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PURPOSE:Lower extremity amputations and diabetic foot-related complications in the Caribbean population have been previously reported [1-3]. However, there is a lack of evidence which assesses the Quality of life experienced in such amputees. The aim of this study was to determine the health-related Quality of life (HRQoL) in patients after a major lower limb amputation.METHODS:All major lower limb amputations undertaken at a tertiary care institution in Trinidad and Tobago, between January 2012 to December 2016 were analysed. The quality of life was assessed using the EURO QOL 5D-5L tool. Statistical analysis was performed using t-test, ANOVA across various subgroups and Kaplan-Meier for mortality. RESULTS:A total of 134 individuals were still alive and willing to participate in the study. The average of HRQoL index value for the cohort was (0.598), which was significantly lower compared to the population norm p < .05 [4]. Statistically significant differences were also seen between patients who ambulated with a prosthesis (.759) compared to those who used another device (0.562), p < 0.05 and to patients who did not ambulate. A comparable Quality of life was seen between the level of amputation (transtibial versus transfemoral) and gender (males versus females), p values were .96 and 1.0 respectively. The overall mortality rate was 14% at 30-days and 27% at one year.CONCLUSION:Overall Quality of life after major amputation, as well as independent mobilisation with a prosthesis, continues to be problematic in the Caribbean population. Factors adversely related to Quality of life post major amputation include increasing age, problems related to mobility and non-ambulatory patients.

Highlights • Patient history and clinical findings are often not specific enough to arrive at a diagnosis of clear cell gallbladder carcinoma. • Consideration of morphologic and immunophenotypic features are essential to establish a diagnosis of clear cell gallbladder carcinoma. • It is important for clinicians to differentiate gallbladder cancer from metastases that most commonly arise from the kidneys and other possible secondary foci., Introduction Clear cell gallbladder carcinoma accounts for less than 1% of all gallbladder malignancies and demonstrates its unique histopathological characteristics in patients with no prior medical illness or familial predisposition. Presentation of case Here we present a case of a 56-year-old female, with no prior medical conditions presented with a 2-month history of upper abdominal pain. Routine hematological and biochemical tests were unremarkable. An abdominal ultrasound revealed the presence of a gallbladder calculi, and a fundic mass while magnetic resonance cholangiopancreatography revealed a 8.0 cm × 3.5 cm gallbladder mass. Computed tomography imaging excluded any distant haematogenous metastases. An open cholecystectomy with lymphadenectomy was proceeded by staging laparoscopy. Upon pathologic investigation, the morphologic and immunophenotypic features supported a diagnosis of clear cell variant of gallbladder carcinoma. Discussion Pathological prognostications for primary clear cell gall bladder carcinomas are not well defined due to the rarity of cases and possible misidentification as secondary metastases. Foci of adenocarcinoma within the tumor along with immunohistochemical staining probes can be informative in consideration of differential diagnosis. Conclusion In these cases, clinical case management should be personalized for increased survival with the possible incorporation of next generation sequencing approaches to guide therapeutic algorithms. We discuss this exceedingly rare case of the clear cell variant of gallbladder carcinoma in detail, highlighting some of the diagnostic, and clinical challenges.