An Analysis of the Protein and Lipid concentrations in the Tear Layer of Contact and Non-contact lens wearers

Purpose: The main reason for embarking upon this specif aspect of the study is to obtain local population statistics in Trinidad, W. I. Most of the research pertaining to the tear layer has been done internationally with statistical analysis stemming from the Wester World. The clinical significance of this study is to provide early means of detection of primary and secondary diseases such as hpyerliproteninemia, dyslipdemia, and triglyceridemia in human population. The significance is to determine the relationship between a contact lens wearer and individual components (total proteins and total lipids) of their tears. This is to examine the tear-lens relationship between the disposition of components of the tear film on soft (hydrogel and silicone hydrogel) contact lenses in relation to lens intolerance, patient discomfort and dry eye syndrome. Method: A total of 93 subjects were interviewd and tear samples were obtained from 81 participants. The capillary tube technique was used to extract tear fluid samples and were stored at -80 degrees celsius. Total Protein and Triglyceride Liquicolour kits were used to analyse tears. Using a mass spectrometer, absorbance values were used to calculate the total proteim and total triglycerid concentrations for non-contact lens and contact lens wearers. Results: It was formulated that the total concentrations of proteins and lipids in the tear film of non-contact lens patients were 7.356 1.31 and 3.76 3.26 mg/dl. The protein and lipid concentrations of contact lens patients were determined; these results were 5.88 0.91 and 2.54 0.72mg/dL. Conclusion: Based on independent statistical analysis, there was no sigificant difference between the protein and lipid concentrations of non-contact lens patients. There was also found to be no significant difference between contact lens and no-contact lens wearers' protein and lipid concentrations.

Challenges and Opportunities of Preclinical Medical Education: COVID-19 Crisis and Beyond.

COVID-19 pandemic has disrupted face-to-face teaching in medical schools globally. The use of remote learning as an emergency measure has affected students, faculty, support staff, and administrators. The aim of this narrative review paper is to examine the challenges and opportunities faced by medical schools in implementing remote learning for basic science teaching in response to the COVID-19 crisis. We searched relevant literature in PubMed, Scopus, and Google Scholar using specific keywords, e.g., "COVID-19 pandemic," "preclinical medical education," "online learning," "remote learning," "challenges," and "opportunities." The pandemic has posed several challenges to premedical education (e.g., suspension of face-to-face teaching, lack of cadaveric dissections, and practical/laboratory sessions) but has provided many opportunities as well, such as the incorporation of online learning in the curriculum and upskilling and reskilling in new technologies. To date, many medical schools have successfully transitioned their educational environment to emergency remote teaching and assessments. During COVID-19 crisis, the preclinical phase of medical curricula has successfully introduced the novel culture of "online home learning" using technology-oriented innovations, which may extend to post-COVID era to maintain teaching and learning in medical education. However, the lack of hands-on training in the preclinical years may have serious implications on the training of the current cohort of students, and they may struggle later in the clinical years. The use of emergent technology (e.g., artificial intelligence for adaptive learning, virtual simulation, and telehealth) for education is most likely to be indispensable components of the transformative change and post-COVID medical education.

Investigating the risk of Incident diabetes mellitus among primary care patients treated with simvastatin in North-Central Trinidad.

AIM: To determine the risk of new-onset diabetes mellitus in patients treated with simvastatin at primary healthcare clinics in North Central Trinidad. MATERIALS AND METHODS: A retrospective descriptive case-series study design was applied to 384 conveniently sampled patient medical records from the cluster of primary healthcare centers during the period of February 2016-May 2016. Information from the patient files were then recorded using a systematic data extraction form. The major inclusion criteria were non-diabetic patients who were compliant with daily simvastatin for a minimum period of 1 year. The risk of incident diabetes mellitus was calculated, using SPSS version 20.0. Chi-squared (χ2) testing was performed to determine any association between new-onset diabetes mellitus and simvastatin use. RESULTS: In all, 207 patients became diabetic during their treatment period translating into a 53.9% risk of incident diabetes mellitus (χ2 = 2.3438, P = 0.1258). A subgroup analysis of 133 subjects was performed to eliminate the confounders of family history of diabetes and age greater than 60 years. In this subgroup, 50 incident diabetics (37%) were identified and a statistically significant association was observed (χ2 = 8.118, P = 0.0042). Linear regression revealed that this association was dose-dependent with a corresponding 32% higher risk in patients taking 40 mg (P = 0.001) of simvastatin daily compared with 20 mg of simvastatin (P = 0.094). Linear regression also revealed that there was significant statistical association between onset of diabetes mellitus and duration of statin therapy (P = 0.006). CONCLUSION: In this population, simvastatin use is associated with a 53.9% increased risk of development of new-onset diabetes mellitus (χ2 = 2.3438, P = 0.1258). A statistically significant association was attained after subgroup analysis involving patients less than 60 years old and without a family history of diabetes with an incident risk of 37%. The increased risk of incident diabetes mellitus conferred by higher doses of simvastatin warrants consideration by physicians considering therapies for dyslipidemia in patients with multiple risk factors for diabetes mellitus.

