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Background: Of the seventy million people who suffer from epilepsy, 40 percent of them become resistant to more than one antiepileptic medication and have a higher chance of death. While the classical definition of epilepsy was due to the imbalance between excitatory glutamatergic and inhibitory γ-aminobutyric acid (GABA)-ergic signalling, substantial evidence implicates muscarinic receptors in the regulation of neural excitability. Summary: Cannabinoids have shown to reduce seizure activity and neuronal excitability in several epileptic models through the activation of muscarinic receptors with drugs which modulate their activity. Cannabinoids also have been effective in reducing antiepileptic activity in pharmaco-resistant individuals; however, the mechanism of its effects in temporal lobe epilepsy is not clear. Key Messages: This review seeks to elucidate the relationship between muscarinic and cannabinoid receptors in epilepsy and neural excitability.

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Background: The use of personal protective equipment (PPE) reduces the risk of transmission of infectious agents significantly among healthcare workers (HCWs). The study aimed to investigate the prevalence and characteristics of PPE-related adverse skin reactions among HCWs working at the main COVID-19 isolation center in Barbados. Methods: A cross-sectional web-based online survey was conducted during April to June 2021 which recorded demographic information, details of PPE use and adverse skin reactions including severity and duration of onset of symptoms. Results: Most of the respondents used PPE for consecutive days (77.9%), 1-6 h/day (59.2%), and more than a year (62.5%). Fewer than half of the participants (45.6%) experienced adverse skin reactions from the use of PPE. The reactions were mostly observed in the cheeks (40.4%) and nose bridges (35.6%). Females had more reactions than their male counterparts (p = 0.003). The use of N95 masks and a combination of surgical and N95 masks produced adverse effects predominantly in the ears (60%) and cheeks (56.4%). Binary logistic regression showed that female HCWs (OR = 5.720 95% CI: 1.631, 20.063), doctors (OR = 5.215 95% CI: 0.877, 31.002), and longer duration of PPE use (>1 year) (OR = 2.902 95% CI: 0.958, 8.787) caused a significantly higher prevalence of adverse skin reactions. Conclusion: The PPE-related skin reactions were common among HCWs which mainly occurred due to prolonged use. Preventive measures inclusive of appropriate training of HCWs on the use of PPE are recommended to minimize these adverse events.

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Endometrial cancer data amongst Barbadian women was collected, to inform screening and management in this under-studied population. We analysed all recorded primary cases between January 1st 2008, and December 31st, 2017. Age-specific incidence, and crude mortality rates were calculated. Descriptive statistics characterized demographics, risk factors, prescription data and histopathology. Log-rank tests assessed simple group differences by EC type. Survival analysis based on tumour type was plotted using Kaplein-Meir curves. There were 270 recorded cases of EC, averaging 66 (8.8) years old (SD 8.75), with parity of 3.60 (2.3). Cases were postmenopausal with 257 (95%) experiencing postmenopausal bleeding. Of the 270 cases, 113 (42%) had type 1 tumours and 157(58%) had type 2 tumours. Weak evidence suggests the latter imparted worse survival (log rank test = 0.02). Estimated crude incidence rate was 18.64 per 100,000 women. Crude mortality rate from EC between January 1st, 2008 and December 31st, 2019 was 27%.

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The worldwide use of medicinal plant products has been steadily increasing over the past few decades, whereas the traditional knowledge and practices of these botanical medicines appears to be diminishing. Considering the need to conserve and document these traditions, the objective of this study was to understand the knowledge, attitudes, and practices of people who are familiar with botanical medicines, as well as any factors that may influence the perceptions and behaviours associated with the use of medicinal plants. A previously validated survey instrument assessing knowledge, attitudes, and practices on the use medicinal plants was randomly administered to residents of three rural Barbadian communities. The data was analyzed using descriptive statistics and cross tabulations (Chi-Square Test, Fisher's Exact Test), with a confidence level of 95% and significance level of p < 0.05. One hundred and fifty-four participants completed the survey with a response rate of 96%. From participant responses we found that over 75% of the study population used botanical medicines. Key findings included a diverse repertoire of traditional knowledge on the use of medicinal plants, which included a total of 29 medicinal applications cited across 69 different plant species and 39 families. The most popular species among respondents (irrespective of use) were Pimenta racemosa (Mill.) J.W. Moore (FC = 30, RFC = 0.26), Momordica charantia L. (FC = 28, RFC = 0.24), Zingiber officinale Roscoe (FC = 22, RFC = 0.19) and Annona muricata L. (FC = 21, RFC = 0.18). The findings also show the persistence of medico-cultural concepts such as cleansing and cooling, and identified significant associations between the use of botanical medicines and related practices with demographic variables such as education (p = 0.05; Fisher's Exact Test) and health insurance, χ2 (1, n = 152) = 4.645, p = 0.003. The findings of this study can be used in the identification and archiving of the medicinal plant practices in Barbados and the wider Caribbean, as well as for the larger purposes of biocultural exploration, preservation and further scientific assessment of botanical medicine practices.

