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Objective: To determine the efficacy of levofloxacin loaded niosomes in treating Sprague Dawley rats infected with Pseudomonas aeruginosa (ATCC 27853). Design and Methodology: Three groups of six (6) animals were infected with a known dose of the pathogen i.e. Pseudomonas aeruginosa via the intraperitoneal (ip) route. At six (6) hours post infection the infected animals were treated with drug free niosomes (control), free levofloxacin (conventional) and levofloxacin trapped in niosomes (ip). Blood was collected via tail snips at days 0,1,3,5,7 and 10 for complete blood counts and viable bacterial counts by colony forming units (CFU/µl). At day 10 the animals were sacrificed and samples from the kidney, liver and spleen were examined for bacterial counts. Results: All animals in the control group succumbed to the infection; one animal from the conventional group died. All niosome treated animals survived. The mean lymphocyte count (X109) was lower for the niosome (7.258±1.773) versus conventional (17.684±10.008) (p<0.03) treated groups at day ten (10). Neutrophil counts (X109) were lower for the niosome (2.563±1.609) versus conventional (6.2±6.548) p<0.02) treated groups. The CFUs in the bloodstream were similar for both treatment groups; the niosome treated group showed greater reduction in liver, kidney and spleen CFUs versus the conventional group (1.33±2.074) vs (5.8± 3.74) (p< 0.043), (1.5±2.35) vs (9.6±8.65) (p< 0.038) and (3.8 4.71) vs (25.6 14.66) (p<0.007) respectively. Conclusions: Further work is recommended on niosomes as a drug delivery system to treat intracellular infections.

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OBJECTIVES: To study the utilization pattern and the cost of sedatives, analgesics and neuromuscular blocking agents in a multidisciplinary intensive care unit (ICU) METHODS: A prospective observational study was conducted in the ICU of the Eric Williams Medical Sciences Complex, Trinidad and Tobago, for a period of twelve weeks. All patients admitted to the ICU were enrolled. No interventions were done. Data collected included demographics, diagnoses on admission, length of stay in the ICU, status of mechanical ventilation, patient outcome, quantity of sedatives, analgesics and neuromuscular blocking agents used in every patient and their cost. RESULTS: There were 333 patient-days encountered from 34 patients studied. Midazolam, fentanyl and cisatracurium were the most commonly used sedative, opioid and neuromuscular blocking agents respectively. The total cost of drugs used for sedation, analgesia and neuromuscular blockade was approximately US$ 19 600 per annum. Cost for this treatment alone accounted for more than 50% of the total ICU drug costs. The costs were significantly higher in patients who stayed more than two weeks in the ICU when compared to those who stayed less than two weeks (p < 0.001). CONCLUSIONS: The study highlights the utilization pattern and financial burden of sedation, analgesia and neuromuscular blockade in the delivery of critical care.

OBJETIVOS: Estudiar el patrón de utilización y costo de los sedantes, analgésicos, y agentes de bloqueo neuromuscular en una Unidad Multidisciplinaria de Cuidados Intensivos (UCI). MÉTODOS: Se llevó a cabo un estudio prospectivo en la UCI del Complejo de Ciencias Médicas Eric Williams, en Trinidad y Tobago, por un período de doce semanas. Todos los pacientes ingresados a la UCI fueron enrolados. No se realizaron intervenciones. Los datos recogidos incluyeron demografías, diagnósticos de ingreso, longitud de la estadía en la UCI, estatus de ventilación mecánica, evolución del paciente, así como la cantidad y el costo de los sedantes, analgésicos y agentes de bloqueo neuromuscular usados en cada paciente. RESULTADOS: Se encontraron 333 días-pacientes a partir de 34 pacientes estudiados. La midazolama, el fentanil y el cisatracurio fueron los agentes sedativos, opioides y de bloqueo neuromuscular más comúnmente usados. El costo total de los medicamentos usados para la sedación, la analgesia y el bloqueo neuromuscular fue de aproximadamente $19 600 USD por año. El costo sólo para este tratamiento representó más del 50% del total de los costos de medicamentos de la UCI. Los costos fueron significativamente más altos en pacientes que permanecieron más de dos semanas en la UCI, en comparación con aquellos que permanecieron menos de dos semanas (p < 0.001). CONCLUSIONES: El estudio pone de relieve el patrón de utilización de la carga financiera de la sedación, analgesia y bloqueo muscular a la hora de ofrecer atención crítica.

