#TurksandCaicos, December 10, 2023 – A combined team of Ministry of Health and Human Services (MoHHS) and TCI Hospital personnel recently represented the Turks and Caicos Islands at a three-day UKHSA AMS Workshop, which was held in Anguilla between November 29^th and December 1^st, 2023. The team included Mrs. Winsome Hayles-Parker – Lead Medical Technologist in Microbiology, TCI Hospital, Mr. Andre Morgan – National Pharmacist, MoHHS and Ms. Arlene Siebs – Director of the National Public Health Laboratory, MoHHS. The workshop was well attended by physicians, pharmacists and laboratory personnel who hailed from the United Kingdom, St. Helena, Anguilla, Bermuda, British Virgin Islands, Cayman and Montserrat.

The workshop involved both laboratory and non-laboratory sessions. The laboratory sessions were practical sessions that were geared toward the diagnostic technologies used by the various UKOTs in the detection of antimicrobial-resistant (AMR) pathogens and the use of BioFire in diagnostics. Most territories are now equipped with the BioFire Assay Technology, which forms part of the laboratory setup for molecular resistance markers.

The non-laboratory sessions included parallel professional development sessions on topics including AMS, the use of the MicroGuide antibiotic prescribing App, antibiotic surveillance, situational analysis of AMS in the UKOTs and AMS accreditation. Importantly, the attendees were able to discuss case presentations on clinical management and infection prevention and control.

In providing comments, Ms. Siebs stated, “Medical Laboratory Scientists must continue to improve their skills and competency as we work together in combatting AMR through laboratory services. I was thrilled at having the opportunity to compare disc susceptibility testing with automated analysers for the detection of antimicrobial resistance in microorganisms.”  

Mrs. Hayles-Parker believes that “the information gathered will be of value in helping us in the TCI to uphold the standards on AMS and in the long term with the fight against AMR. As we move forward as change agents, we are better able to assist with safeguarding the health and wellbeing of the people of the TCI.”

Mr. Morgan concluded that “the three-day workshop was a major success and I am excited to utilise the information acquired in strengthening the TCI’s National Action Plan for Antimicrobial Resistance, which will, in turn, develop and strengthen antimicrobial stewardship in the Turks and Caicos Islands. I hope that these advances will continue to safeguard against this emerging AMR global threat by implementing strategies that will ensure sustainable pharmaceutical care for the present and future.”

Cleveland Clinic Expert Shares Six Simple Steps to Prevent Vast Majority of Strokes

December 5, 2023 – According to the World Stroke Organization (WSO), stroke is the leading cause of disability worldwide. The WSO says one in four people will have a stroke in their lifetimes, and each year over 12 million people worldwide have strokes. However, it adds that 90% of strokes are preventable by addressing a small number of risk factors that are responsible for most strokes. In The Bahamas, on average 224 people (or 9.56%) die annually from strokes. 

Here, Andrew Russman, DO, Medical Director of Cleveland Clinic’s Comprehensive Stroke Center and a vascular neurology specialist, offers advice on how to reduce stroke risk by better managing existing health conditions and also through implementing lifestyle changes. “These tips are interrelated as most of the lifestyle changes mentioned also play a role in improving management of hypertension, high cholesterol and diabetes, which all increase stroke risk,” Dr. Russman points out.

1. Reduce hypertension

Uncontrolled hypertension – that is, blood pressure that is consistently above 130/80 – is the single most important modifiable risk factor in stroke worldwide, says Dr. Russman.

Aside from medication, an important step in reducing blood pressure is to reduce salt intake, which Dr. Russman says is good advice even if you don’t have high blood pressure. “We recommend consuming no more than 2g of salt per day. I advise my patients to check food labels and nutritional websites for sodium levels as their intake is usually far higher than they realize,” he adds.

2. Be wary of diabetes

It is important to be tested for diabetes, and if diagnosed, to manage the condition wells, says Dr. Russman. He explains that diabetes causes narrowing of small, medium and large blood vessels in the body, including vessels of the eyes, kidney, heart and brain. Owing to this, diabetes can contribute to a variety of vascular, cardiovascular and cerebrovascular problems including stroke. In addition, for patients who have survived a stroke, the risk of having a second is three times higher in those patients whose diabetes is not controlled.

