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Aim: Despite the implementation of mandatory helmet laws in Jamaica in 1999, compliance remains poor. We carried out a descriptive study of non-compliant motorcycle accident victims in order to define a high-risk population to target for educational campaigns. Methods: Demographic and clinical data were collected from all motorcycle accident victims treated at tertiary referral hospital in Jamaica between January 1, 1999 and January 1, 2007. Pedestrians and automobile passengers involved in collisions with motorcycles were excluded. The demographics of the sub-population of non-compliant patients were analyzed using SPSS version 12. Results: There were 270 motorcycle accident victims, of which 136 (50.4%) were un-helmeted. The majority of non-compliant patients were in the third and fourth decades of life. There were 11 non-compliant females at a mean age of 27 years (SD 8.4; Range 16-42; Median 26; Mode 26) and 125 non-compliant males at a mean age of 32.2 years (SD 109; Range 7-63; Median 30; Mode 27). There were trends toward decreased compliance in females (11/13 females vs 125/257 males) and pillion passengers (23/26 pillion passengers vs 112/244 drivers). Since 1999, there has been a downward trend in the prevalence of non-compliance with helmet laws. Conclusion: The compliance with mandatory helmet use on Jamaica's motorways is low. Educational campaigns targeting high-risk groups may be an effective strategy to improve compliance. Young women in the second and third decades who are pillion passengers on motorcycles comprise a high-risk group that deserves special attention in public health campaigns. It is time for legislators to revise the legislation with special attention to appropriate penalties for non-compliance and motorcycle license issuance protocols. Keywords: * Road Traffic Accident * Helmet * Trauma * Head Injury * Motorcycle * Motor Vehicle Collision, Introduction Motorcycle users contribute 13% of all road traffic accident victims admitted to the University Hospital of the West Indies (UHWI), a tertiary care hospital in Jamaica (1). In 1999, [...]

Motorcycle Collisions place a heavy burden on health care delivery systems in Jamaica. Preventive strategies are important public health issues that may minimize the impact of these injuries on limited health resources. Secondary prevention aims to limit the severity of injury once a collision has occurred. We explore the existing strategies for secondary prevention of motorcycle collision injuries in Jamaica Keywords: ,Motorcycle ,Collision ,Preventive Strategy ,Legislative policy ,Trauma ,Injury ,Road Traffic Accident, Introduction The demand for trauma care in Jamaica has reached epidemic proportions (1-3). In this setting 13% of all road traffic accident victims are injured on motorcycles (1) and the [...]

Objective: To determine the therapeutic outcome after trans-sphenoidal resection of pituitary tumours using the sub-labial paraseptal approach at a tertiary institution in a developing Caribbean nation. Method: A cross-sectional analytical study using data collected from the hospital records of all patients who had sublabial paraseptal trans-sphenoidal (SPTS) hypophysectomy between January 1989 and June 2005 was undertaken. The data were analyzed using SPSS Version 12. Results: There were 119 SPTS hypophysectomies performed over the study period. There were 73 (61.3%) females and 46 (38.7%) males, with a mean age of 45.4 years (SD +/-14.8; Range 10-79; Median 45; Mode 45). These patients presented with visual disturbances (80.7%), non-specific headaches (72.3%), amenorrhoea (21.9%), galactorrhoea (19.3%), cranial nerve palsies (16%) and pituitary apoplexy (5%). Visual failure (80.7%) and endocrinopathies (44.5%) were the main indications for surgery. The operation resulted in adequate resection in 95% of cases, with endocrine cure in 69% and subjective improvement in vision in 41.8% patients. The commoner post-operative complications were transient CSF leaks (5%), with only 1 (0.8%) requiring lumbar drainage, transient diabetes insipidus (10.9%) and permanent diabetes insipidus (0.8%). There was tumour recurrence in 23 (19.3%) patients, nine of them requiring post-operative radiotherapy. There were no surgical deaths. Conclusions: The SPTS approach to pituitary tumours is a safe and effective treatment option in this setting. Heightened clinical vigilance, opportunities for earlier investigation and wider availability of adjunctive pharmacotherapy may improve the results of treatment of this common disorder. Keywords: hypophysectomy craniotomy pituitary tumour trans-sphenoidal operative approach, Introduction Pituitary tumors are relatively common neoplasms, accounting for approximately 10-15% of all primary brain tumours worldwide (1-2). The prevalence of pituitary tumours at the University Hospital of the West [...]

