Sandeep Maharaj | The University of the West Indies at St. Augustine Trinidad and Tobago (original) (raw)

Papers by Sandeep Maharaj

Not allowed to speak—another let-down for the Caribbean people

The Lancet, Jun 1, 2023

Wound Healing Activity of the Fruit Skin of Punica granatum

Journal of Medicinal Food, Sep 1, 2013

The skin of the fruit and the bark of Punica granatum are used as a traditional remedy against di... more The skin of the fruit and the bark of Punica granatum are used as a traditional remedy against diarrhea, dysentery, and intestinal parasites. The fruit skin extract of P. granatum was tested for its wound healing activity in rats using an excision wound model. The animals were divided into three groups of six each. The experimental group of animals was topically treated with P. granatum at a dose of 100 mg/kg every day for 15 days, while the controls and standard group animals were treated with petroleum jelly and mupirocin ointment, respectively. Phytochemical analysis of the extract revealed the presence of saponins, triterpenes, tannins, alkaloids, flavonoids, and cardiac glycosides. Extract-treated animals exhibited 95% reduction in the wound area when compared with controls (84%), which was statistically significant (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.01). The extract-treated wounds were found to epithelize faster compared with controls. The hydroxyproline content of extract-treated animals was significantly higher than controls (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.05). The fruit skin extract did not show any antimicrobial activity against the microrganisms tested. P. granatum promotes significant wound healing in rats and further evaluation of this activity in humans is suggested.

A Contextual Framework for Sustainability in a Government Funded Health Management System – A Stu... more A Contextual Framework for Sustainability in a Government Funded Health Management System – A Study of CDAP in Trinidad & Tobago Sandeep Bhupendra Maharaj This study examined the relationship among the constructs of the stakeholders’ awareness of context, health care strategies and organization capacities and their ability to create a sustainable Chronic Disease Assistance Programme (CDAP). Samples of 161 pharmacies registered in the CDAP program were surveyed to test four hypothesized relationships among the constructs in creating sustainability. For data analysis two step procedures were undertaken. In the first step, analysis of data imputation was used to obtain composite values for multiple items representing broad level variables. In the second step, descriptive and hierarchical regression analyses were used to test and explain the hypothesis using these variables. Sustainability, a performance construct, was measured on three (3) dimensions, namely performance legitimacy, per...

Challenges

As climate change continues unabated, research is increasingly focused on capturing and quantifyi... more As climate change continues unabated, research is increasingly focused on capturing and quantifying the lesser-known psychological responses and mental health implications of this humanitarian and environmental crisis. There has been a particular interest in the experiences of young people, who are more vulnerable for a range of reasons, including their developmental stage, the high rates of mental health conditions among this population, and their relative lack of agency to address climate threats. The different geographic and sociocultural settings in which people are coming of age afford certain opportunities and present distinct challenges and exposures to climate hazards. Understanding the diversity of lived experiences is vitally important for informing evidence-based, locally led psychosocial support and social and climate policies. In this Project Report we describe the design and implementation of the “Changing Worlds” study, focusing on our experiences and personal reflect...

International Health Trends and Perspectives

The Caribbean Region has been one the hardest hit by the COVID-19 pandemic due to vaccine inequit... more The Caribbean Region has been one the hardest hit by the COVID-19 pandemic due to vaccine inequity, human resource constraints, and pre-existing infrastructural constraints, which led to countries taking viral mitigation and prevention measures for instance border lockdown and states of emergency. While at that phase, treating COVID-19 patients has been the number one priority, several other health services have been neglected, threatening public health. During that period there was significant disruption of healthcare delivery to patients with Chronic non-communicable Diseases in the region which deteriorated capacity issues in the health system, for example Human Resource Deficiencies, Financing of the Health Sector, Governance, and a lack of Health Information Systems. This paper provides an overview of how pandemic insurance claims and big data analytics tools can assist in gaining insights into the current state of the population’s health. Big data and analytical approaches pro...

