A Case of Hepatic Injury Following Shrapnel Injury to the Abdomen in a Paediatric Patient

In children, trauma is the leading cause of morbidity and mortality worldwide. Trauma can be a catalyst resulting in intra-abdominal solid organ injury in this population. The case report highlights a prepubescent male who presented with a penetrating abdominal wound resulting in hepatic injury. The mechanism of injury in this case is unusual and differs from previously reported causes of penetrating abdominal trauma in children. The case demonstrates that penetrating abdominal injuries may be more likely to require surgical intervention secondary to their association with a high percentage of multiple organ injuries. Penetrating injuries in children require a high degree of vigilance to rule out visceral injury.

Risk factors associated with COVID-19 Intensive Care Unit hospitalisation in Guyana: A cross-sectional study

Objective The purpose of the study was to determine risk factors associated with COVID-19 ICU hospitalisation at Georgetown Public Hospital Corporation (GPHC), Guyana. Methods A retrospective chart-review was conducted on all COVID-19 admissions from March to September 2020. The predictive factors were demographics, comorbidities, signs and symptoms of COVID-19 and laboratory findings on admission. Descriptive frequency analysis was done for all independent variables and the Chi-square test was used to compare differences between groups where suitable. Univariate and multivariate binary logistic regression was used to examine the association between the independent variables and the risk for ICU hospitalisation. Results There were 136 patients with COVID-19 at GPHC during March to September 2020 and after exclusion, 135 patients were used in the study. There were 72 (53.4%) patients who required non-ICU care, while 63 (46.6%) ICU care and average age ± SD (median) was 51 ±16 (n= 49) and 56 ±18 (n= 60), respectively. In the multivariate regression model, the odds of ICU admission for those aged 40-65 was 0.14 (p <.01) compared to those > 65 years. Patients with class 2 and above obesity had higher odds of ICU admission compared to non-obese patients OR 11.09 (p= .006). Patients with 2 and 3 or more comorbidities also had higher odds of ICU admission compared to those with no comorbidities OR 7.83 (p= .03) and 132 (p <.001), respectively. Patients with LDH 228-454 U/L and > 454 U/L on admission had higher odds of ICU admission compared to those with normal LDH OR 19.88 (p= .001) and 23.32 (p= .001), respectively. Patients with albumin < 3.50 mg/dL on admission also had higher odds of ICU admission compared to those with normal albumin OR 5.78 (p= .005). Conclusion Risk factors associated with ICU hospitalisation were advanced age, obesity, multiple comorbidities, elevated LDH and low albumin. Protecting the population at risk for ICU admission and prioritizing them for vaccination is recommended to reduce the risk of running out of ICU capacity.

Surgical Perspective: UWI Graduates Path to a Certificate of Completion of Training (CCT) & Fellowship in the UK

Surgical post graduate training is a rapidly evolving field that has seen major technological shifts in its delivery of care. Our aim in this article is to deliver a viewpoint of a contemporary roadmap for the University of the West Indies (UWI) graduate. The overall path and length of training schemes in the United Kingdom (UK), in respect to general surgery and urology is presented. It is important for the reader to understand that the UWI graduate has many different avenues they can pursue to gain entry onto a UK surgical training programme. The Caribbean should benefit from the connectivity and collaboration with our international colleagues. Keywords: surgery, postgraduate, training, general surgery, urology, fellowship

Surgical Resection of a Foramen Magnum Meningioma—A Rarely Encountered Skull Base Tumour in Trinidad

Tumours of the foramen magnum are infrequent compared to other locations within the neuraxis. Meningiomas are one of the most frequently encountered tumours of the nervous system, but only 1.8 to 3.2% actually originate within the foramen magnum. However, they account for almost 50% of all tumours in this region. We report a case of a large foramen magnum meningioma in a 16-year-old female, the diagnostic difficulty it presents due to its rarity and indolent course, and the surgical strategies employed to manage this case. This was the first performance of a far-lateral craniotomy in San Fernando General Hospital. The use of a staged procedure to facilitate this skull base tumour resection resulted in an excellent outcome.

Awake craniotomy for a low-grade glioma - a pilot procedure at a public hospital in Trinidad and Tobago

Awake craniotomies (AC) are proven to reduce the neurological deficit associated with tumour resection in areas of eloquent cortex. Successful performance requires not only technical skill, but the availability of neuronavigation, cortical mapping, intra-operative frozen section and the appropriate anaesthetic support. This case report describes the first fully awake craniotomy done in Trinidad, at a public hospital, for a patient with seizures secondary to a low-grade glioma. It resulted in an excellent patient outcome, with full cessation of seizures and no postoperative deficits.

