High Self-Reported Prevalence of Kidney Stones in Trinidad and Tobago: Results of a Cross-Sectional Online Survey.

Introduction No data exist on the prevalence of kidney stone disease in Trinidad and Tobago. Local clinicians have noted that the disease is very common, and this study represents the first attempt to investigate the prevalence of urolithiasis in these islands. Objectives The objective is to estimate the prevalence of kidney stone disease in Trinidad and Tobago and to investigate the epidemiology of the disease. Methods An online survey using the online tool Survey Monkey was distributed among members of the public via instant messaging and social media. The survey captured data relating to the stone status and demographics of respondents. Results 1225 patients completed the survey of whom 46.5% were males and 53.5% were females. Respondents were equally distributed throughout the country. 16.74% of those surveyed indicated that they were currently affected by stones confirmed by imaging. Kidney stones were more common among Trinidadians of East Indian ancestry (20.6% vs 10.6%). Positive correlations were established between kidney stones and the presence of hypertension, diabetes, and gout. Persons with kidney stones were more likely to have a family member with the disease - 45.6% vs 31.4% among those without kidney stones. Conclusion This study demonstrates a high self-reported prevalence of kidney stones in Trinidad and Tobago.

Pharmacovigilance in the Caribbean Countries: an Overview.

Purpose of overview: The constant surge in accessing essential medicines creates a greater need for continuous monitoring of usage. The inability to source active pharmaceutical ingredients during the COVID-19 pandemic resulted in drug shortages that increased online requests for medications. E-commerce and social sites have opened the floodgate for the marketing of falsified, substandard, and unregistered pharmaceuticals, making them easily accessible to consumers with the click of a button. A high prevalence of such products with compromised quality highlights further the need for enhanced post-marketing vigilance of safety and quality within the pharmaceutical industry. This review aims to assess the extent to which pharmacovigilance (PV) systems in selected Caribbean countries conform to the minimum World Health Organization (WHO) requirements, highlight the importance of PV in ensuring the safer use of medicines across the Caribbean region, and identify opportunities and challenges in building comprehensive PV systems. Recent Findings: The review finds that while major advancements in PV and adverse drug reaction (ADR) monitoring have occurred in Europe and other parts of the Americas, little has been done in the Caribbean region. Only a few countries in the region are active members of the WHO's global PV network, and ADR reporting is minimal. The reason for low reporting includes a lack of awareness, commitment, and participation of healthcare professionals, manufacturers, authorized distributors, and the general consumers. Summary: Nearly all established national PV systems do not fully conform to the minimum PV requirements by the WHO. Legislation, regulatory framework, political commitment, adequate funding, strategies, and incentives to encourage reporting of ADRs are needed to build sustainable PV systems in the Caribbean.

A cross-sectional survey of prospective healthcare professionals' knowledge, attitudes and perceptions of medical Cannabis.

Background: Compounds isolated from Cannabis possess many beneficial effects creating a renewed worldwide interest in its therapeutic potential. With increased legalization for medicinal use globally, healthcare professionals must be familiar with the drug's uses and potential adverse effects. Objective: To determine prospective healthcare providers' knowledge, attitude and perception to medical Cannabis. Method: A self-administered online questionnaire comprising 21 questions to assess the knowledge, attitude and perception of medical Cannabis was distributed via google forms among students at the Faculty of Medical Sciences, the University of the West Indies, St Augustine Campus. Chi-square analysis was used to detect significant associations between demographics and measured variables. A p-value <0.05 was considered significant. Results: Popular perceived therapeutic benefits of Cannabis were chronic pain (91.2%), anxiety (84.2%) and seizures (71.1%), and identification of the risks associated with the use of Cannabis was low. Users of Cannabis were able to identify indications and symptoms that can be treated with Cannabis but were less aware of the adverse effects of the drug than non-users (p < 0.001). More than three-quarters (87.3%) believed they could identify therapeutic uses and adverse effects but only 14.2% were ready to answer queries from patients. The main source of Cannabis information was the internet and information was lacking in the medical school curriculum. Conclusion: The majority of students could not identify the drug's indications and adverse effects. There is a need to improve training for all prospective medical personnel to cater for the change in legislation status.

Contraceptives Are Also Drugs.

We report a patient who stated that contraceptives are not drugs. She presented with distressing symptoms of UTI following sexual activity and denied using any medication. Her physician prescribed co-amoxiclav based on her urine culture and sensitivity report, and the patient returned three days later with complete relief of symptoms but complained of vaginal bleeding. The patient then disclosed that her gynaecologist administered a contraceptive injection one month prior for endometriosis. When asked why she did not disclose this information at her previous visit, she responded, "that's not a drug, it is a contraceptive." It is essential to inquire from every woman of childbearing potential if she is currently using contraceptives to enhance patient care and for public health considerations.