Advances in Medical Education and Practice

The COVID-19 pandemic precipitated a swift transition to online learning in medical and health sc... more The COVID-19 pandemic precipitated a swift transition to online learning in medical and health sciences. This study investigated the associations of previous experience with online learning, current confidence with online learning, and resilient coping skills with perceived stress reported by pharmacy students during the emergency transition to online learning. Methods: Undergraduate pharmacy students (N=113, response rate = 41%) completed an online, self-report, cross-sectional survey during April-June 2020. Measures included Likert items measuring prior experience and current comfort levels with online learning, the Brief Resilient Coping Scale (BRCS), and the Perceived Stress Scale 10-Item Version (PSS-10). Experience, comfort with online learning, reported scores, and internal consistency for the BRCS and PSS-10 were summarized. A linear regression model examined the associations of prior experience with online education, gender, and resilient coping with perceived stress. Results: Of the 113 respondents (78% female, mean age 22.3 years), > 50% had only occasional prior experience with online learning, coursework, and examinations, but 63% expressed confidence with online learning. Mean PSS-10 and BRCS scores were 23.8 and 13.3, respectively, and both scales demonstrated good internal consistency (α > 0.80). BRCS score was the single predictor of the PSS-10 score (r 2 = 0.18, p < 0.001). Female gender was not a significant predictor (p = 0.11). A multiple regression model explained moderate variation in perceived stress (adjusted R 2 = 0.19). Conclusion: PSS-10 and BRCS scores indicated moderate levels of stress and coping skills among students during online teaching. Most students had some prior exposure to online learning, coursework, and examinations. Higher resiliency scores, but not prior online learning experience, predicted lower perceived stress.

The Lancet Regional Health - Americas

The CARICOM region has experienced significant challenges during the COVID-19 pandemic, one being... more The CARICOM region has experienced significant challenges during the COVID-19 pandemic, one being issues surrounding mental health. This article seeks to highlight that mental health was a major issue prior to the pandemic and the situation could be potentially worst. Therefore we suggest supporting communities remains a pivotal tool in the armamentarium in dealing with diseases that have psychosocial aspects. Collaboration with regional bodies, transnational organizations and philanthropic entities and the process of health diplomacy will open the means through which valuable resources can become available. CARICOM as a Regional health body should be empowered to recognize population mental health challenges as a real and present danger to the well-being of the persons under its care and have an actionable plan that is realistic and sustainable.

Prehospital and Disaster Medicine

Introduction:The United Nations (UN) recognizes Small Island Developing States (SIDS) as a hetero... more Introduction:The United Nations (UN) recognizes Small Island Developing States (SIDS) as a heterogenous group with common geographic and socio-economic challenges. Their vulnerability to disasters was exacerbated during COVID-19 because of emerging nationalism and protectionism towards supply chains and resources. This study aimed to determine if multilateralism engagement improved COVID-19 outcomes and if Foreign Affairs investment improved short term COVID-19 outcomes.Method:Metrics were developed to reflect country parameters, clinical impact of COVID-19, engagement in multilateralism, health systems strength and integration in the International Political Economy. Open-source information was used to quantify proxy measures with the calculated percent spent on foreign affairs being the major proxy of multilateralism and disaster impact as lag time to vaccination, case burden and deaths in the first six months of 2020. Data was collected for each of the 38 SIDS. SPSS was used to as...