Pituitary tumors account for approximately 10-15% of primary brain tumours worldwide. It is important for clinicians be familiar with the varied modes of presentation since favorable therapeutic outcomes depend on an early diagnosis. We sought to document the clinical presentation in patients with pituitary tumours. Methods: We performed a retrospective analysis of hospital records from all patients with pituitary tumours treated over 15 years from January 1989 to June 2005. The information collected included patient demographics, duration of symptoms, presenting clinical features, visual field testing and hormone assays. Data were analyzed using SPSS version 12.0. Results: Pituitary tumours were present in 119 patients, with a 1:1.6 male to female ratio. There were 73 females and 46 males, who presented at a mean age of 45.4 years (SD +/-14.8; Range 10-79; Median 45; Mode 45).Non-functional tumours were present in 55% of patients at a mean age of 50.8 years (SD +/-13.4; Median 51; Mode 63) while patients with hormonally active tumours presented earlier at a mean age of 39.2 years (SD +/-13.9; Median 38; Mode 45). Visual disturbances were present in 80.7% of patients with hormonally inactive tumours, and included field deficits (79.1%) and abnormal acuity (92.5%). The other non-hormonal presentations included non-specific headaches (72.3%), cranial nerve palsies (16%) and pituitary apoplexy (5%).The commoner endocrine presentations included hyper-prolactinemia (24.4%), amenorrhoea (21.9%), hypothyroidism (7.6%), acromegaly (5.9%), cushing's disease (4.2%) and hyperthyroidism (0.8%). Conclusion: Most patients present relatively late because the majority of pituitary tumours are hormonally inactive. Visual disturbances, headaches and symptoms of hyper-prolactinemia are common presenting complaints. Heightened clinical vigilance and early investigation in patients with suggestive clinical presentations may improve the results of treatment of this common disorder. Keywords: Pituitary Adenoma | Trans-sphenoidal resection | Pituitary Tumour | Clinical Features, Introduction Pituitary tumors are relatively common neoplasms, accounting for approximately 10-15% of all primary brain tumours (1,2,3). The prevalence of pituitary tumours at the University Hospital of the West Indies [...]

During the first 36 months after its introduction to Jamaica, ERCP was performed with relatively high overall morbidity and poor therapeutic success. We sought to evaluate outcomes after eight years of experience with ERCP at a tertiary level hospital in Jamaica. All consecutive patients who had ERCP performed between March 1999 and March 2007 were identified from an operative log. Their hospital records were retrospectively analyzed. There were 369 procedures performed over the study period, but the final analysis was performed on 301 patients who met the inclusion criteria. There were 79 males and 222 females, with a mean age of 45.0 years (SD +/-18.6; range 14-94). There has been a reduction in the incidence of post-ERCP pancreatitis (5.3% vs. 10%) and overall morbidity (24/301; 7.97% vs. 12.5%). The commoner complications included pancreatitis (16/301; 5.32%), ascending cholangitis (8/301; 2.66%), perforation (0) and hemorrhage (0). There were 4/301 (1.33%) deaths directly resulting from an ERCP complication (ascending cholangitis in 3; multiple organ failure from severe pancreatitis in 1). There has also been improvement in the success of stone clearance from the common bile ducts (55/72; 76.39%) and biliary stenting (32/36; 88.89%). Currently, local endoscopists are performing ERCP with acceptable morbidity and mortality compared to international standards. Keywords: Endoscopic retrograde cholangiopancreatography, Endoscopic sphincterotomy, Choledocholithiasis, Post-ERCP pancreatitis, Table of Contents Abstract Introduction Method Results Discussion Conclusions References Introduction Endoscopic retrograde cholangiopancreatography (ERCP) was introduced to Jamaica in 1999. During the first 36 months of its use, only [...]