A rare case of massive lower gastrointestinal bleeding from a ruptured splenic artery aneurysm.

Splenic artery aneurysms (SAAs) are an extremely rare cause of asymptomatic massive lower gastrointestinal bleeding with less than a handful of patients surviving such a presentation. A 24-year-old female presented in shock after multiple episodes of massive rectal bleeding. Imaging revealed a heterogeneous mass arising from the tail of the pancreas eroding into the splenic flexure of the colon. Further episodes of bleeding led to an exploratory laparotomy. Intraoperatively, a suspected neoplastic process arising from the tail of the pancreas with contiguous involvement of the splenic flexure of the colon and the greater curvature of the stomach was noted. Distal pancreaticosplenectomy, gastric wedge resection with segmental colectomy and primary anastomosis were performed. Histology revealed a SAA with rupture into the colon. This case report shows that en-bloc resection of a ruptured SAA can be performed with success in the emergency setting.

Contraceptive knowledge, attitudes and changing practices in women presenting to maternal and child health clinics in North Central Trinidad.

UNLABELLED: The relationship between contraceptive awareness and use in an environment of both high levels of unplanned pregnancies and prevalence of HIV/AIDS continues to be a major challenge. The objective of this study is to ascertain the knowledge of contraception and methods chosen in women of 18-45 years old attending primary care facilities in North Central Trinidad. METHODS: We used a cross-sectional study design with a knowledge, attitude, and practices type survey design. Five primary care facilities were selected using cluster sampling. All participants eligible for entry into the study were administered a structured, pretested questionnaire. RESULTS: 269 participants were enrolled in the study. The majority (88%) had good knowledge of contraceptive methods, yet this knowledge was not translated into the prevention of pregnancies as 64.3% had had an unplanned pregnancy. The male condom is now the predominant method of contraception. CONCLUSION: The study provides evidence on the level of knowledge of contraception methods and their use, as well as attitudes and practices among women who are pregnant or who recently completed a pregnancy. Although the knowledge of contraception methods was relatively high, attitudes and practice remain unacceptable and the male condom is now the predominant method of choice.

The role of serum markers in assessing the severity and outcome of community acquired pneumonia in Trinidadian population

Our aim was to determine whether the use of serum inflammatory markers such as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and procalcitonin (PCT), either individually or in combination, is significantly associated with community-acquired pneumonia and to determine the role in assessment of the severity and outcome. This study was a prospective cohort study, included forty Trinidadian patients diagnosed with community acquired pneumonia. Blood samples were collected to measure inflammatory markers. Patients were classified according to the pneumonia severity index (PSI) scoring where after serum marker levels were compared among respective groups. Proportions test for positive predictive value of the serum marker indicated that CRP (P=0.001) and ESR (P=0.001) had higher sensitivities to community acquired pneumonia than PCT (P=0.05). There was no association between each of the serum markers and PSI. Eighty three percent low risks had a length of stay of two weeks, while only 18% of high risk stayed for the same duration. The combination of highly sensitive markers like CRP and ESR and a specific marker such as PCT emphasize their importance in better risk assessment in community acquired pneumonia patients.