Background This study aimed to screen cardiovascular patients for depressive symptoms at a tertiary centre in Trinidad and Tobago; and to determine any significant associations amongst patients’ demographics, comorbidities, and cardiovascular medications with depressive symptoms. Methods In this observational, cross-sectional study, patients (n = 1203) were randomly selected from the cardiology outpatient clinics at the Eric Williams Medical Sciences Complex. After meeting selection criteria, informed consent was obtained, and patients were administered a case report form, which included the Patient Health Questionnaire-9 (PHQ-9). Descriptive analyses included frequency, percentage and summary statistics. Inferential analyses included 95% confidence intervals (CIs), independent sample t-test, Fisher’s exact test, Chi-square test, and multivariate logistic regression. Results The study had a 96% respondent rate, whereby the average age was 62 years old. Slightly less than half were male, and 52.5% were female. Over 90 % of the sample had cardiovascular disease (CVD). One-quarter of the sample had a PHQ-9 score of ≥10, with almost one-fifth having no depressive symptoms. Females, lower levels of education and income were all found to be statistically significant at risk for depressive symptoms (all p-values < 0.001). Comorbidities associated with depressive symptoms included hypertension, prior cerebrovascular events, chronic kidney disease, and chronic obstructive pulmonary disease with odds ratios (ORs) and 95% confidence intervals (CIs) of OR 1.988 (CI 1.414–2.797), OR 1.847 (CI 1.251–2.728), OR 1.872 (CI 1.207–2.902) and OR 1.703 (CI 1.009–2.876) respectively. Only the cardiovascular medication of ticagrelor was found to be significantly associated with depressive symptoms (p-value < 0.001). Conclusions Twenty-five percent of screened cardiovascular patients displayed significant depressive symptoms with a PHQ-9 ≥ 10. This study also highlights the importance of implementing a multidisciplinary approach to managing cardiovascular disease and screening for depressive symptoms in this subpopulation. Further studies are required to validate these findings. Trial Registration ClinicalTrials.gov number, NCT03863262. This trial was retrospectively registered on 20th February 2019.
Penetrative cardiac injury can often result in life-threatening sequelae such as myocardial contusion or rupture, coronary vessel and valvular damage, pericardial effusion with tamponade, and arrhythmias of which gunshot injury is a chief culprit. We report a case of a suspected acute coronary syndrome after a cardiac gunshot injury that was conservatively managed.
Coronary artery disease (CAD) is amongst the leading causes of death in human immunodeficiency virus (HIV)-infected persons. Severe left main disease (LMD) occurs in approximately five percent of HIV-infected patients, with chronic total occlusion (CTO) of this vessel being an even rarer phenomenon. We describe a non-adherent HIV-infected patient with a left main coronary artery (LMCA) CTO that presented with heart failure with mildly reduced ejection fraction (HFrEF) and ventricular tachycardia (VT).
Background: The options for renal replacement therapy for end stage renal disease include haemodialysis (HD), peritoneal dialysis (PD) and renal transplantation. In this study demographic, sociocultural and biological factors were assessed over a 1-year period for patients on renal replacement therapy. Methods: This cross-sectional study included all patients 18 years and older and on renal replacement therapy for at least 3 months in Trinidad and Tobago. Five hundred and thirty participants were recruited from our organ transplantation unit, all centres facilitating PD and a stratified random sample of all HD centres (100 T, 80 PD, 350 HD from October 2015 to October 2016. A questionnaire was administered and included demographics, knowledge and understanding and biological factors impacting on renal replacement therapy. Results: Thirty eight percent of all patients were between 56 to 65 years of age. The Indo Trinidadian population accounted for 51% of the subjects. 52.5% were male and 47.5% were female. From the data, 72% of patients were diabetic and/or hypertensive. In the transplant recipients, 39% were diabetic and/or hypertensive and 27% reported chronic glomerulonephritis as the aetiology of their kidney failure. The diagnosis of chronic kidney disease was made when patients were at end stage renal disease requiring intervention in 84.2% of persons. The employed population of patients constituted 65% of renal transplant recipients, 43.75% of peritoneal dialysis patients and 22.86% of haemodialysis patients. The patient's physician had the greatest influence on renal replacement therapy choice (85.4% haemodialysis, 85% peritoneal dialysis, 71% transplant
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