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OBJECTIVES: To study the utilization pattern and the cost of sedatives, analgesics and neuromuscular blocking agents in a multidisciplinary intensive care unit (ICU). METHODS: A prospective observational study was conducted in the ICU of the Eric Williams Medical Sciences Complex, Trinidad and Tobago, for a period of twelve weeks. All patients admitted to the ICU were enrolled. No interventions were done. Data collected included demographics, diagnoses on admission, length of stay in the ICU, status of mechanical ventilation, patient outcome, quantity of sedatives, analgesics and neuromuscular blocking agents used in every patient and their cost. RESULTS: There were 333 patient-days encountered from 34 patients studied. Midazolam, fentanyl and cisatracurium were the most commonly used sedative, opioid and neuromuscular blocking agents respectively. The total cost of drugs used for sedation, analgesia and neuromuscular blockade was approximately US$ 19,600 per annum. Cost for this treatment alone accounted for more than 50% of the total ICU drug costs. The costs were significantly higher in patients who stayed more than two weeks in the ICU when compared to those who stayed less than two weeks (p < 0.001). CONCLUSIONS: The study highlights the utilization pattern and financial burden of sedation, analgesia and neuromuscular blockade in the delivery of critical care.

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The extract of Vanda roxburghii was administered topically to rats at a dose of 150mgkg(-1) day(- 1) for 10 days and was studied for its effect on wound healing, using the excision wound model. A 60 per cent reduction in wound diameter was observed in the test group rats receiving the extract compared to controls (48 per cent). Significant increases in wet and dry granulation tissue weights (P < .001), hydroxyproline (P < .001), and hexosamine (P < .003) contents were detected. An increase in protein content was also detected in the test group (P > .05, ns). These findings are consistent with wound healing at cellular levels. The pro-healing action may be attributed either to increased collagen deposition or to better alignment and maturation or both. The test wounds (extract-treated wounds) were, on average, fully healed by the 13th day, whereas the control group healed, on average, by the 20th day. These data suggest that the extract of Vanda roxburghii administered topically has wound-healing potential in rats.

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The aim of this study is to describe the epidemiological features of acute poisoning in children less than 16 years old who were admitted to a paediatric hospital in north Trinidad. The specific objectives included the determination of the age range most susceptible to poisoning, which agents are mainly responsible, an examination of the need for preventive strategies and educational programmes as well as to evaluate the need for a poison control centre in the country. Data were extracted from the medical records of 169 patients (83 males (49%) and 86 females (51%) with acute poisoning during the period of January 1998 to December 2000. The results revealed that the majority of cases of poisoning were accidental (84.6%), suicide (11.2%) and forced poisoning (4.1%). The largest category of poisoning was a miscellaneous group (24.8%) followed by the drug category (21.8%), kerosene (19.5%), pesticides (15.9%) and bleach (9.4%). Paraquat ingestion constituted 5.3% of cases. The highest prevalence of acute poisoning occurred within the age group of 0-4 years (69.2%), followed by the age group of 10-13 years (13.6%), 5-9 years (9.4%) and the age group with the lowest incidence was 14-16 years (7.6%). The only fatality was a female (10-13 year-group) and this was due to suicidal ingestion of paraquat. All other cases were treated and subsequently discharged. The frequency of accidental poisoning in Trinidad merits more widespread public education aimed at preventing exposure to toxic substances while increasing the use of deterrents such as child-resistant containers.