Treatment of multiple system atrophy using intravenous immunoglobulin.

BACKGROUND: Multiple system atrophy (MSA) is a progressive neurodegenerative disorder of unknown etiology, manifesting as combination of parkinsonism, cerebellar syndrome and dysautonomia. Disease-modifying therapies are unavailable. Activation of microglia and production of toxic cytokines suggest a role of neuroinflammation in MSA pathogenesis. This pilot clinical trial evaluated safety and tolerability of intravenous immunoglobulin (IVIG) in MSA. METHODS: This was a single-arm interventional, single-center, open-label pilot study. Interventions included monthly infusions of the IVIG preparation Privigen®, dose 0.4 gram/kg, for 6 months. Primary outcome measures evaluated safety and secondary outcome measures evaluated preliminary efficacy of IVIG. Unified MSA Rating Scale (UMSARS) was measured monthly. Quantitative brain imaging using 3T MRI was performed before and after treatment. RESULTS: Nine subjects were enrolled, and seven (2 women and 5 men, age range 55-64 years) completed the protocol. There were no serious adverse events. Systolic blood pressure increased during IVIG infusions (p<0.05). Two participants dropped out from the study because of a non-threatening skin rash. The UMSARS-I (activities of daily living) and USMARS-II (motor functions) improved significantly post-treatment. UMSARS-I improved in all subjects (pre-treatment 23.9 ± 6.0 vs. post-treatment 19.0±5.9 (p=0.01). UMSARS-II improved in 5 subjects, was unchanged in 1 and worsened in 1 (pre-treatment 26.1±7.5 vs. post-treatment 23.3±7.3 (p=0.025). The MR imaging results were not different comparing pre- to post-treatment. CONCLUSIONS: Treatment with IVIG appears to be safe, feasible and well tolerated and may improve functionality in MSA. A larger, placebo-controlled study is needed.

A gap between acceptance and knowledge of herbal remedies by physicians: the need for educational intervention.

BACKGROUND: The unprecedented global increase in the use of herbal remedies is set to continue apace well into the foreseeable future. This raises important public health concerns, especially as it relates to safety issues including adverse effects and herb-drug interactions. Most Western-trained physicians are ignorant of the risks and benefits of this healthcare modality and assessment of acceptance and knowledge would identify appropriate intervention strategies to improve physician-patient communication in this area. METHODS: A cross-sectional survey was done using an interviewer-administered pilot tested de novo questionnaire at six public hospitals in Trinidad between May-July 2004. The questionnaire utilized weighed questions to quantify acceptance (maximum score = 14 points) and knowledge (maximum score = 52 points). Acceptance and knowledge scores were analyzed using the ANOVA and Tukey's tests. RESULTS: Of 192 physicians interviewed, most (60.4%) believed that herbal remedies were beneficial to health. Respondents had relatively high acceptance levels (mean = 5.69 +/- 0.29 points or 40% of total possible score) and poor knowledge (mean = 7.77 +/- 0.56 points or 15% of total possible score). Seventy-eight physicians (40.6%) admitted having used herbs in the past, and 60 of these (76.9%) were satisfied with the outcome. Although 52 physicians (27.1%) recommended the use of herbs to their patients only 29 (15.1%) were able to identify at least one known herb-drug interaction. CONCLUSION: The use of herbal remedies is relatively high in Trinidad, as throughout the world, and most patients self-medicate with or without the knowledge of their attending physician. Surprisingly, we demonstrated relatively high acceptance levels and use of herbs among physicians in Trinidad. This interesting scenario of high acceptance levels and poor knowledge creates a situation that demands urgent intervention. We recommend educational intervention to narrow the gap between acceptance and knowledge so that physicians would be adequately equipped to communicate with their patients on this modality. The integration of herbal medicine into the curriculum of medical schools, continuing education programs and the availability of reputable pharmacopoeias for referencing at public health institutions are useful instruments that can be used to close this gap and promote improved physician-patient communication.