An Assessment of Work Environment Factors Correlating with Burnout Status of Physicians Employed with the Public Hospitals Authority in The Bahamas

Objective To identify the prevalence and factors associated with the Burnout Syndrome in physicians working in the Public Hospitals Authority (PHA), Nassau, Bahamas. Methods A cross-sectional study was done in 2014 utilising a self-administered survey comprising of demographics, general health, work environment, and Maslach Burnout Inventory items to assess burnout among physicians working in nine (9) departments of PHA. The IBM SPSS (v. 20.0 or more current) Statistical Analyses software was used for data analysis. Results The study participants were 153 physicians. Their mean age was 35.84 (± 7.09) years old; median 34.00 (IQR: 31.00, 40.00) years old, 99 (64.7%) were females. No associations were found among these, other socio-demographic variables measured and burnout status. Physicians in the department of Internal Medicine represented 34 (22.2%), Family Medicine 31 (20.3%), Emergency Medicine 30 (19.6%), Paediatrics 21 (13.7%), and physicians in other departments 34 (22.3%). Of the physicians employed under the PHA, 55.7% collectively exhibited burnout. Poor balance of family life, 15 work environment potential stressors and 4 potential stress relievers were found to each be weakly or very weakly related to burnout status. Postgraduate programme year, irregular sleep pattern and lack of appreciation were moderately strong positively related. Logistic regression analysis showed the key predictors of burnout status to be lack of appreciation (OR=1.69, p=.002) and number of years worked post-internship (OR=.94, p=.039). Conclusion: Physician’s sense of appreciation and number of years post internship were clear predictors of burnout.

Cardiovascular Health in a Single Community in Rural Haiti: A Cross-sectional Study

Introduction There is a growing burden of cardiovascular disease in low- and middle-income countries and assessment of cardiovascular health (CVH) may identify populations at risk for poor CVH. Methods Between July 2014 and August 2014, we performed a household survey from a convenience sample among adult community members in rural northern Haiti. We used a modified World Health Organization STEPwise approach to chronic disease questionnaire to capture self-reported data on tobacco, diet, physical activity, and diabetes, and measured blood pressure and body mass index. We used an adapted American Heart Association definition and thresholds for determining ideal, intermediate, and poor cardiovascular health. We used linear and logistic regression to examine associations between socio-demographic characteristics with CVH score and ideal CVH. Results Among 540 participants (mean [SD] age = 40.3 [17.1] years, 67% women), there was a high prevalence of poor CVH (n=476, 88.1%) compared with intermediate (n=56, 10.4%) and ideal (n=41, 7.6%) CVH. Ideal metrics for blood pressure (47%) and diet (26%) were least often met, while body weight (84%), physical activity (83%), and smoking (90%) were most often met. Men were associated with better CVH score (0.31, [0.04–0.59]; P=0.03), and being a farmer was associated with ideal CVH (P=0.006). Conclusion In this community-based sample of a farming community in rural Haiti, very few adults had ideal CVH. Higher CVH score was associated with male sex, and farming as a primary occupation. Women and non-farmers may represent at-risk subgroups within this population. Blood pressure and diet may represent possible areas for improvement. Keywords: Haiti; Cardiovascular Health; Cardiovascular disease epidemiology; Hypertension.

Adherence To Antihypertensive Medications Among Primary Care Centre Attendees in Trinidad: A Cross-Sectional Study

Objective: To determine the adherence levels to antihypertensive medications and its associated factors among primary care attendees in Trinidad. Methods: A cross-sectional study was carried out whereby an interviewer-administered questionnaire was administered to public primary care attendees throughout Trinidad. Non-pregnant hypertensive adults, attending chronic disease clinic on anti-hypertensive medications for at least 1 year were eligible. Results: Of 225 participants (92% response rate), 58% displayed a low level of adherence to anti-hypertensive medications and 73.3% had uncontrolled hypertension, both independent of age, gender, and ethnicity. Experiencing adverse effects to prescribed medications (P=0.003) and self-reported use of herbal/alternative treatment (P=0.024) for hypertension were significantly associated with higher rates of low adherence. Having too many pills to take and fear about the potential effects of these medications on the body were both correlated with low adherence (P< 0.001) Obtaining antihypertensive medications from a national chronic disease assistance program was inversely correlated with low adherence (P= 0.03). There were no statistically significant associations between adherence and average systolic blood pressure (P= 0.20), home self-monitoring (P= 0.75), daily dosing frequency (P= 0.53), or daily number of pills (P= 0.68) Conclusion: Most primary care hypertensive patients who attended chronic disease clinics at primary care health centers around Trinidad were found to have uncontrolled hypertension along with low adherence to antihypertensive medications. Education, screening for herbal use, and improvements to the existing national medication program, are discussed as interventions to improve adherence in this setting. Keywords: Hypertension, Adherence, Antihypertensive medications, Primary Care