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Adrenal insufficiency and bowel obstruction: An overlooked association

Case Reports in Clinical Medicine 2013年第2期2卷 111-114页

作者： Ryan A. Kunjal Ria R. Ramadoo Surujpal Teelucksingh Vijay Naraynsingh Department of Clinical Medical Sciences University of the West Indies St. Augustine Trinidad and Tobago Department of Clinical Surgical Sciences University of the West Indies St. Augustine Trinidad and Tobago

Bowel obstruction is a documented but rare presentation of adrenal insufficiency (AI). We report a case of acute AI manifesting as intestinal pseudo-obstruction (IPO) in a patient with underlying iatrogenic adrenal suppression. An 83 years old female was admitted for partial small bowel obstruction that failed to resolve with conservative management. She then underwent exploratory laparotomy where no mechanical obstruction was found and the small bowel was manually decompressed. Postoperatively she developed acute swelling of her right ankle which was similar to mono-articular attacks in the past. This was diagnosed clinically as gout. Her obstruction failed to settle and a second laparotomy was done which yielded the same as the first. Given her past account of arthritic pain, direct questioning of steroid use unearthed a history of multiple intra-articular corticosteroid injections for analgesia. She also described several short courses of high dose oral steroids for respiratory tract infections, including a recent course which was abruptly stopped two days prior to presentation. Clinical suspicion of AI was supported by biochemical testing of stress cortisol levels and change in the serum cortisol in response to 250 μg of synthetic adrenocorticotropic hormone. Moreover, her improvement following a therapeutic trial of steroid replacement was dramatic and strongly supports this diagnosis. It is therefore worthwhile to consider a diagnosis of AI in cases of bowel obstruction in patients with comorbidities that predispose to steroid use and especially in settings where steroid abuse is prevalent.

关键词： Pseudo-Obstruction Steroids Adrenal Insufficiency

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A Conservative Approach to Treatment of Dental Erosion: Case Report

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Open Journal of Stomatology 2019年第11期9卷 241-248页

作者： Khaila Davis Risa Yuk Low Reisha Rafeek School of Dentistry Faculty of Medical Sciences University of the West Indies St Augustine Trinidad & Tobago

Tooth surface loss is a common condition with nearly three-quarter of the population in trinidad & tobago exhibiting signs and about one-fifth of those persons have moderate or severe wear. These patients become difficult to treat due mainly to loss of clinical crown height and also loss of occlusal vertical dimension. This case depicts the use of a conservative approach to treating a patient with moderate tooth surface loss, as assessed via the tooth wear index, with aetiology of acid erosion. The poor appearance of the dentition was the patient’s chief presenting complaint. With the use of 3M Filtek? Z 250 Universal Restorative Composite (St Paul, MN, USA), temporary posterior build-ups were placed to increase the patient’s Occlusal Vertical Dimension (OVD) and were subsequently replaced with metal onlays. Anterior composite veneers were placed to achieve an aesthetically pleasing result at the increased OVD. The combined use of composite and metal onlays allowed for an economical and more conservative treatment modality for dental erosion rather than full coverage posterior and anterior crowns.

关键词： Erosion Tooth Wear Onlays Veneers

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Characterization of Multidrug Resistant Escherichia coli Isolates Recovered from Humans and Chickens, trinidad and tobago

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Advances in Infectious Diseases 2016年第4期6卷 145-156页

作者： Sandra Ashiboe-Mensah Francis Dziva Patrick Eberechi Akpaka Caroline Mlambo Abiodun A. Adesiyun Department of Paraclinical Sciences Faculty of Medical Sciences The University of the West Indies St. Augustine Trinidad and Tobago School of Veterinary Medicine Faculty of Medical Sciences The University of the West Indies St. Augustine Trinidad and Tobago

