Polypharmacy and potential drug-drug interactions in emergency department patients in the Caribbean

Background Potential Drug–Drug Interactions (DDI) account for many emergency department visits. Polypharmacy, as well as herbal, over-the-counter (OTC) and combination medication may compound this, but these problems are not well researched in low-and-middle-income countries. Objective To compare the incidence of drug–drug interactions and polypharmacy in older and younger patients attending the Emergency Department (ED). Setting The adult ED of a tertiary teaching hospital in Trinidad. Methods A 4 month cross sectional study was conducted, comparing potential DDI in older and younger patients discharged from the ED, as defined using Micromedex 2.0. Main outcome measure The incidence and severity of DDI and polypharmacy (defined as the use of ≥5 drugs simultaneously) in older and younger patients attending the ED. Results 649 patients were included; 275 (42.3%) were ≥65 years and 381 (58.7%) were female. There were 814 DDIs, of which 6 (.7%) were contraindications and 148 (18.2%) were severe. Polypharmacy was identified in 244 (37.6%) patients. Older patients were more likely to have potential DDI (67.5 vs 48.9%) and polypharmacy (56 vs 24.1%). Herbal products, OTC and combination drugs were present in 8, 36.7 and 22.2% of patients, respectively. On multivariate analysis, polypharmacy and the presence of hypertension and ischaemic heart disease were associated with an increased risk of potential DDI. Conclusion Polypharmacy and potential drug–drug interactions are common in ED patients in the Caribbean. Older patients are particularly at risk, especially as they are more likely to be on multiple medications. The association between herbal medication and polypharmacy needs further investigation. This study indicates the need for a more robust system of drug reconciliation in the Caribbean

Premature Puberty in Obese Female Children Aged 5-17 in the United States for 2013-2014

The prevalence of obesity in female children in the Unites States has increased from 5% to 17.1% from 1965 to 2015 and the prevalence of premature puberty has increased as well. Increased weight is correlated with premature puberty in females and interestingly, different studies have shown that there has been a gradual decline of age for onset of puberty. Early sexual maturation in female children are associated with many negative consequences such as increased risk of adult obesity, type 2 diabetes, increased aggression, increased adolescent risk taking behaviors, increased sexual activity, and breast cancer. The target population for this study is obese female children in the United States in the past 5 years. Using the primary data from the National Health and Nutrition Examination Survey (NHANES), the specific study population of obese females aged 5 through 17 years in the United States recorded during the period January 2013 - December 2014. The results of this study also showed a mean BMI of 21.1 which was higher than the 2015 average of 17.1 while a mean age of puberty was found to be 11.3 which is higher than the 2015 average of 9. The strength of correlation was found with Spearman’s Rho. In this study, the results have shown a contrasting view and have shown a negative weak association between the two variables with a rho value of -.089. Efforts towards a reduction of obesity is expected to yield a lowered incidence of premature puberty

Spectrum of microbial growth and antimicrobial usage in an intensivecare unit of a tertiarycare hospital in Trinidad West Indies

Background. Intensive-care units (ICUs) are a source of multidrug-resistant organisms, owing to the indiscriminate usage of broad-spectrum antimicrobial drugs. In such settings, one must be aware of the spectrum of microbes and pattern of antibiotic usage.Objectives. To evaluate the spectrum, susceptibility and resistance patterns of microbes found in ICU patients in a tertiary-care teaching hospital in Trinidad, and to quantify antimicrobial usage.Methods. All adult patients (≥15 years of age) admitted to the ICU for ≥48 h who developed nosocomial infections conforming to the Centers for Disease Control and Prevention criteria were included. Demographic data and clinical data, including specimens sent, isolates grown, antimicrobial sensitivity and resistance patterns, the usage of antimicrobials and patient outcomes, were recorded. Variables such as age, admission white blood cell count, duration of first antibiotic used, length of ICU stay, length of hospital stay, organ support and total comorbidities were analysed. Antimicrobial usage was quantified as the defined daily dosage per 1 000 patient-days.Results. A total of 153 patients with 287 microbiological specimens were studied. The mean patient age was 48.4 years, and the mean ICU length of stay was 7.9 days. The most common admitting diagnoses were sepsis and multiple trauma. Staphylococcus aureus was the most common isolate from blood and central venous lines, and Pseudomonas aeruginosa from tracheal aspirates and wound swabs. Non-survivors had significantly higher age, leucocyte count and organ support requirements, and shorter lengths of stay. Cefuroxime was the most-used antimicrobial in the unit.Conclusion. The usage pattern of antimicrobials did not correlate with susceptibility in most instances. There is a need to improve antimicrobial usage by implementing antimicrobial-stewardship programmes to establish an  antimicrobial protocol and guidelines for usage in the ICU

Effectiveness of Cancer Registries

Cancer is identified as one of the greatest morbidity and mortality causes throughout the world. The purpose of this work is to show the importance and impact of cancer registries on identification and treatment of cancers. Cancer registries are instrumental in identifying distribution of incidence and burden, risk factors, and at risk populations. By understanding its efficiency and cost effectiveness, policy makers, private stakeholders, and health ministries can implement these high quality data collection methods throughout expanding locations

Public health response and lessons learned from the 2014 chikungunya epidemic in Grenada

ABSTRACT In June 2014, the first cases of chikungunya virus (CHIKV) were diagnosed on the island of Carriacou, part of the tri-island state of Grenada. In the three months that followed, CHIKV spread rapidly, with conservative estimates of the population infected of at least 60%. Multiple challenges were encountered in the battle to manage the spread and impact of this high–attack rate virus, including 1) limited indigenous laboratory diagnostic capabilities; 2) an under-resourced health care system; 3) a skeptical general public, hesitant to accept facts about the origin and mode of transmission of the new virus; and 4) resistance to the vector control strategies used. Lessons learned from the outbreak included the need for 1) a robust and reliable epidemiological surveillance system; 2) effective strategies for communicating with the general population; 3) exploration of other methods of mosquito vector control; and 4) a careful review of all health care policies and protocols to ensure that effective, organized responses are triggered when an infectious outbreak occurs

The Centrality of Community Dynamics in the Socio-economic Recovery of Devastated Communities

Objective: To assess and explore the health and socio-economic outcomes of Jubilee, a community on the Caribbean island of Grenada hit by Hurricane Ivan in 2004 and to identify remaining barriers to recovery. Methods: The assessment consisted of a mixed methods approach employing observations, household surveys, in-depth interviews and focus groups. Results: Eighty-five per cent of the residents live in a single-family home type dwelling which is occupied by multiple families. Twenty-seven per cent of the respondents depended on a river or stream for water and 83% utilized an outdoor pit latrine. Construction accounted for 28% of the employment while 16% reported having no occupation. Public and private transportation was limited and 48% of the residents lived on less than one United States of America (US) dollar per day. Access to healthcare was reported by 89% and the prevalence of diabetes and hypertension was identified by 13% and 30% of the residents respectively. Social fragmentation within the community represents a barrier that keeps the community from developing common goals leading to full economic recovery. Conclusion: Jubilee has not fully recovered from the effects of Hurricane Ivan, but progress has been made in the reconstruction effort. These efforts have addressed the most immediate and basic needs of the community, mainly utility service infrastructure and home repairs. However, issues related to the community’s economic recovery are still unresolved