Cureus

Objective: This study assessed the risk factors for sustaining a snake bite, the prehospital meas... more Objective: This study assessed the risk factors for sustaining a snake bite, the prehospital measures employed, and the clinical needs of patients admitted with confirmed envenomation. Methodology: Data was collected at a single center, a rural secondary care hospital in Trinidad and Tobago. A cross-sectional method was used that enrolled all consenting patients requiring admission following clinical confirmation of snake envenomation during the period 2017-2019. Data collection involved a review of the patient record from the emergency room and hospital admission to establish the clinical need during the time of admission which was defined as the administration of medication, need for surgery, and critical care intervention. Data collection also involved a patient interview to establish demographics, prehospital measures employed, and assessment of the risk factors associated with sustaining the snake bite. Results: 29 patients were admitted for snakebite envenomation during 2017-2019 and all patients consented to enrolment. Of these patients, 22 were male and most commonly were within the age range of 18-40 years old. 34.5% of patients were farmers and 68.9% of patients identified being bitten by the Mapepire Balsain snake. 65.5% of patients reported being unaware of the risk of snake bites and 82.8% were not wearing boots, with the lower limb being the most common bite site among 55.2%. 41.4% of bites were sustained during work-related activity while 34.5% of bites were sustained during recreational activity. Prehospital measures were employed by 18 of the 29 patients with the most common types being irrigation (10.3%), cutting (6.9%), tourniquets (44.8%), pressure immobilization (6.9%), topical applications (3.4%), and ingestion of a substance (6.9%). 34.5% received hospital care within 1 hour of the bite while 55.2% arrived at the hospital between 1 and 4 hours of being bitten. The clinical challenges of these patients included local reactions (82.8%), coagulopathy (72.4%), compartment syndrome (17.2%), cellulitis (3.4%), and dislocated shoulder (3.4%). The clinical needs of these patients included vitamin K (13.8%), antibiotics (93.1%), tetanus shots (17.2%), analgesia (6.8%), and anti-venom (82.7%). 10.3% of patients required debridement and 3.4% required a fasciotomy. The average stay in the hospital was 3.8 days. There were no documents of deaths or need for critical care. Conclusion: Persons are most likely to be envenomated by the M. Balsain in Trinidad. These patients are commonly males ranging anywhere from 18 to 40 years presenting local reactions and coagulopathy needing admittance to the hospital. While the majority of patients requiring admission performed some type of prehospital measure, very few did so with pressure immobilization. Furthermore, the majority of patients had a prolonged time before presenting to the hospital; this is a potential area for improvement in the health system through education and sensitization. There was a significant utilization of resources on these patients when taking into consideration their clinical needs, medication, and hospital stay; primary prevention should be a focus through the education of groups who are at higher risk for a venomous snake encounter.

Implementation-Challenges, Performance-Management & Developing Country Correspondence to Author

Asian journal of biochemical and pharmaceutical research

Abstract: The aim of present work is to develop and validate spectrophotometric methods for the d... more Abstract: The aim of present work is to develop and validate spectrophotometric methods for the determination of Ropinirole in pharmaceutical formulation. Distilled water was used as a solvent throughout the study. Quantitative determination of Ropinirole in pharmaceutical ...

A Review of the Article: Naturopathic medicine for the prevention of cardiovascular disease: a randomized clinical trial

Caribbean Medical Journal, 2014

Journal of Global Health, 2021

Electronic supplementary material: The online version of this article contains supplementary mate... more Electronic supplementary material: The online version of this article contains supplementary material. Funding: There were no funding requirements for this paper. Authorship contributions: All authors contributed equally to conceptualization of the article, review and development of the article.

Pharmaceutical Policy in Trinidad and Tobago

This chapter describes the pharmaceutical policy landscape in Trinidad and Tobago. The Republic o... more This chapter describes the pharmaceutical policy landscape in Trinidad and Tobago. The Republic of Trinidad and Tobago is a twin-island democratic nation located off the north coast of Venezuela in the Caribbean. The country is experiencing an epidemiological transition with a decline in the incidence of communicable diseases, and increases in chronic, noncommunicable diseases. Therefore, it is critical that pharmaceutical polices are reflective of our new health realities.