Dr. Russman says that as part of their treatment plan, people with diabetes should have their condition monitored through HbA1C tests, which provide a three-month snapshot of their blood sugar control. “We                                      recommend that these individuals aim for an HbA1C result of 7.0 or less. Taking prescribed medication correctly, watching their diet, exercising regularly, and following their healthcare provider’s recommendations                          will help them achieve this.”

3. Address atrial fibrillation

The WSO says atrial fibrillation is associated with one in four strokes, and Dr. Russman says these strokes tend to be more severe and disabling than strokes associated with other risk factors.

“Atrial fibrillation is a heart rhythm condition characterized by very rapid heartbeats that don’t allow the top left chamber of the heart – the left atrium – to contract normally. Instead, it fibrillates and flutters so blood                         is not ejected normally from the chamber,” he says. “Anytime blood is stagnant for too long, it can form a blood clot that can travel elsewhere in the body. This clot could cause a stroke by blocking a blood vessel in the brain, depriving that part of the brain of the oxygen and nutrients it needs.”

Dr. Russman says atrial fibrillation is the most common acquired heart rhythm disorder in older adults, and its associated risk is strongly related to age. “The older you are, the more at risk you are of acquiring the condition, but also the higher the risk of stroke associated  with the condition,” he says. “It is estimated that up to half of all patients with a heart rhythm condition are not aware of it. However, once diagnosed, atrial fibrillation can be treated with a blood-thinning medication. These do carry some risks, but the benefits far outweigh these in the vast majority of patients.”

4. Manage cholesterol levels

In addition to reducing high levels of low-density lipoprotein (LDL) or ‘bad’ cholesterol through diet, for example, by avoiding saturated fat, individuals might be prescribed statin medications that reduce future risk of heart attacks and strokes. Dr. Russman says these medications, particularly rosuvastatin and atorvastatin, may benefit patients beyond simply reducing cholesterol levels in that they also appear to reduce inflammation and stabilize plaque build-up in blood vessels.

5. Stop smoking

“Any type of smoking is associated with increased risk of cardiovascular disease and stroke, and is strongly associated with accelerated hardening of the arteries and narrowing of blood vessels in the brain, heart and   elsewhere,” says Dr. Russman. “We therefore strongly recommend everyone completely stop any form of nicotine ingestion to significantly reduce their long-term risk for a multitude of diseases.”

6. Adopt a healthy lifestyle

Dr. Russman recommends following an eating plan that is low in saturated fats and sodium, and to avoid alcohol and excessive caffeine consumption. Regular physical activity is also important as it can reduce the risk of stroke directly, but also indirectly as it helps to lower high blood pressure and blood sugar levels. Exercise can also help to reduce stress, as can other activities such as meditation or deep breathing, which is important as stress causes the body to release chemicals that can increase blood pressure, affect hormones and raise blood sugar levels, says Dr. Russman.

Dana Malcolm 

Staff Writer 

December 5, 2023 – Deaths due to HIV/AIDS have been cut dramatically by fifty percent in the past thirteen years and on December 1, which is the annual commemoration of World AIDS Day, the World Health Organization called on communities to stand up to reduce the risks even further.  The 2023 theme is “Let Communities Lead” as a testament to the notion, shared by the WHO, that “we can end AIDS with communities leading the way.”

In the past five decades, treatment surrounding AIDS has increased exponentially and stigma is decreasing. According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), AIDS-related deaths have been reduced by 69% since the peak in 2004 and by 51% since 2010. In 2022, around 630,000 people died from AIDS-related illnesses worldwide, compared to 2.0 million people in 2004 and 1.3 million people in 2010.

“Much more than a celebration of the achievements of communities, it is a call to action to enable and support communities in their leadership role,”  the WHO encourages.

The WHO is now focused on spreading awareness about the status of the pandemic and encouraging progress in HIV/AIDS prevention, treatment, and care around the world.

Locally, among the events planned in the Turks and Caicos Islands is the annual Surf and Turf Horse Racing night on Friday 8th December at Opus Wine Bar and Grill, residents are invited for an evening of food, luck, and chances. All proceeds go towards the Turks and Caicos AIDS Awareness Foundation and Edward Gartland Youth Center.