A gap between acceptance and knowledge of herbal remedies by physicians: the need for educational intervention

BACKGROUND: The unprecedented global increase in the use of herbal remedies is set to continue apace well into the foreseeable future. This raises important public health concerns, especially as it relates to safety issues including adverse effects and herb-drug interactions. METHODS: A cross-sectional survey was done using an interviewer-administered pilot tested de novo questionnaire at six public hospitals in Trinidad between May–July 2004. The questionnaire utilized weighed questions to quantify acceptance (maximum score = 14 points) and knowledge (maximum score = 52 points). Acceptance and knowledge scores were analyzed using the ANOVA and Tukey's tests. RESULTS: Of 192 physicians interviewed, most (60.4 per cent) believed that herbal remedies were beneficial to health. Respondents had relatively high acceptance levels (mean = 5.69 ñ 0.29 points or 40 per cent of total possible score) and poor knowledge (mean = 7.77 ñ 0.56 points or 15 per cent of total possible score). Seventy-eight physicians (40.6 per cent) admitted having used herbs in the past, and 60 of these (76.9 per cent) were satisfied with the outcome. Although 52 physicians (27.1 per cent) recommended the use of herbs to their patients only 29 (15.1 per cent) were able to identify at least one known herb-drug interaction. CONCLUSION: Surprisingly, we demonstrated relatively high acceptance levels and use of herbs among physicians in Trinidad. This interesting scenario of high acceptance levels and poor knowledge creates a situation that demands urgent intervention. The integration of herbal medicine into the curriculum of medical schools, continuing education programs and the availability of reputable pharmacopoeias for referencing at public health institutions are useful instruments that can be used to close this gap and promote improved physician-patient communication.

Protection against paracetamol-induced hepatic injury by prazosin pre-treatment in CD-1 mice

A synergistic depletion of glutathione has been suggested to be one critical factor in the hepatic injury in mice induced by non-toxic doses of paracetamol (APAP) when co-administered with  -adrenergic agonists. Prazosin (an  -adrenergic antagonist) could confer hepatoprotection following a toxic APAP dose (530 mg/kg) by increasing glutathione levels and enhancing bioinactivation by glucuronidation and glutathione conjugation. The effect of prazosin pre-treatment on APAP-induced gluthathione depletion and bioinactivation in vivo was assessed. Prazosin (15 mg/kg) pre-treatment provided protection against APAP-induced hepatic injury as evidenced by a significant decrease in serum transaminase (ALT) levels after 5 h (p < 0.05). Interestingly, prazosin pre-treatment did not prevent the dramatic depletion of glutathione by high dose APAP and it had no effect on the quantity of the glutathione conjugate formed. However, prazosin pre-treatment caused a significant increase in recovery of the administered dose (530 mg/kg) as the glucuronide metabolite (p < 0.05). UDP-glucuronosyltransferase (UGT) is involved in the bioinactivation of APAP by glucuronidation and we showed that prazosin had no effect on microsomal UGT kinetics. Thus, prazosin had no effect on either APAP-mediated glutathione depletion or the extent of APAP-glutathione conjugate formation and may be affecting other mechanisms to reduce oxidative stress caused by a toxic dose of APAP

Protection against paracetamol-induced hepatic injury by prazosin pre-treatment in CD-1 mice.

A synergistic depletion of glutathione has been suggested to be one critical factor in the hepatic injury in mice induced by non-toxic doses of paracetamol (APAP) when co-administered with alpha-adrenergic agonists. Prazosin (an alpha-adrenergic antagonist) could confer hepatoprotection following a toxic APAP dose (530 mg/kg) by increasing glutathione levels and enhancing bioinactivation by glucuronidation and glutathione conjugation. The effect of prazosin pre-treatment on APAP-induced gluthathione depletion and bioinactivation in vivo was assessed. Prazosin (15 mg/kg) pre-treatment provided protection against APAP-induced hepatic injury as evidenced by a significant decrease in serum transaminase (ALT) levels after 5h (p<0.05). Interestingly, prazosin pre-treatment did not prevent the dramatic depletion of glutathione by high dose APAP and it had no effect on the quantity of the glutathione conjugate formed. However, prazosin pre-treatment caused a significant increase in recovery of the administered dose (530 mg/kg) as the glucuronide metabolite (p<0.05). UDP-glucuronosyltransferase (UGT) is involved in the bioinactivation of APAP by glucuronidation and we showed that prazosin had no effect on microsomal UGT kinetics. Thus, prazosin had no effect on either APAP-mediated glutathione depletion or the extent of APAP-glutathione conjugate formation and may be affecting other mechanisms to reduce oxidative stress caused by a toxic dose of APAP.

Medicinal herb use among asthmatic patients attending a specialty care facility in Trinidad.