Pharmacists knowledge, perception and practice regarding medication disposal.

Background: Medications that are improperly disposed contribute to environmental contamination with proven negative impacts on biological ecosystems. The role of the pharmacist in providing medication disposal advice is paramount to reducing this effect. Objective: To investigate pharmacists' knowledge, perception and practices regarding medication disposal in Trinidad. Methods: A cross-sectional study was conducted electronically over 4 months amongst public and private sector pharmacists using a self-administered questionnaire. The questionnaire comprised 32 questions and four sections - demographics, knowledge, perception and practice regarding medication disposal. Ethical approval was obtained from the Ethics Committee, the University of the West Indies, the four Regional Health Authorities in Trinidad, and the Ministry of Health, Government of the Republic of Trinidad and Tobago. Data were analysed using IBM SPSS Statistics Version 24. Chi-squared tests sought to detect significant associations between demographics and responses. Results: Of 400 pharmacists, (response rate 52.0%) most were female (63.0%), had <5 years experience (47.1%), and worked in a community pharmacy (68.0%). Most (79.3%) believed that improperly disposed medications can negatively affect the environment but only 45.2% thought that improperly disposed antibiotics could lead to antimicrobial resistance. Most returned expired drugs to the pharmaceutical distributor (80.8%), or disposed of through the Drug Inspectorate (63.9%), but 32.3% still disposed of expired medicines in the workplace garbage, with community pharmacies being more likely to carry out this practice (p = 0.011). Most pharmacists (36.5%) do not counsel patients on medication disposal and 64.4% would not recommend flushing expired drugs down the toilet. Only 20.7% would recommend flushing narcotics, which is considered the best practice to prevent accidental poisoning. Conclusions: Continuing education for pharmacists is needed to increase awareness of the best practices of medication disposal, along with an awareness campaign on medication disposal.

Early COVID-19 response in two small island developing states: Maldives and Trinidad and Tobago.

Problem: Coronavirus disease 2019 (COVID-19) was declared a pandemic on 11 March 2020. Severe illness requires intensive care facilities, which are limited in smaller, resource-constrained settings. Context: Maldives and Trinidad and Tobago are small island developing states with comparable climates. Similar to island nations in the Western Pacific Region, they are prone to natural disasters and so engage in planning and preparedness activities on an ongoing basis. This paper describes the initial measures taken by both countries during the first wave of COVID-19, from March to May 2020. Action: In both countries, multisectoral high-level leadership allowed for timely and decisive actions. Early school closures, early border closures and early lockdowns were enforced. Mandatory mask wearing and physical distancing were instituted. Cases and contacts were isolated in facilities away from public sector hospitals, and isolation was implemented at the government's expense. Volunteers were trained to manage dedicated hotlines. Additionally, the governments held daily press briefings. Outcome: During the first wave, Maldives contained its epidemic to one geographical cluster; Trinidad and Tobago successfully avoided community spread, thus averting an overwhelmed health system. Discussion: Diligent contact tracing with quarantine implemented at the government's expense successfully minimized spread in both countries. Small countries need volunteers to help with activities such as contact tracing, and recruiting and training volunteers before a health emergency occurs is key. Lessons learned from the experience of Maldives and Trinidad and Tobago could serve as a model for other small island developing states, including those in the Western Pacific Region.

Patients' knowledge, attitudes and concerns regarding the disposal of expired/unused medication.

OBJECTIVES: Unused/expired medicines that are improperly disposed of can enter soil and water supply and have negative implications for public health. This study aimed to assess patients' knowledge and understanding of medication disposal practices and their willingness to participate in a medication takeback programme. METHODS: A self-administered questionnaire comprising of 26 questions based on demographics, knowledge, beliefs, practices and concerns was utilized in this study. The study was conducted over 12 weeks at outpatient pharmacy sites located in the four Regional Health Authorities in Trinidad. Statistical Package for the Social Sciences (SPSS) version 24 was used for statistical analysis. KEY FINDINGS: A total of 547 persons completed the questionnaire. Knowledge of the dangers of improper medication disposal was highest in those aged 18-25 years (P = 0.007) and having secondary/tertiary level education (P = 0.002). Disposal of unused/expired medication via household thrash (86.1%) was the most commonly encountered practice. Only 14.1% (n = 77) of respondents asked the pharmacist for advice on best disposal practice, although 47.3% (n = 259) thought that the pharmacist should be the main source of advice for information on medication disposal practices. There was a willingness to participate in a medicine takeback programme from 82% (n = 449) of the respondents, and the majority (67.5%) (n = 303) would prefer it if medication takeback programmes were implemented at private community pharmacies. CONCLUSIONS: Patients in Trinidad utilized household garbage as their main disposal method. There is a need to implement a medication takeback programme and educate the public on proper medication disposal.