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The aim of this study is to describe the epidemiological features of acute poisoning in children less than 16 years old who were admitted to a paediatric hospital in north Trinidad. The specific objectives included the determination of the age range most susceptible to poisoning, which agents are mainly responsible, an examination of the need for preventive strategies and educational programmes as well as to evaluate the need for a poison control centre in the country. Data were extracted from the medical records of 169 patients (83 males (49) and 86 females (51) with acute poisoning during the period of January 1998 to December 2000. The results revealed that the majority of cases of poisoning were accidental (84.6), suicide (11.2) and forced poisoning (4.1). The largest category of poisoning was a miscellaneous group (24.8) followed by the drug category (21.8), kerosene (19.5), pesticides (15.9) and bleach (9.4). Paraquat ingestion constituted 5.3 of cases. The highest prevalence of acute poisoning occurred within the age group of 0-4 years (69.2), followed by the age group of 10-13 years (13.6), 5-9 years (9.4) and the age group with the lowest incidence was 14-16 years (7.6). The only fatality was a female (10-13 year-group) and this was due to suicidal ingestion of paraquat. All other cases were treated and subsequently discharged. The frequency of accidental poisoning in Trinidad merits more widespread public education aimed at preventing exposure to toxic substances while increasing the use of deterrents such as child-resistant containers

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A number of crude extracts from folk medicinal plants were screened for cytotoxicity against the human T-cell leukemia cell line. Fixed aliquots from a quantified cell suspension were incubated for three days in the presence of a control and several different concentrations of the given plant extract

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In order to achieve sustained antiplatelet effect from indomethacin, it was incorporated in a non-ionic surfactant vesicle (niosome). The objective was to study the effect of niosomal-encapsulated indomethacin on platelet function such as inhibition of aggregation and ATP release induced by a variety of agonists (adenosine 5'-diphosphate (ADP), epinephrine, arachidonic acid, ristocetine) and to explore the feasibility of carrier-mediated drug delivery to the platelets. Multilamellar vesicles (niosomes) were prepared from Tween-60 by the lipid hydration method. Freshly prepared human platelet rich plasma (PRP) was used for aggregation/inhibition studies, the extent of which was observed as a change in light transmission measured by the Chronolog Aggregometer. The percent inhibition of aggregation induced by the agonist ADP ranged from 28. 21+/-0.28 at the 2.0 micromol level to 92.6+/-1.20 at 12.7 micromol of the encapsulated drug while the same concentrations of the drug inhibited aggregation only to the extent of 13.75+/-0.13 and 36. 82+/-0.57%, respectively. A 100% inhibition of aggregation induced by arachidonic acid was achieved by niosomal indomethacin while inhibition by the free drug was 41.9% at equimolar concentrations. ATP release study showed that 100% inhibition was achieved by 8 micromol of the encapsulated drug while inhibition by the free drug was 40.00+/-1.82%. Therefore, at equimolar doses, the niosomal drug proved to be more efficient in inhibiting platelet aggregation than the free drug, probably due to greater quantity of the drug reaching the specific site of inhibition in the interior of the platelets and acting directly on the cyclo-oxygenase system to prevent thromboxane formation.

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The early years of the CARE family planning and reproductive health program were geared primarily toward modern methods of contraception and providing services. However, new and fresh opportunities to address reproductive health awareness and natural family planning are now emerging as important options. In these programs, coordination and collaboration with other sectors such as food and nutrition, children's health and natural resource management, combined with more sophisticated approaches for assessing need and reaching communities with information, has resulted in more people being reached than ever before with appropriate options and opportunities for reproductive health awareness and care. There are examples of CARE projects from India, Peru and Nepal where activities which feature working across development sectors and engaging communities to address their individual and collective RH needs are featured. Ways to disseminate information about reproductive health are being broadened to include creative combinations of interpersonal, mass and folk media', whether it be an informal one-to-one counseling session with flipcharts, a community mobilization event, a multi-media campaign, or any combination thereof. Likewise, the target audience need not always be the women of reproductive age, not should the RH messengers always be the medical and public health professionals. What is critical in all of these instances is to craft strategies based on appropriate research and need, continuously monitor progress, refine approaches as necessary, track results and evaluate the process and impact of interventions leading to behavior change. The challenge is not insignificant, but the rewards to be reaped through the improved programs are clearly worth striving for.

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A number of crude extracts from folk medicinal plants were screened for cytotoxicity against the human T-cell leukemia cell line. Fixed aliquots from a quantified cell suspension were incubated for three days in the presence of a control and several different concentrations of the given plant extract

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