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Background: Anastomotic leakage remains a concern in general surgical practice. The significance lies in the resultant abdominal sepsis, related morbidity and mortality, risk of anastomotic loss, permanent stoma creation and the effect on local recurrence and overall patient survival in colorectal cancer cases., Objectives: This study serves to determine the leak rates and the mortality thereof related to colonic and rectal anastomoses at the University Hospital of the West Indies (UHWI) in Kingston, Jamaica. Independent factors contributing to anastomotic leaks in these patients will also be assessed and correlations determined., Methods: A review of the medical records of one hundred and thirty-three cases of colonic and rectal anastomoses identified retrospectively over a three-year period provided relevant information for analysis., Results: Anastomotic leaks were identified in twelve patients, providing a leak rate of 9.0%. No 30-day mortality related to anastomotic leakage was noted. Based on a multivariate analysis, male gender was identified as the sole independent factor related to anastomotic leakage., Conclusion: Colorectal anastomotic leak rates at UHWI fell at the upper limit of leak rates typically quoted in the literature. No modifiable risk factor appeared to contribute to this leak rate. Early identification and intervention is critical in limiting mortality associated with colorectal anastomotic leakage.

Objective: To determine accuracy of knowledge and sexual behaviour patterns of junior high school students in New Providence towards HIV/AIDS and identify gender variations., Methods: A cross-sectional study with cluster sampling of classrooms was undertaken at two schools utilizing a questionnaire. SPSS was used for statistical analysis., Results: Three hundred and fifty-four students participated in the study; the mean age was 12.25 years, 55.1% males and 44.9% females. Most (88%) students identified sexual intercourse as a mode of HIV transmission, 62.5% were accurate regarding anal sex and 32.9% were accurate about sexual intercourse in the water, as modes of HIV transmission. Abstinence was identified as a method of HIV prevention by 54.1% of students although 85.2% of students knew that condoms were a method of prevention. On beliefs regarding transmission, 21.2% believed mosquito bites and 13.1% believed toilet seats were routes for disease spread. Only 16.9% of participants reported a history of sexual intercourse; of those, 57.6% indicated that they were age ≤ 10 years when they first had intercourse. Concerning use of birth control, 64.5% of sexually experienced respondents reported never using any method., Conclusion: Junior high school students have fairly accurate knowledge of HIV/AIDS but misconceptions regarding transmission are still prevalent; patterns in gender variation are few.

Background: Propofol sedation is increasingly used for colonoscopy and may be associated with increased satisfaction and efficiency in diagnostic and therapeutic endoscopy. However propofol has a relatively narrow therapeutic window as it frequently produces deep sedation, and can precipitate respiratory depression., Aim: To determine the efficacy, safety and patient satisfaction with propofol sedation in patients undergoing colonoscopy at the University Hospital of the West Indies (UHWI)., Methods: Patients undergoing outpatient colonoscopy at the UHWI who were sedated with propofol were studied. Boluses of 10 - 20 mg of propofol at intervals of 2 - 5 minutes, as needed for adequate sedation, were administered after initial induction. Continuous monitoring of the pulse rate, and oxygen saturation were performed and the blood pressure checked every 2 - 5 minutes. All patients received supplemental oxygen (4 L/min). The following observations were recorded: the endoscopist recorded the ease of the procedure, the anaesthetist recorded the comfort of the patient throughout the procedure and at the time of discharge, and the patient stated the degree of satisfaction with the procedure. Any unusual events were recorded., Results: Sixty consecutive patients sedated with propofol were studied. There were 28 (46.7%) males, with a mean age of 58.3 years and 32 (53.3%) females, with mean age of 59.5 years. Most were normal healthy patients (56.6%). Comorbid illnesses were present in 43.4%, with hypertension being most common (23.3%). All patients were classified as ASA class 1 and 2. The average dose of propofol used was 180 mg (range 50 - 355 mg). The mean duration of colonoscopy was 19.5 minutes. The mean recovery period (able to stand) was 29.6 minutes. There were no documented cases of significant hypotension, bradycardia, or hypoxaemia during the procedure. Transient apnoeic episodes during the initial stages of sedation occurred in 12 (20%) patients. The majority of patients (91.7%) rated the experience as being extremely good or excellent. The majority could not recall the actual colonoscopy and there were minimal subjective reports of nausea or discomfort during the procedure., Conclusions: Propofol sedation was associated with quick recovery and excellent satisfaction by patients and is a suitable alternative for sedation for colonoscopy in Jamaica.

