In the context of access to oral care in Trinidad and Tobago, medical practitioners appear to be important providers and may benefit from further training in the diagnosis and management of oral diseases.

CD4+ testing is the most predictable indicator of HIV disease progression, and owing to limited resources is widely used to determine whether a patient is eligible for antiretroviral therapy (ART). Currently, in settings where it is available, CD4+ testing is used to determine whether a patient is eligible for ART, and it is more reliable in determining ART eligibility than symptomatic staging. [1,2] Patients who do not have reliable on-site access to testing must often make numerous visits to healthcare facilities for testing blood draws, receiving test results, and routine clinical care visits due to sample and result transportation to and from centralised testing facilities. Furthermore, it has been suggested that up to 80% of patients are lost to follow-up before ART initiation. [3] To overcome some of the challenges associated with centralised laboratory testing and patient loss to follow-up, high-quality pointof-care (POC) diagnostic technologies are available to alleviate critical testing needs in facilities lacking on-site CD4+ testing and provide same-day test results. [4] Firstly, POC CD4+ technologies have the potential to increase patient access to CD4+ testing by reducing test turnaround time, allowing for more immediate clinical decisions, reducing patient loss to follow-up, and increasing the number of patients initiating ART. [5,6] Secondly, POC technologies can reduce the burden of managing an extensive sample transportation network that cannot fully meet patient need and a growing network of conventional instruments that are increasingly difficult to maintain. Thirdly, providing POC testing administered by personnel with minimal technical training can make remote healthcare facilities more self-sufficient and allow for efficient task-shifting of testing and related tasks. [7] Objectives In 2012, the Free State Department of Health in South Africa (SA) implemented the Alere Pima POC CD4+ technology at 30 healthcare facilities. These technologies are used exclusively to determine ART This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

Objective: The aim of this study was to determine the effect of Hydroxyurea on adverse clinical events and haematological indices in paediatric patients with sickle cell anaemia.Method: This study compared the same cohort of patients before and after Hydroxyurea therapy monitoring the rate of adverse events pre and post treatment and haematological indices. Results:Of the 40 patients, the incidence rate of painful crises post-treatment was 80% lower than pretreatment. Post-treatment incidence rates of painful crises managed at home, requiring emergency department care or requiring admission to the ward were also lower 79%, 81% and 84% respectively. There was no significant difference in the incidence of other clinical events. The haemoglobin concentration increased within the first month and plateaued while the mean MCV and MCHC continued to increase until 6 months before plateauing out. The WBC and ANC decreased over the first month before levels stabilized. The reticulocyte % and the ARC decreased over the first 3 months before plateauing while the platelet count remained stable. Conclusion:Hydroxyurea significantly reduced the incidence of painful crises. There were significant increases in haemoglobin, MCV and MCHC with decreases in WBC, ANC, ARC, and reticulocyte percentage while the platelet count remained relatively stable.

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Although this derivation study must be externally validated before widespread use, patients presenting to the ED with an acute UGIB with platelet count of >200 × 10 /L and an INR of <1.3 may be at very low risk for a variceal source of their upper gastrointestinal hemorrhage.