Effects of PCOS on the quality of life of women ages 18-45: A Systematic Review

Polycystic ovary syndrome (PCOS) is a common hormonal disorder with an unknown aetiology that manifests in women of reproductive age. ➢ Excessive insulin levels, genetic predisposition, inflammation, and excessive androgen levels are involved in its development. ➢ PCOS can affect the quality of life (QoL) of women through characteristics like amenorrhea, excess androgens, polycystic ovaries, infertility, hirsutism, acne, and drastic weight gain. ➢ Associated complications like endometrial cancer, abnormal uterine bleeding, miscarriages, gestational diabetes, type 2 diabetes, hypertension, eating disorders, and depression may also arise, which can further lower QoL.

Strategic Role and Challenges of Community Pharmacists in SARS-CoV-2 Outbreak.

This study highlights the importance of community pharmacists' strategic role in hindering the progression of the SARS-CoV-2 virus in the community setting and innovative measures to protect themselves. This article focuses on the features, control, and prevention of COVID-19 and social awareness measures of the pandemic. The means employed by the community pharmacist to safeguard his health while providing pharmaceutical services during COVID-19 is compiled and presented to benefit health-care professionals around the world. As per the US Center for Disease Control and Prevention, community pharmacists play a crucial role in providing essential drugs to patients without knowing their current COVID-19 status. They also work in conditions that make them susceptible to COVID-19 exposure. Despite the availability of guidelines, community pharmacists need to be trained in personal protective equipment for efficient protection and prevention of spread. Community pharmacists are essential frontline warriors against transmission of the SARS-CoV-2 virus in the community and act as frontline workers to educate the public on COVID-19. They are at high risk and need to observe necessary precautions to mitigate the spread of the virus.

Pharmacist Rethink through a Planetary Health Lens.

Planetary Health is a rapidly developing field that is gaining momentum and significance as the world grapples with the devastating effects of infectious diseases, climate change, biodiversity loss, complex food insecurities, and international competition for resources. These challenges are often attributable to the financial activity made by nation states and increasing disposable individual wealth. The outcomes have created a perfect storm of events that, if not managed properly, threatens the health of current and future generations. Given the front-line role pharmacists play within health system in the community and institutional levels, the profession is uniquely positioned to make a meaningful impact to planetary health. This article aims to explore contributions pharmacists can make to secure planetary health.

Natural Thiazoline-Based Cyclodepsipeptides from Marine Cyanobacteria: Chemistry, Bioefficiency and Clinical Aspects.

BACKGROUND: Peptides and peptide-based therapeutics are biomolecules that demarcate a significant chemical space to bridge small molecules with biological therapeutics, such as antibodies, recombinant proteins, and protein domains. INTRODUCTION: Cyclooligopeptides and depsipeptides, particularly cyanobacteria-derived thiazoline-based polypeptides (CTBCs), exhibit a wide array of pharmacological activities due to their unique structural features and interesting bioactions, which furnish them as promising leads for drug discovery. METHODS: In the present study, we comprehensively review the natural sources, distinguishing chemistries, and pertinent bioprofiles of CTBCs. We analyze their structural peculiarities counting the mode of actions for biological portrayals which render CTBCs as indispensable sources for emergence of prospective peptide-based therapeutics. In this milieu, metal organic frameworks and their biomedical applications are also briefly discussed. To boot, the challenges, approaches, and clinical status of peptide-based therapeutics are conferred. RESULTS: Based on these analyses, CTBCs can be appraised as ideal drug targets that have always remained a challenge for traditional small molecules, like those involved in protein- protein interactions or to be developed as potential cancer-targeting nanomaterials. Cyclization-induced reduced conformational freedom of these cyclooligopeptides contribute to improved metabolic stability and binding affinity to their molecular targets. Clinical success of several cyclic peptides provokes the large library-screening and synthesis of natural product-like cyclic peptides to address the unmet medical needs. CONCLUSION: CTBCs can be considered as the most promising lead compounds for drug discovery. Adopting the amalgamation of advanced biological and biopharmaceutical strategies might endure these cyclopeptides to be prospective biomolecules for futuristic therapeutic applications in the coming times.