BACKGROUND: There is an increasing prevalence of asthma in the Caribbean and patients remain non-compliant to therapy despite the development of guidelines for management and prevention. Some patients may self-medicate with medicinal herbs for symptomatic relief, as there is a long tradition of use for a variety of ailments. The study assessed the prevalence of use and the factors affecting the decision to use herbs in asthmatic patients attending a public specialty care clinic in Trinidad. METHODS: A descriptive, cross-sectional study was conducted at the Chest Clinic in Trinidad using a de novo, pilot-tested, researcher-administered questionnaire between June and July 2003. RESULTS: Fifty-eight out of 191 patients (30.4%) reported using herbal remedies for symptomatic relief. Gender, age, ethnicity, and asthma severity did not influence the decision to use herbs; however, 62.5% of patients with tertiary level schooling used herbs, p = 0.025. Thirty-four of these 58 patients (58.6%) obtained herbs from their backyards or the supermarket; only 14 patients (24.1%) obtained herbs from an herbalist, herbal shop or pharmacy. Relatives and friends were the sole source of information for most patients (70.7%), and only 10.3% consulted an herbalist. Ginger, garlic, aloes, shandileer, wild onion, pepper and black sage were the most commonly used herbs. CONCLUSIONS: Among patients attending the Chest Clinic in Trinidad the use of herbal remedies in asthma is relatively common on the advice of relatives and friends. It is therefore becoming imperative for healthcare providers to become more knowledgeable on this modality and to keep abreast with the latest developments.

Medicinal herb use among asthmatic patients attending a specialty care facility in Trinidad

Background: There is an increasing prevalence of asthma in the Caribbean and patients remain non-compliant to therapy despite the development of guidelines for management and prevention. Some patients may self-medicate with medicinal herbs for symptomatic relief, as there is a long tradition of use for a variety of ailments. The study assessed the prevalence of use and the factors affecting the decision to use herbs in asthmatic patients attending a public specialty care clinic in Trinidad. Methods: A descriptive, cross-sectional study was conducted at the Chest Clinic in Trinidad using a de novo, pilot-tested, researcher-administered questionnaire between June and July 2003. Results: Fifty-eight out of 191 patients (30.4 per cent) reported using herbal remedies for symptomatic relief. Gender, age, ethnicity, and asthma severity did not influence the decision to use herbs; however, 62.5 per cent of patients with tertiary level schooling used herbs, p = 0.025. Thirty-four of these 58 patients (58.6 per cent) obtained herbs from their backyards or the supermarket; only 14 patients (24.1 per cent) obtained herbs from an herbalist, herbal shop or pharmacy. Relatives and friends were the sole source of information for most patients (70.7 per cent), and only 10.3 per cent consulted an herbalist. Ginger, garlic, aloes, shandileer, wild onion, pepper and black sage were the most commonly used herbs. Conclusions: Among patients attending the Chest Clinic in Trinidad the use of herbal remedies in asthma is relatively common on the advice of relatives and friends. It is therefore becoming imperative for healthcare providers to become more knowledgeable on this modality and to keep abreast with the latest developments.

Medicinal herb use among asthmatic patients attending a specialty care facility in Trinidad

BACKGROUND: There is an increasing prevalence of asthma in the Caribbean and patients remain non-compliant to therapy despite the development of guidelines for management and prevention. Some patients may self-medicate with medicinal herbs for symptomatic relief, as there is a long tradition of use for a variety of ailments. The study assessed the prevalence of use and the factors affecting the decision to use herbs in asthmatic patients attending a public specialty care clinic in Trinidad. METHODS: A descriptive, cross-sectional study was conducted at the Chest Clinic in Trinidad using a de novo, pilot-tested, researcher-administered questionnaire between June and July 2003. RESULTS: Fifty-eight out of 191 patients (30.4 per cent) reported using herbal remedies for symptomatic relief. Gender, age, ethnicity, and asthma severity did not influence the decision to use herbs; however, 62.5 per cent of patients with tertiary level schooling used herbs, p = 0.025. Thirty-four of these 58 patients (58.6 per cent) obtained herbs from their backyards or the supermarket; only 14 patients (24.1 per cent) obtained herbs from an herbalist, herbal shop or pharmacy. Relatives and friends were the sole source of information for most patients (70.7 per cent), and only 10.3 per cent consulted an herbalist. Ginger, garlic, aloes, shandileer, wild onion, pepper and black sage were the most commonly used herbs. CONCLUSIONS: Among patients attending the Chest Clinic in Trinidad the use of herbal remedies in asthma is relatively common on the advice of relatives and friends. It is therefore becoming imperative for healthcare providers to become more knowledgeable on this modality and to keep abreast with the latest developments.