To characterize extended-spectrum beta-lactamase (ESBL) and extra-intestinal pathogenic Escherichia coli (ExPEC) associated virulence genes in E. coli isolates from chickens and humans in trinidad and tobago. This cross sectional study was conducted over a three-month period. A total of 471 E. coli isolates;160 from humans treated at a regional tertiary hospital and 311 from chicken caecal samples from “pluck shops” in trinidad & tobago were identified using both conventional and molecular microbiological methods. Phenotypic confirmation of ESBL producing E. coli isolates from humans was by Microscan system (Siemens, USA) while the double disk diffusion method was used for the chicken isolates. Polymerase chain reaction (PCR) analysis was used to determine the ESBL and ExPEC-associated virulence genes in representative human isolates and all chicken isolates. From the 311 chicken E. coli isolates, 49.2% (153/311) produced ESBL, while 56.3% (90/160) from humans were ESBL positive. All human and chicken ESBL isolates were 100% susceptible to carbapenems and aminoglycosides antimicrobials. PCR detected 21.1% blaCTX-M, 13.3% blaTEM and 7.8% blaSHV genes among E coli isolates from humans compared to 0.6% blaCTX-M and 48.6% blaTEM genes in chickens. PCR analysis revealed diverse virulence profiles among the isolates. There was a high occurrence rate of ExPEC-asso- ciated virulence genes in E. coli isolates from both humans and chickens. However, the CTX-M-1 genes were most predominant in humans while TEM occurred in chic- ken isolates. The diverse ESBL and virulence associated gene profiles encountered in E. coli isolates from humans and chickens on the surface depicts no similarity or relationships despite occurrence in both cohort groups. Therefore E. coli strains from chickens and humans require further investigation to determine their clonal relatedness or transmission in the country.

关键词： Extended-Spectrum Beta-Lactamase (ESBL) Escherichia coli PCR Virulence Genes trinidad & tobago

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<i>In vitro</i>ruminal fermentation of leaves from three tree forages in response to incremental levels of polyethylene glycol

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Open Journal of Animal Sciences 2012年第3期2卷 142-149页

作者： Andell Edwards Victor Mlambo Cicero Horatio Octavius Lallo Gary Wayne Garcia Michael Davanan Diptee Department of Food Production Faculty of Science and Agriculture University of The West Indies St Augustine Trinidad and Tobago School of Veterinary Medicine Faculty of Medical Sciences Mt Hope Trinidad and Tobago The Open Tropical Forage-Animal Production Laboratory (OTP-APL) Department of Food Production Faculty of Science and Agriculture University of the West Indies St Augustine Trinidad and Tobago

Polyethylene glycol (PEG), a phenol binding agent has been used extensively to measure the biological activity of tannins in forage species. The optimum inclusion rate of PEG, per unit weight of sample varies from species to species. Determining optimum inclusion levels can prevent wastage and reduce the cost of diagnosing the biological activity of tannins, especially in developing countries. This study was designed to determine the optimum PEG inclusion levels required to completely ameliorate In vitro ruminal bioactivity of tannins in leaves from Leucaena leucocephala, Gliricidia sepium and Trichanthera gigantea using the Reading Pressure Technique. Fermentation parameters were generated by fitting gas production data to the Orskov and McDonald (1979) non-linear equation: . An asymptotic response to incremental levels of PEG was observed with cumulative gas production at 48 h post inoculation. The minimum level of PEG required to maximize In vitro ruminal fermentation of tree leaves was found to be 200 mg PEG/g DM for all tree species. Gas production rate constant for the insoluble fraction (c) showed an increase (P In vitro organic matter degradability (iOMD) declined (P In vitro ruminal tannin biological activity in leaves of the three tree species.

关键词： Tannin-Binding Agents In vitro Ruminal Gas Production Organic Matter Digestibility Tannin Bioactivity Optimum Inclusion Rate

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Intensities of human disturbance dictate the floral diversity in tropical forest:the case of a secondary forest in Benguet, Philippines

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Journal of Mountain Science 2023年第6期20卷 1575-1588页

作者： Domelson A.BALANGEN Melchor S.CATONES Jane M.BAYENG Jones T.NAPALDET Global Inclusive Solution Environmental Consulting Services La TrinidadBenguet 2601Philippines Graduate School University of the Philippines Los BanosLaguna 4030Philippines Chemistry Department Benguet State UniversityLa TrinidadBenguet 2601Philippines Biology Department Benguet State UniversityLa TrinidadBenguet 26o1Philippines

This study inventoried the floral diversity of a secondary forest in Tuba,Benguet,Philippines as affected by different intensities of human *** study is unique from other land use studies in Southeast Asia in having conventional farms as the most disturbed land use while other sites have oil palm plantations.A total of 267 species belonging to 222 genera and 78 families was *** showed that the level of human disturbance is the major factor affecting the floral diversity while the effect of elevation is *** level of human disturbance is significantly associated with species richness,species composition,dominant species and biodiversity *** human disturbance,as in the case of conventional farms,results in lower species richness,predominantly weed composition,dominant weed species and lower biodiversity *** the other hand,lesser human disturbance(as in the case of secondary forest)leads to higher species richness,greater native species composition,dominance of indigenous species,and higher diversity *** most disturbed land use experienced the greatest loss of species richness,change in floristic composition and vegetation structure,as well as a shift from native to alien-dominated plant *** results showed that the effect of land use change is not limited to species richness but also to species composition,dominant species and biodiversity ***,the study is an important baseline data for biodiversity conservation of the Marcos Highway Watershed Forest Reserve.

