Health literacy in patients requiring joint replacement

Objectives: To assess the general and musculoskeletal health literacy in a group of patients requiring joint replacement at the public hospitals. To determine factors associated with both general and musculoskeletal health literacy. Design and Methodology: In this cross-sectional study, a convenience sample of 82 patients completed a demographic survey as well as the Newest Vital Sign (NVS), a general health literacy tool, and the Literacy in Musculoskeletal Problems (LiMP) which assesses musculoskeletal health literacy. Statistical analysis was performed using Stata version 15, chi-squared tests were used to determine the relationships between general and musculoskeletal health literacy and demographic variables. Results: There was 61 females and 21 male patients (74% and 26% respectively) with a mean age of 63.5 years (SD +/- 8.2) . The mean score for the NVS was 2.3 (SD +/-0.9) {> 3 indicates adequate General Health Literacy}and LiMP 3.7 (SD+/- 1.7) {>5 indicates adequate Musculoskeletal Health Literacy}. Male patients, secondary school education, being employed and previous healthcare experience were all statistically associated with higher NVS and LiMP scores. Conclusion: Inadequate general and musculoskeletal health literacy (90% and 80% respectively) was found in the majority of patients. The inability to make good decisions about health care due to insufficient health literacy is associated with poor outcomes and increased utilisation of resources. Greater emphasis should be placed on educational campaigns to improve health literacy.

100% survival: a cardiac surgery centre experience inTrinidad and Tobago

OBJECTIVE: To report the 2012 results of a cardiac surgerycentre in Trinidad and Tobago. METHODS: Data was reviewed on 245 consecutive patients who underwent cardiac surgery in 2012 at Eric Williams MedicalScience Complex (E.W.M.S.C) Mount Hope, Trinidad. RESULTS: Mean patient age was 58.5 ±9.5 years; 147 patients(60%) were male and the mean calculated EUROSCORE IIwas 1.7. Coronary artery bypass surgery was the most commonprocedure, performed on 190 patients, 98% were done on the beating heart and 3.15% (6 patients) were redo-CABG. Thirteen patients (5.3%) underwent CABG plus other procedures, 9patients (3.7%) had aortic valve replacement, 21 patients (8.6%)had mitral valve repair/replacement, 2 patients (0.8%) had double valve replacement and 10 patients (4.1%) a variety ofother procedures including atrial or ventricular septal defect closure, fibro-elastoma removal, type A Aortic dissection.The operative mortality in the study period was 0%, and at 6months follow-up all patients were alive. CONCLUSION: Excellent results similar to the best institutions in the world can be obtained even in a medium volume centre in a developing country.

The cardiac catheterization lab: implementing best practice in Trinidad and Tobago

On 13 May 2012, the Quarterly Cardiology Conference program was organized by the Trinidad and Tobago Medical Association and The University of the West Indies, St. Augustine. The program provided a forum for discussion of issues related to the implementation of best practices in the management of patients requiring cardiac catheterization laboratory (Cathe Lab ) procedures. The participants who were stakeholders in the management of patients referred for catheter-based procedures reviewed best practice guidelines for patients, identified local barriers to the implementation of these best practices and made recommendations for the implementation of these best practice guidelines

The epidemiology of end stage renal disease at a centre in Trinidad / Epidemiología de la fase terminal de la enfermedad renal en un centro de Trinidad

OBJECTIVE: The aim of this study is to estimate the trends in prevalence of end stage renal disease (ESRD) during the period 1999-2007 at one site in Trinidad, the Eric Williams Medical Sciences Complex (EWMSC), and to describe the epidemiological features, age, gender, ethnicity and co-morbidities associated with ESRD. DESIGN AND METHODS: A retrospective cohort study design was used. There was a count of patients on haemodialysis at the EWMSC centre from 1999 - 2007 in order to demonstrate trends in prevalence but more detailed data were collected and analysed for patients with ESRD attending the nephrology clinic between January 2002 and December 2007. The data that were collected from the patients' records included: demographic data (age, gender and ethnicity), medical history (diabetes mellitus, hypertension, end stage renal disease and autoimmune disorders), history of dialysis (type of vascular access, frequency of dialysis), mortality and its cause. RESULTS: Records of 81 patients were retrieved. Their age range was 10-79 years. The survey showed that patients most affected in the study population were: males, aged 50-59 years, who were hypertensive and/or diabetic and of African descent. CONCLUSIONS: In conclusion, we provide epidemiological evidence of ESRD and the associated contributing factors at one hospital in Trinidad.