Objective: To assess the knowledge, compliance and practice among healthcare workers of occupational infection control at two hospitals in Jamaica., Methods: Employing a cross-sectional study design, medical personnel (physicians and nurses) at two hospitals in Jamaica, were studied, utilizing a structured questionnaire consisting of 14 items to collect the data., Results: Participants considered the following fluids, not blood stained, high risk for HIV transmission: breast milk (79%), saliva (14%), urine (27%), pleural fluid (53%), CSF (55%), synovial fluid (37%), faeces (27%), peritoneal fluid (53%) and vomitus (21%). The respondents estimated the risk of transmission of infection after a needlestick injury from a patient with: HIV, mean 22.5%, HB, 34% and HCV, 26%. Needles for drawing blood were identified as having the highest risk for transmission of infections in 63%. The following precautions were adhered to all the time: wearing gloves (38%), not re-sheathing needles (22%), not passing needles directly to others (70%), properly disposing of sharps (86%) and regarding patients' blood and other high risk fluid as potentially infected (62%). Post exposure, 43% indicated bleeding/squeezing the NSI site as the initial first-aid procedure, washing with soap and water (29%) and irrigating the area with water (20%)., Conclusions: Healthcare workers are aware of the risk of transmission of infection, however compliance with universal precautions was inadequate. An improvement in knowledge and practice with clear guidelines are needed and a comprehensive programme to educate HCWs regarding compliance with universal precautions is urgently required.

Backgrounds: Febrile neutropaenia is a common complication of chemotherapy in cancer patients. Empirical antibiotic regimes are based on the epidemiological characteristics of bacterial isolates globally and locally., Method: This study retrospectively reviewed all cases of febrile neutropaenia in patients with confirmed cancer admitted at the University Hospital of the West Indies in the four-year period between, January 1, 2003 and December 31, 2006 and who received chemotherapy. Cases were identified from blood culture records and hospital charts which were reviewed to determine the aetiological agents causing bacteraemia, their antimicrobial susceptibilities and clinicalfeatures. These cases were compared with non-neutropaenic cancer patients admitted with fever., Results: A total of 197 febrile episodes in cancer patients were reviewed. Thirty-seven per cent had febrile neutropaenia while 62% were non-neutropaenic. Acute myeloid leukaemia was the most common haematological malignancy and the most common solid tumour was breast cancer. Twenty-six per cent of patients had a positive blood culture. In febrile neutropaenic patients, Escherichia coli was the most common organism isolated followed by coagulase-negative staphylococci while in non-neutropaenic patients, coagulase-negative staphylococci was most common. Acinetobacter infections was prominent in non-neutropaenic patients but absent in neutropaenic patients. More than one organism was cultured in 9 neutropaenic and 18 non-neutropaenic patients. Mortality was 10.8% in neutropaenic and 24.4% in non-neutropaenic patients., Conclusion: Gram-negative organisms are the predominant isolates in febrile neutropaenic episodes in this cohort of patients. Non-neutropaenic patients had an increased mortality with an increase in Acinetobacter infections and multiple isolates.

Objective: To assess the prevalence of needlestick injuries (NSIs) and other high risk exposures among healthcare workers at two hospitals in Jamaica., Methods: Employing a cross-sectional study design, medical personnel (physicians, nurses) at two hospitals in Jamaica, were studied, utilizing a structured questionnaire consisting of 14 items to collect data on needle stick injuries and other injuries., Results: There were 67 needlestick injuries in 47 persons. Of those sustaining an injury, 52% of physicians and 40% of nurses had NSIs. Re-capping needles accounted for 21% of injuries, various minor procedures, 21%, injury during surgery, 19.4% and taking blood, 12%. In those sustaining NSIs, 47% were reported and 26% of reported cases received counselling. Appropriate blood tests were performed on 34% and post-exposure prophylaxis (PEP) for HIV was administered to 30%. Hollow bore needles caused 47.8% of injuries, 25.4% occurred with suture needles and 19.4% with intravenous branulas. Other occupational exposure was reported by 31%, including blood on hands and other body parts 39%, blood to face and eyes, 18%, splashed with liquor, 18%, splashed with bloody fluid, 11% and contact with vomitus and urine in eye, 4%., Conclusion: Needlestick injuries and other high risk exposures were high; incident reporting and post exposure management were inadequate. A comprehensive programme to address factors that contribute to the occurrence of NSIs and other occupational exposures is urgently needed.

Objective: To determine antibiotic usage patterns in the Intensive Care Unit (ICU) at the University Hospital of the West Indies (UHWI)., Method: A cross-sectional, analytical study of consecutive patients admitted to the ICU was conducted between July and December 2007. Exclusion criteria were HIV-positive patients, patients < 12 years and those discharged or who died within 48 hours of admission. Data were collected from medical records, stored and analysed using the SPSS Version 12., Results: Of the 150 eligible patients, 109 had complete data (73%). Mean age was 50.8 +/- 20.7 years, with mean APACHE II score of 15.6 +/- 6.7. Forty-five patients (41.3%) received prophylactic antibiotics, most commonly ceftriaxone (31.7%) and metronidazole (19.0%). Appropriate discontinuation within 24 hours occurred in only 11.1%. Two-thirds of patients (67.9%) were treated with empiric antibiotics, most commonly piperacillin/tazobactam (32.1%), ceftazidime (27.5%) or metronidazole (27.5%). Reasons for empiric choice were primarily coverage of organisms based on presumed source of sepsis (45.6%), and broad spectrum, high-powered coverage (23.5%). Courses ranged from 1 - 42 days and were adequate based on subsequent cultures in 71% of cases. Culture reports took between 2 - 8 days with a mean of 3.7 days to become available. De-escalation was practised in only 2 of 26 (7.7%) cases and intravenous to oral switch therapy in only 3.3%. Thirty-two (29.4%) patients died, with sepsis being a cause in 12 (37.5%)., Conclusions: Improved attention to discontinuation of prophylactic antibiotics, appropriate duration of antibiotic courses and de-escalation are essential if the antibiotic practices in the ICU at the UHWI are to compare favourably with international recommendations.