关键词： Land use change Secondary forest Conventional farming Endemic species Exotic species

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Using a Simple Chair-Side Copy Denture Technique in the AvaDent Digital Denture Process: A Case Report and Review

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Open Journal of Stomatology 2018年第7期8卷 241-249页

作者： Amit Paryag Reisha Rafeek Ashley Meighan School of Dentistry Faculty of Medical Sciences The University of the West Indies St. Augustine Trinidad & Tobago

Introduction: Several techniques have been described by which a pair of dentures may be replicated. Case Report: The method described in this paper used materials readily available in a private practice to generate a pair of duplicate dentures for a 74-year-old Black male, which captured all of the features of the patients’ existing pair. These were modified chair-side and used to capture vital information on fit, occlusion and aesthetics, forming a template which was transferred to the laboratory and used to generate new dentures via the traditional laboratory process. The same template was also used to generate a pair of “AvaDent Digital Dentures” by digital scanning and production of a digital denture template for try and then fabrication of the digital denture. Conclusion: The results of this pilot study show that this simple chair-side method of fabricating duplicate dentures can be incorporated successfully into the AvaDent Digital Denture fabrication process to generate a pair of dentures with comparability if not superior fit and aesthetics to a pair fabricated from the same template via the traditional laboratory process.

关键词： Digital Dentures Duplicate Chair-Side Complete Dentures

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Molecular and Susceptibility Analysis of Toxigenic <i>Clostridium difficile</i>Obtained from Adult Patients Suspected of CDI in trinidad

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Open Journal of Medical Microbiology 2015年第1期5卷 43-57页

作者： Lemar Wayne Blake Patrick Eberechi Akpaka Adesh Ramsubhag Reneasha Kevi-Ann Steffi Hitlal-Blake Microbiology & Pathology Unit Department of Para-Clinical Sciences The University of the West Indies St. Augustine Trinidad & Tobago Department of Life Sciences The University of The West Indies St. Augustine Trinidad and Tobago Department of Medical Sciences The University of the West Indies Mona Jamaica

Clostridium difficile is a Gram positive rod-shaped bacterium that produces two major toxins, A and B. The detection of the organism and its toxins has been widely carried out using specialized Enzyme-Linked Immunosorbent Assay (ELISA) kits;however these generally have been unsuccessful in identifying all Clostridium difficile positive samples. In this study, fifteen clinically symptomatic patients from three of the five major regional hospitals in trinidad were investigated for Clostridium difficile infections. Stool samples were assessed by ELISA and cultured isolates were characterized using agar dilution antibiotic sensitivity assays, conventional Polymerase Chain Reaction (PCR), DNA sequencing and phylogenetic analysis of toxin A and B genes. All 15 patient stool samples and isolates were positive for toxigenic Clostridium difficile via ELISA and PCR respectively. All isolates were positive for the housekeeping tpi and Toxin B genes by PCR but only three of these were positive for the Toxin A gene. The Toxin B gene sequences showed 100% similarity levels among isolates while the Toxin A gene sequences showed 99% similarity among isolates. Phylogenetic analysis showed that the strains isolated in trinidad most likely belonged to the same strain/group. Agar dilution sensitivity tests showed highest susceptibility to Pipercillin/Tazobactam and Meropenem (87%) and the highest resistance was seen with Cefotaxime in 93%. These results indicate that similar virulent strains of C. difficile are present in the trinidad population and that pathogenic strains are more likely to be susceptible to Pipercillin/Tazobactam and Meropenem.

