODUCTION: Within the Caribbean, the majority of studies conducted have reported that significantly more males present with schizophrenia than females. In Trinidad and Tobago, in a cohort of first admissions to an outpatient psychiatric clinic, schizophrenia was reportedly to be twice as common in males when compared to females (16.2 per cent vs. 8.2 per cent, p<0.01) (Hilwig and Maharajh 1992). A similar trend of male preponderance in schizophrenia in Trinidad (75 per cent) was reported (Bhugra et al 1996). In another Trinidadian study, Hutchinson et al. (2003) examined all first admissions to a psychiatric unit at a General Hospital and reported that psychotic illnesses (schizophrenia spectrum and affective psychoses) were significantly more common in men (p<0.01). These studies however, stated total gender rates for all age categories

Factors affecting future choice of specialty among first-year medical students of the University of the West Indies, Trinidad

BACKGROUND: This study was conducted to determine factors that influence career choice among 1st-year medical students. DESIGN AND METHODS: A cross-sectional survey of 170 1st-year medical students from the University of the West Indies, St Augustine Campus was undertaken with a questionnaire designed to assess their perceptions of careers in various specialties. Likert scales were used to quantify the reasons for their preferences. RESULTS: The response rate was 136/170 (80%). The age of respondents ranged from 16 to 36 years, mean 20.45, SD 2.88. Of the generic factors students considered important in their choice of a specialty, students ranked the ability to help patients the highest (rating of 1.44), along with the diagnosis and treatment of disease second (rating of 1.49); 38 (27.9%) cited medicine, 26 (19.1%) surgery, 13 (9.6%) paediatrics, 10 (7.4%) family practice and 4 (2.9%) psychiatry as their chosen career. Students begin their medical training with the view that a career in psychiatry is less attractive than other specialties surveyed. The average attractiveness was estimated as surgery 1.64, medicine, 1.81, paediatrics 1.95 and psychiatry 2.57. The differences between the averages were highly significant (F = 57.6, P < 0.001). CONCLUSION: The findings suggest that although 1st-year medical students rank the diagnosis and treatment of disease and the ability to help patients as the greatest influence in choosing a specialty, internal medicine was the most popular chosen career, while the surgical specialties were identified as the most attractive. Medical students have serious reservations about psychiatry as a career choice.

Delusional parasitosis [abstract]

Delusional parasitosis is a rare psychiatric syndrome in which the patient believes that he/she is infested with parasites despite clear evidence to the contrary. It was first described in the literature about 100 years ago when it was referred to as psychogenic parasitosis. It can occur in the form of a delusional disorder of the somatic type (DSM IV) but it has also been reported in schizophrenia, affective or organic psychosis or induced psychosis. Patients with delusional parasitosis generally think that mites, lice or other insects have invaded their skin and most frequently seek treatment from dermatologists or family practitioners. It is a chronic disorder that may occur at any age but is more common in the elderly, particularly in females. The patient may try to pick the parasites out of the skin causing cutaneous lesions. Treatment is based on antipsychotic agents, psychotherapy and cooperation between dermatologist and psychiatrist. A case of delusional disorder of the somatic type (DSM IV) in a 55-year-old male is described. The patient sought medical attention because he strongly believed that his skin was infested with mites for three years. He tried to pick mites out of the skin of his face, neck, abdomen and back and this caused severe keloid formation. He was first seen by a dermatologist whose clinical and laboratory investigations for parasitic infestations were negative. After investigation, the patient was referred to the psychiatrist. Haloperidol was prescribed and there was good response to antipsychotic treatment. The delusional symptoms improved over the first three months and then a full recovery was observed. The patient maintained the recovery at one-year follow-up. (AU)

Quantification of EEG waves in healthy persons and patients with brain disorders [abstract]

The biological processes that give rise to many disorders of the brain such as schizophrenia, depression and epilepsy are yet to be clearly explained. The electroencephalograms (EEG) from patients with these disorders have been reported to exhibit "chaotic" properties. Coarse-grained correlation dimension (Dcg) has been found to be an effective tool in analyzing waveforms with chaotic properties. We therefore tested the hypothesis that the Dcg of the EEG of patients with the above disorders will be different from those of healthy volunteers. Twenty-five minutes of EEG recordings were obtained from different regions of the brain of 20 healthy volunteers, seven patients with schizophrenia, one with depression, and one with partial seizure. Each person's EEG was edited to obtain 51 seconds of artifact-free recording. A software was developed in-house and used to obtain estimates of the Dcg. A confidence interval for each of the 21 EEG electrode points was established for the healthy volunteers (control group). Compared to the control group, the Dcg measurements of some of the schizophrenics, of the depressed patients, and that of the epileptics showed significant differences (p< 0.005). The results of this study indicate that the Dcg of the EEG for some brain disorders may be of use in the diagnosis of these conditions. Given the preliminary nature of this study, further work with larger sample sizes will be necessary in order to determine the reliability and sensitivity of this method. (AU)