Targeting insulin resistance with selected antidiabetic agents prevents menopausal associated central obesity, dysglycemia, and cardiometabolic risk.

Menopause consequent to reduced circulating estrogen is associated with diminished insulin receptor sensitivity and fat redistribution, particularly central adiposity and increased waist circumference. Peri and menopausal women are at risk of hyperglycemia, prediabetes and attendant metabolic disturbances. Hormone replacement therapy increases insulin receptor sensitivity, but may precipitate an increased cardiovascular risk, depending on the route, if not commenced within the proposed period denoted by the 'timing hypothesis'. The therapeutic ideal of dietary modification with increased physical activity may have compliance issues. We theorize that selected antidiabetic agents reduce visceral fat deposits, restore insulin sensitivity and inhibit inflammatory mediator release. Glucagon-like peptide 1 agonists, sodium-glucose cotransporter 2 inhibitors and even metformin are worthy interventions to treat menopausal-induced obesogenic metabolic conditions. Loss of visceral fat restores insulin receptor sensitivity, decreases central obesity and adipokines to halt dysmetabolic changes.

Efficacy of Levofloxacin Loaded Nonionic Surfactant Vesicles (Niosomes) in a Model of Pseudomonas aeruginosa Infected Sprague Dawley Rats.

This study examined the effectiveness of niosomes loaded with levofloxacin in treating Pseudomonas aeruginosa (American Type Culture Collection-ATCC 27853) infections in Sprague Dawley rats since these infections are becoming more common and resistant to treatment. Levofloxacin entrapped in niosomes was prepared using the thin-film hydration method and was assessed for in vitro release and stability. Three groups of six (6) animals were infected with a lethal dose of Pseudomonas aeruginosa via the intraperitoneal (Ip) route. At six (6) hours postinfection, the animals were treated with either drug-free niosomes (control), free levofloxacin (conventional), or levofloxacin trapped in niosomes (Ip) at a dose of 7.5 mg/kg/once daily. Blood was collected via tail snips on days 0, 1, 3, 5, 7, and 10 for complete blood counts and viable bacterial counts (CFU/µl). At day 10, the animals were sacrificed, and the kidney, liver, and spleen were harvested for bacterial counts. The niosomes showed a sustained drug release profile and were most stable at 4°C. All animals in the control group succumbed to the infection; one animal from the conventional group died, and all niosome treated animals survived at day 10. The mean lymphocyte count (×109) was lower for the niosome (7.258 ± 1.773) versus conventional group (17.684 ± 10.008) (p < 0.03) at day ten (10). Neutrophil counts (×109) were lower for the niosome (2.563 ± 1.609) versus conventional (6.2 ± 6.548) (p < 0.02) groups. Though CFUs in the bloodstream were comparable for both treatment groups, the niosome treated group showed a significant reduction of CFUs in the liver, kidney, and spleen versus the conventional group (1.33 ± 2.074) vs (5.8 ± 3.74) (p < 0.043), (1.5 ± 2.35) vs (9.6 ± 8.65) (p < 0.038) and (3.8 4.71) vs (25.6 14.66) (p < 0.007), respectively. These findings indicate that niosome is promising as a drug delivery system in treating systemic infections, but further work using niosomes with surface modification is recommended.

Natural Bioactive Thiazole-Based Peptides from Marine Resources: Structural and Pharmacological Aspects.

Peptides are distinctive biomacromolecules that demonstrate potential cytotoxicity and diversified bioactivities against a variety of microorganisms including bacteria, mycobacteria, and fungi via their unique mechanisms of action. Among broad-ranging pharmacologically active peptides, natural marine-originated thiazole-based oligopeptides possess peculiar structural features along with a wide spectrum of exceptional and potent bioproperties. Because of their complex nature and size divergence, thiazole-based peptides (TBPs) bestow a pivotal chemical platform in drug discovery processes to generate competent scaffolds for regulating allosteric binding sites and peptide-peptide interactions. The present study dissertates on the natural reservoirs and exclusive structural components of marine-originated TBPs, with a special focus on their most pertinent pharmacological profiles, which may impart vital resources for the development of novel peptide-based therapeutic agents.

The Knowledge, Attitudes, Perception and Beliefs (KAPB) on Sexual Education and Sexual Practices Among Young Adults Attending University in Trinidad and Tobago

During secondary school, students are exposed to Sexual Education (Sex-Ed) in varying forms. This can influence future sexual behaviours and attitudes. This study investigated the impact that Sex-Ed programmes had on the knowledge, attitude, perception and beliefs (KAPB) of sex-related topics in T&T among UWI-STA students aged 19-24 (AU)