关键词： Clostridium difficile Infection (CDI) Toxigenic Clostridium difficile Toxin A Gene Toxin B Gene Housekeeping Gene (tpi) Antibiotic Susceptibility Testing Phylogenetic Sequencing

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Successful Detection of a Preferred Frame Using Eclipses of Jupiter’s Moon Io

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Journal of Applied Mathematics and Physics 2022年第2期10卷 322-332页

作者： Stephan J. G. Gift Department of Electrical and Computer Engineering Faculty of Engineering The University of the West Indies St. Augustine Trinidad and Tobago

In this paper tests by Maxwell and Gift that search for a preferred frame or ether arising from movement through that frame using Jupiter’s moon Io are reviewed and discussed. Unlike the Michelson-Morley second-order experiment which unsuccessfully attempted to detect the orbital motion of the Earth relative to the ether, these tests are both first-order and therefore are unaffected by the second-order effects of length contraction and clock retardation. The test by Maxwell utilizes the delay in the eclipse of Io as the Earth orbits the Sun in an attempt to detect ether drift resulting from the galactic movement of the Sun. This test requires a 6-year duration for its full execution and was never performed because of practical difficulties. The test first presented by Gift can be conducted over a few days and employs the observed variation of the period of Io as the Earth moves toward or away from Jupiter. The result is a positive detection of ether drift arising from the orbital motion of the Earth. The detected ether drift is evidence of a preferred frame which we argue corresponds to the solar system barycentric or sun-centered inertial (SCI) frame.

关键词： Ether Drift Maxwell Roemer Jupiter Io Luminiferous Ether Preferred Frame Sun-Centered Inertial Frame

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Self monitoring of blood glucose and its association with glycaemic control and lipid levels in type 2 diabetic patients aged 40 - 75 in trinidad and tobago

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Journal of Diabetes Mellitus 2012年第3期2卷 294-300页

作者： B. Shivananda Nayak Khateija Gowrie Renelle Romano Carl Spencer Domonique Noel Hellen Bissoon Ikageng Dipatene Nadia Mahabir Rissa Ragbir Shalane Xavier Department of Preclinical Sciences Faculty of Medical Sciences The University of the West Indies St. Augustine Trinidad and Tobago

This study was done to assess whether self monitoring of blood glucose is associated with better glycaemic control in type 2 diabetic trinidadians. Data was collected from 146 type 2 diabetics via interviews and medical files. Variables extracted included fasting blood glucose, HbA1c and lipid profile. Recent users of the glucometer had better glycemic control compared with longstanding users (HbA1c: 8.4% ± 0.28% vs 9.4% ± 0.62%). Diabetics using a glucometer for >11 years had the highest cholesterol (234 ± 27mg/dL) while those using it 6 months to 5 yrs had the lowest values (206 ± 8 mg/dL). Using the glucometer occasionally or once a week had little impact on these indices. Usage of insulin preparation was positively correlated with HbA1c (r = 0.295;p = 0.001) while those relying on oral hypoglycaemic agents showed a negative correlation (r = -0.265). Further, those who took their medication as prescribed had a lower HbA1c than those who took their medication occasionally. Ironically, HbA1c fell with increasing duration between clinic visits with those visiting annually having the lowest HbA1c (9.0% ± 0.2% vs 7.1% ± 0.7%). Compliance with lifestyle and exercise resulted in lower HbA1c and blood lipids. Poor client education on glucometer usage, administration of insulin and non-compliance with diet and exercise were associated with higher HbA1c.

关键词： Glucometer Blood Glucose Glycemic Control Lipid Profile

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Prevalence of Bimaxillary Protrusion: A Systematic Review

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Open Journal of Epidemiology 2021年第1期11卷 37-46页

作者： Trudee Hoyte Anil Ali David Bearn School of Dentistry Faculty of Medical Sciences The University of The West Indies Trinidad and Tobago School of Dentistry University of Dundee Scotland UK

Objective: This study aimed to systematically review current relevant literature on the prevalence of bimaxillary protrusion. Materials and Methods: The electronic databases PubMed, Medline, Scopus, Google Scholar and the Cochrane Library were searched using specific inclusion criteria to obtain applicable articles. References from included studies were also examined. Results: Three articles were identified that met the inclusion criteria. Prevalence of bimaxillary protrusion ranged from 3.7% to 68.8% in different populations reported in the literature examined. GRADE assessed overall confidence was deemed to be very low. Conclusion: These results show that the prevalence of bimaxillary protrusion varies greatly between races and geographic regions. The trinidad and tobago population has a high prevalence of bimaxillary protrusion.

关键词： Bimaxillary Protrusion Prevalence Systematic Review

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