Relationship of C-Reactive Protein, Uric Acid, Lipid Profile with Type 2 Diabetes Mellitus in Trinidad

Objectives: To examine the relationship of C-reactive protein (CRP), lipid profile, uric acid, ag... more Objectives: To examine the relationship of C-reactive protein (CRP), lipid profile, uric acid, age and gender in subjects with type 2 diabetes and to determine whether there are links between these variables and disease manifestations. Methods and materials: A retrospective study comprised 206 patients from two major hospitals of Trinidad and Tobago with (67) and without (139) diabetes. Results: There were 117 females (57%) and the majority of participants were Indo-Trinidadians (60.7%). The diabetic subjects had elevated C-reactive protein (0.95 mg/L±1.6), uric acid (6.0 ± 2.1), triglycerides (155.53 ± 82.14) and LDL cholesterol (123.35± 51.84) when compared to non-diabetic population with CRP (0.48 mg/L± 0.56) uric acid (5.66 ± 2.47), triglycerides (138.39 ±72.22) and LDL-cholesterol (117.36 ± 35.50). The incidence of diabetes showed a normal distribution, increasing with age and peaking in the 50-59 age groups. An association was observed between uric acid and lipid profile in diabetic subjects. After adjustment for age and gender, in the diabetic population with an elevated CRP, a direct relationship was observed between uric acid and cholesterol levels as the same patients show marked elevations in both categories. Conclusions: Our study did not found any useful predictors for CRP and diabetic subjects. The CRP levels within the participants fluctuated to a great extent and showed no correlation with increased uric acid, lipid profile or diabetic status.

To assess the impacts of use of information technology for electronic dispensing, patient databas... more To assess the impacts of use of information technology for electronic dispensing, patient databases, inventories, ordering and purchasing processes, security, advertising and sales in pharmacies and how it affects the retail sector of business in Trinidad and Tobago.

Journal of Pharmaceutical Policy and Practice

Background A dispensing error can be defined as an inconsistency between the drug prescribed and ... more Background A dispensing error can be defined as an inconsistency between the drug prescribed and drug dispensed to a patient. These errors can lead to ineffective and sometimes unwanted pharmaceutical outcomes. Dispensing errors can be harmful or even fatal to patients. Case presentation The objective to this study was (a) to determine the types and frequency of dispensing errors at the Eric Williams Medical Sciences Complex (EWMSC), (b) to explore the reasons for the occurrence of dispensing errors, and (c) to make suitable recommendations for their prevention. An observational study for a period of 2 weeks was carried out at various in- and outpatient departments of the EWMSC. The observations were carried out during 7:00 am to 3:00 pm. Dispensing errors identified during this period were recorded and analyzed. Results Sixty-eight errors were identified in the adult outpatient pharmacy of the EWMSC; 19 errors in the pediatric outpatient pharmacy, whereas 22 errors were found in in...

Molecules (Basel, Switzerland), Jan 27, 2017

The present investigation reports the synthesis of a phenylalanine-rich N-methylated cyclopeptide... more The present investigation reports the synthesis of a phenylalanine-rich N-methylated cyclopeptide, cordyheptapeptide A (8), previously isolated from the insect pathogenic fungus Cordyceps sp. BCC 1788, accomplished through the coupling of N-methylated tetrapeptide and tripeptide fragments followed by cyclization of the linear heptapeptide unit. Structure elucidation of the newly synthesized cyclopolypeptide was performed by means of FT-IR, ¹H-NMR, (13)C-NMR, and fast atom bombardment mass spectrometry (FABMS), and screened for its antibacterial, antidermatophytic, and cytotoxic potential. According to the antimicrobial activity results, the newly synthesized N-Methylated cyclopeptide exhibited potent antibacterial activity against Gram-negative bacteria Pseudomonas aeruginosa and Klebsiella pneumoniae and antifungal activity against dermatophytes Trichophyton mentagrophytes and Microsporum audouinii at a concentration of 6 μg/mL, in comparison to the reference drugs, gatifloxacin an...