Background: Although the Jamaica road traffic act mandates motorcycle riders to wear approved helmets, opponents suggest that the local road conditions obviate any benefits from helmet use that have been proven in Developed countries. They suggest that the narrow, winding, poorly surfaced, congested local highways do not allow motorcyclists to sustain high velocity travel. The accidents then tend to occur at lower speeds and are accompanied by less severe injuries. This study was carried out to determine the impact of helmet use on traumatic brain injuries from motorcycle collisions in patients admitted to a tertiary referral hospital in Jamaica., Methods: A prospectively collected trauma registry maintained by the Department of Surgery at the University Hospital of the West Indies in Jamaica was accessed to identify all motorcycle collision victims from January 2000 to January 2007. The therapeutic outcomes of traumatic brain injuries were compared between helmeted and un-helmeted riders. The data was analyzed using SPSS Version 12., Results: Of 293 motorcycle collision victims, 143 sustained brain injuries. There were 9 females (6.3%) with an average age of 23 +/- 7.3 years and 134 males (93.7%) at an average age of 33.4 +/- 11.2 years (mean +/- SD). Only 49 (34.3%) patients wore a helmet at the time of a collision. Helmet use at the time of a collision significantly reduced the severity of head injuries (28.6% vs 46.8%, P = 0.028) and the likelihood of sustaining intra-cranial lesions (26.5% vs 44.7%, P = 0.03) from head injuries., Conclusion: Wearing a helmet at the time of a motorcycle collision reduces the severity of head injuries. However, the prevalence of helmet use at the time of a collision is unacceptably low.

Objective: In the Cayman Islands, a vascular access service was created in 2005 to facilitate the creation of vascular access for hemodialysis by local surgeons. The present retrospective audit aims to establish the outcomes of this practice in the Cayman Islands., Methods: Data from the operative log of the Cayman Islands Hospital was collected over a period of 36 months. The data were analyzed using SPSS version 12.0 (SPSS Inc, USA). Statistical analyses were performed using Student's t tests and Fisher's exact tests., Results: A total of 19 operative procedures were performed to create vascular accesses in 12 men and seven women. Thirteen procedures (68%) created autogenous arteriovenous fistulas (AVFs) and six (32%) involved the insertion of a prosthetic arteriovenous graft (AVG). There were six incident dialysis patients, all of whom had an AVF created. The remaining 13 prevalent dialysis patients had new accesses in the form of AVFs (n=7) or AVGs (n=6). The statistical analyses were limited by sample size, but with AVFs, there were trends toward reduced incidence of secondary failure (four of 13 versus four of six), thrombosis (four of 13 versus two of six), infectious morbidity (zero versus two of six) and less demand for interventions to maintain patency (one of 13 versus two of six) with AVFs. There were also trends toward superior primary (461 days versus 227 days) and secondary (803 days versus 205 days) patency rates for AVFs., Conclusions: In this setting, the rate of AVF creation exceeds the goals set by the National Kidney Foundation Kidney Disease Outcomes Quality Initiative and the Fistula First Breakthrough Initiative. To ensure continued delivery of modern quality care, further audits of the local practice will be required at regular intervals.

We evaluated dietary and other risk factors in a black California cohort. Baseline data were gathered in 1974 and 1976, and mortality follow-up continued through 1985. A study census questionnaire was returned from 3,299 subjects who lived in a household containing at least one Seventh-Day Adventist. Of these, 1,668 subjects also completed a detailed life-style and dietary questionnaire in 1976. Vital status was ascertained using church records and the California State death tapes. Mortality hazard ratios (HR; both sexes combined) across three increasing consumption levels were determined for nuts (1.00, 0.60, 0.56), fruits (1.00, 0.38, 0.57), and green salads (1.00, 0.54, 0.65). Consumption of meats appeared more hazardous for women, although there was no dose-response relation. Education (HR = 1.00, no college; 0.74, some college; 0.42, college graduate), male gender (HR = 1.55), diabetes mellitus (HR = 1.77), and hypertension (HR = 2.52) were independently associated with mortality, as was obesity, which had a curvilinear association in women and a linear association in men. Exercise was not associated with mortality after excluding those with morbidity at baseline. In summary, traditional risk factors operated with similar force in this black population. In addition, the frequent consumption of nuts, fruits, and green salads appears protective.