Report on the first palliative care conference in Trinidad and Tobago

BACKGROUND: When the burdens of curative treatment outweigh the benefits, the goal of a patient's care may change from curing to comfort also called palliative care. It improves the quality of life of patients and families who face life-threatening illness, by providing pain and symptom relief, spiritual and psychosocial support from diagnosis to the end of life and bereavement. The essential components of palliative care are effective control of symptoms and effective communication with patients, their families, and others involved in their care. Rehabilitaion, with the aim of maximizing independence, is also essential. As the disease progresses, continuity of care becomes increasingly important, coordination between services is required, and information must be transferred promptly and effeciently between professionals in the community, in hospitals, and in hospices. Objectives: This report seeks to highlight the beginnings of palliative care worldwide and in Trnidad and Tobago, how these services developed and what the citizens of Trinidad and Tobago have available at their disposal and lastly, a bit about how this field is projected to develop in the future. METHODOLOGY: For this report interviews were conducted with Dr. Richard Clerk and other members of the board of the Palliative Care Society of Trinidad and Tobago. Information was also collected at the palliative care society inaugural palliative care conference. This conference ran from the 22nd to the 23rd October, 2011. Major findings: Palliative care services in Trinidad and Tobago include 3 major hospices in Port of Spain and St. James, and other is being established at the Petrotrin Medical Centre located at Point a Pieere..... CONCLUSION: The population of Trinidad and Tobago is aging, as such there is a greater demand for palliative care, however services in Trinidad and Tobago are far from adequate for our popualtion however, great strides are being taken to resolve this deficit.....

Steroid-induced iatrogenic disease after treating for pseudothrombocytopenia.

Pseudothrombocytopenia, a spontaneous in vitro occurrence after the addition of anticoagulant to blood, causes clumping of platelets resulting in a spurious observation of low platelet counts (<10,000/µL) without any associated hemorrhagic manifestations. We describe a 46-year-old male patient who was diagnosed with immune thrombocytopenic purpura (ITP) based on a reported platelet count of 22,000/µL. He was prescribed high-dose glucocorticoid therapy, up to 60 mg of prednisolone daily for over a year. After repeated hospital admissions, he came under our care as an emergency admission for nonketotic hyperosmolar hyperglycemia. He was diabetic, osteopenic, and had been treated for tuberculosis, all likely consequences of prolonged glucocorticoid therapy. In the presence of persistent platelet counts below 10,000/µL, and without associated clinical hematological manifestations of ITP, a smear of citrated blood was examined and a platelet count of 215,000/µL was observed. This case highlights the possible consequences of misdiagnosis of pseudothrombocytopenia. Failure to recognize this phenomenon may lead to debilitating iatrogenic disease.

White blood cell counts in healthy Jamaican adults.

The investigation of presumed neutropenia places a burden on the health services, especially those of developing countries, including Jamaica. This may be because the normal ranges used in the laboratory are based on the values generated from the Caucasian population. Previous studies looking at African and Afro-Caribbean groups have found lower counts for these populations compared with Caucasians. To address this issue, 195 healthy adults donating blood at the National Public Health Laboratory and the University Hospital of the West Indies blood banks in Kingston, Jamaica, were screened for complete blood count (CBC) differentials between June 2001 and June 2006. The geometric means for the neutrophil counts were found to be 2.4 x 10(9)/L for men and 2.7 x 10(9)/L for women, with 95% confidence intervals of 2.2-2.8 x 10(9)/L and 2.5-3.1 x 10(9)/L respectively. Values for the Jamaican population were similar to those of other Afro-Caribbean groups. Based on this distribution, 14% of healthy Jamaicans would fall below the normal ranges derived from Caucasians and therefore presumed to have neutropenia. We recommend that the lower reference ranges obtained for Afro-Caribbean adults be adopted for that population.

Lumbar spine synovial cysts. A case report and review of the literature.

This paper reports the case of a sixty-year-old man who presented with backache and radiculopathy secondary to the development of a lumbar spinal synovial cyst following an episode of trauma. There was resection of the cyst with partial facetectomy. Current literature reports are outlined.

Lumbar spine synovial cysts. A case report and review of the literature

This paper reports the case of a sixty-year-old man who presented with backache and radiculopathy secondary to the development of a lumbar spinal synovial cyst following an episode of trauma. There was resection of the cyst with partial facetectomy. Current literature reports are outlined.