Paraphimosis due to erotic dancing

Paraphimosis usually develops when a tight foreskin is retracted over the glans penis for a prolonged period. Many esoteric aetiologies have been implicated in the development of paraphimosis including piercing the foreskin, Plasmodium falciparum infection, application of celadine juice to the foreskin, chancroid, pessaries and the implantation of pearls. We report the first two cases of paraphimosis developing during wining, an erotic dance native to Trinidad & Tobago.

Combined Monteggia and Galeazzi fractures in a child's forearm

The Monteggia fracture dislocation and Galeazzi fracture dislocation are well recognized in isolation. The incidence of both of these fractures in the same forearm is rare. Only two other cases have been reported. This case report highlights the importance of early diagnosis and treatment of this combined fracture in a multiple trauma patient.

Normative values for hand grip strength in Trinidad And Tobago

Objectives: To establish normative Hand Grip Strength (HGS) data for Trinidad and Tobago and to assess factors that may influence hand grip strength within this population. Design and Methodology: A cross sectional study of participants between the ages of 18-80 years was conducted at five distinct geographic regions in Trinidad and Tobago. Demographic data was collected including hand dominance. HGS was measured using a Jamar dynamometer. Descriptive statistics were performed for all direct measurements and Pearson's correlation coefficient used to analyze the relationship between variables. All statistical analysis was performed using the Statistical Package for Social Sciences (SPSS v20) p-value < 0.05 was considered significant. Results: A total of 1354 participants took part in the study, with 121 exclusions leaving 1233 for analysis. There were 561 males (45.5%) and 672 females (54.5%). The mean age of the participants was 42.5 years (SD +/-15.5) and mean body mass index (kg/m2) 27.3 (SD +/- 6.0). The overall mean HGS for our sample was 28.4 kgs. (SD +/- 2.9) with males having a higher overall HGS compared with females. Conclusions: This study presents previously unreported normative data on HGS in a Trinidad and Tobago population. This data will allow for a more objective evaluation of hand function in patients following injury and has implications for the assessment of disability in workmen's compensation.

Epidemiology and management trends of patients with severe sepsis and septic shock in Trinidadian Intensive Care Units: A prospective multicenter trial

Objectives: To investigate the epidemiology, management and predictors of mortality in severe sepsis. Design and Methodology: Prospective observational study in 4 Trinidadian Intensive Care Units (ICU) over a one year period August 2017-August 2018. Physiologic and treatment data was collected on admission to ICU and patients were followed up until ICU discharge and then at 28 days to determine mortality. Results: 163 patients fit the criteria for severe sepsis and were enrolled. Twenty-eight day and ICU mortality rate were 42% (68) and 34 % (56) respectively. Case distribution by the various hospitals were San Fernando General Hospital 62% (101), Port of Spain General Hospital 16% (26), Eric Williams Medical Sciences Complex 12.3% (20) and Sangre Grande Hospital 9.8% (16). The most common source of sepsis was pulmonary (54%) followed by abdominal (17%) and urological sepsis (14%). Acute Kidney Injury (AKI) was present in 71% (115) patients and 43% (46) of patients with stage 2 and above AKI received Renal Replacement Therapy (RRT) in the ICU. In the regression model, the only factors that were found to predict both 28 day and ICU mortality were stage 2 AKI [OR 6.2 (95% CI 1.7- 23.1, p = .007)], stage 3 AKI [OR 7.2 (95% CI, 2.1-24.0, p=.001)] , mean arterial pressure of < 60mmHg in the first 24 hours [OR 10.8 (95% CI 1.7-68.1, p= .001)], presence of either moderate-severe Acute Respiratory Distress Syndrome [OR 4.1 (95% CI 1.8 ­ 9.2, p = .002)] and Acute Physiology, Age, Chronic Health Evaluation (APACHE) II score [OR 1.08 (95% CI, 1.0-1.2, p=.039)]. Conclusion: Severe sepsis is associated with a high hospital mortality rate and this sepsis burden varies according to region. Limited access to RRT remains a problem in certain centers.

Prospective study of primary anastomosis without colonic lavage for patients with an obstructed left colon

BACKGROUND: Traditionally, left-sided colon obstruction is managed by a multistaged defunctioning colostomy and resection. However, there is growing acceptance of one-stage primary resection and anastomosis with on-table antegrade irrigation. This paper presents a series of patients managed prospectively by primary anastomosis without intraoperative colonic lavage. METHODS: Emergency resection of acutely obstructed left-sided colonic carcinomas was performed. This was followed by primary anastomosis without on-table lavage after bowel decompression using a new technique. RESULTS: Fifty-eight consecutive, unselected patients underwent bowel decompression, resection and primary colocolic anastomosis. Only one patient developed a leak at the anastomotic site, requiring pelvic abscess drainage and transverse loop colostomy. One death occurred 12h following surgery. Autopsy confirmed that this was due to myocardial infarction. Mean hospital stay was 9.8 days. CONCLUSION: Emergency surgery on the obstructed left colon can be carried out safely after decompression alone, without intraoperative colonic lavage (AU)