OBJETIVO: El objetivo de este estudio es estimar las tendencias de la prevalencia de la enfermedad renal en fase terminal (ERFT) durante el periodo 1999-2007 en el Complejo de Ciencias Médicas Eric Williams, en Trinidad, y describir los rasgos epidemiológicos - edad, género, etnicidad - y co-morbilidades asociadas con la ERFT. DISEÑO Y MÉTODOS: Se usó un diseño de estudio de cohorte retrospectivo. Se llevó a cabo un análisis de todos los pacientes que asistieron a las clínicas de nefrología de EWMSC, de enero de 2002 a diciembre de 2007. Los datos recogidos de las historias clínicas de los pacientes al final del período de estudio incluyeron: datos demográficos (edad, género y etnicidad), historia médica (diabetes mellitus, hipertensión, enfermedad renal en fase terminal, trastornos autoinmunes), historia de diálisis (tipo de acceso vascular, frecuencia de diálisis), mortalidad y causa. RESULTADOS: Se obtuvieron las historias clínicas de 81 pacientes, cuya edad fluctuaba de 10 a 79 años. La encuesta mostró que los pacientes más afectados en la población del estudio fueron varones, de 50-59 años de edad, que eran hipertensos y/o diabéticos, de ascendencia africana. CONCLUSIONES: En conclusión, se ofrece evidencia epidemiológica de la ERFT en un hospital en Trinidad y se señalan los factores asociados que contribuyen a la enfermedad.

The epidemiology of end stage renal disease at a centre in Trinidad.

OBJECTIVE: The aim of this study is to estimate the trends in prevalence of end stage renal disease (ESRD) during the period 1999-2007 at one site in Trinidad, the Eric Williams Medical Sciences Complex (EWMSC), and to describe the epidemiological features, age, gender, ethnicity and comorbidities associated with ESRD. DESIGN AND METHODS: A retrospective cohort study design was used. There was a count of patients on haemodialysis at the EWMSC centre from 1999-2007 in order to demonstrate trends in prevalence but more detailed data were collected and analysed for patients with ESRD attending the nephrology clinic between January 2002 and December 2007. The data that were collected from the patients' records included: demographic data (age, gender and ethnicity), medical history (diabetes mellitus, hypertension, end stage renal disease and autoimmune disorders), history of dialysis (type of vascular access, frequency of dialysis), mortality and its cause. RESULTS: Records of 81 patients were retrieved. Their age range was 10-79 years. The survey showed that patients most affected in the study population were: males, aged 50-59 years, who were hypertensive and/or diabetic and of African descent. CONCLUSIONS: In conclusion, we provide epidemiological evidence of ESRD and the associated contributing factors at one hospital in Trinidad.

S100A9 is not essential for disease expression in an acute (K/BxN) or chronic (CIA) model of inflammatory arthritis.

OBJECTIVE: S100A8 (calgranulin A, MRP8) and S100A9 (calgranulin B, MRP14) are calcium-binding proteins highly expressed by activated myeloid cells and thought to be involved in the pathogenesis of inflammatory diseases. Circulating levels of S100A8/S100A9 are elevated in both human and experimental models of autoimmune disease, including rheumatoid arthritis (RA). METHODS: Mice deficient in S100A9 (S100A9 - /-) and wild-type controls were immunized using standard techniques for the K/BxN serum transfer or the collagen-induced arthritis (CIA) model. RESULTS: S100A9 - /- animals, with defective expression of both S100A8 and S100A9 proteins, had similar arthritis and histopathology to that of wild-type controls in both mouse models. CONCLUSION: S100A8 and S100A9 are not essential for disease expression in either the K/BxN serum transfer or the CIA model of inflammatory arthritis.

The C5b-9 membrane attack complex of complement activation localizes to villous trophoblast injury in vivo and modulates human trophoblast function in vitro.

The complement system plays an important role in normal human pregnancy. Uncontrolled activation of this system has been associated with many disease states. We tested the hypothesis that the C5b-9 membrane attack complex (MAC) localizes to sites of villous injury and modulates trophoblast function. Placental sections from pregnancies with no complications, intrauterine growth restriction, or preeclampsia were immunostained and the surface density for MAC and fibrin was determined by morphometric analysis. Primary cytotrophoblasts from term placentas were cultured in a FiO(2) of <1%, 8% and 20% with 10% human serum containing active MAC or heat-inactivated control serum. Immunofluorescent MAC binding to trophoblast was quantified, and the neoepitopes formed in cytokeratin 18 filaments and poly-ADP-ribose polymerase during apoptosis were used to measure cell death. Trophoblast differentiation was assessed by HCG secretion, formation of syncytia, and expression of syncytin. MAC localized to fibrin deposits in normal placentas, and especially in placentas from IUGR and preeclampsia. MAC binding to cytotrophoblasts was inversely proportional to FiO(2) and enhanced apoptosis. MAC increased markers of differentiation in cultures at 72h (medium HCG, syncytia and syncytin expression). Our findings demonstrate that MAC associates with fibrin deposits at sites of villous injury in vivo. Hypoxia also enhances MAC deposition in cultured trophoblasts and MAC alters trophoblast function in a phenotype specific manner.