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Antimicrobial resistance (AMR) is a serious threat to global public health. It increases morbidity and mortality, and is associated with high economic costs due to its health care burden. Infections with multidrug-resistant (MDR) bacteria also have substantial implications on clinical and economic outcomes. Moreover, increased indiscriminate use of antibiotics during the COVID-19 pandemic will heighten bacterial resistance and ultimately lead to more deaths. This review highlights AMR's scale and consequences, the importance, and implications of an antimicrobial stewardship program (ASP) to fight resistance and protect global health. Antimicrobial stewardship (AMS), an organizational or system-wide health-care strategy, is designed to promote, improve, monitor, and evaluate the rational use of antimicrobials to preserve their future effectiveness, along with the promotion and protection of public health. ASP has been very successful in promoting antimicrobials' appropriate use by implementing evidence-based interventions. The "One Health" approach, a holistic and multisectoral approach, is also needed to address AMR's rising threat. AMS practices, principles, and interventions are critical steps towards containing and mitigating AMR. Evidence-based policies must guide the "One Health" approach, vaccination protocols, health professionals' education, and the public's awareness about AMR.

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HYPOTHESIS / INTRODUCTION: Prior studies have denoted gender differences in the expression and therapeutic benefits of hypertension treatment and clinical outcomes. This study documents for the first time gender differences in the expression of blood and urine angiotensin peptides in normotensive Afro-Caribbean Barbadians (25 males; 26 females). MATERIALS AND METHODS: Participants provided clinical anthropometric measurements, 24h ambulatory blood pressure and urine collections, and a blood sample for measurements of angiotensin peptides. RESULTS: Plasma renin activity ranged between 0.00 and 3.00 ng/ml/h. Plasma and urinary Ang II were comparable in both genders, while urinary Ang-(1-7) was greater in females (p<0.05). Urinary Ang-(1-7) and office systolic blood pressure correlated significantly in females only (p<0.01), while plasma Ang-(1-7) and Ang II correlated significantly in both genders (p>0.05). CONCLUSIONS: A shift in the balance between Ang II and Ang-(1-7) and their respective pressor and depressor axes might be markers of the cardio-renal protective mechanisms that may be present in females of Afro-Caribbean descent.

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PURPOSE: The purpose of our study was to assess the success in the public primary health care clinics in Barbados, a developing nation with a predominantly Afro-Caribbean population, of achieving the targets for the management of type 2 diabetes (T2D) set by local guidelines introduced in 2006. The targets are: A1C < 6.5% (48 mmol/mol), blood pressure (BP) ≤130/80 mm Hg and LDL cholesterol < 1.8 mmol/L. METHODS: A retrospective descriptive chart review of 499 (317 females, 182 males) T2D patients using random quota sampling. RESULTS: Only 41.2% (Men 48.3%, women 36.8%, P = .048) of the patients reached the A1C target, 39.3% (men 48.6%, women 34.0%, P = .002) reached BP target and 8.6% (men 10.8%, women 7.3%, P = .24) reached the LDL target and only 1.2% (n = 3) attained all three targets. CONCLUSION: Similar to other studies in developed and developing countries of varying ethnic composition, there was suboptimal attainment of the defined targets for all parameters and inadequate monitoring. The main predictors affecting the attainment of treatment goals were the frequency of monitoring, duration of the disease, sex and ethnicity related factors. Interestingly, the findings support a possible viewpoint that ethnicity, defined by an interplay of genetics, culture and environmental attributes, is not the single most important predictor for poor target attainment in T2D. The low attainment of the targets emphasizes the question of less rigorous and more individualized treatment to achieve better outcomes in a developing territory as recommended by the 2014 guidelines.

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