Management of a Transaxial, Tricompartmental Gunshot Injury in a Low-Resource Tertiary-Care Center in the Anglosphere Caribbean.

Trauma, both penetrating and blunt, consists of a significant percentage of surgical admissions in Caribbean hospitals. Due to financial constraints, ideal resources for optimal surgical management are not always available. Despite these disadvantages, successful outcomes for complex, emergent cases are achieved through a combination of timely clinical assessment, intervention, and ingenuity in using the resources at hand. In this case report, we describe a 17-year-old male who suffered major visceral injuries and presented in extremis from a single gunshot wound. While fleeing the scene of a crime, he was shot in his right pelvis, with the projectile exiting his left thorax. Injuries matching a transaxial gunshot trajectory that crossed the diaphragm and involved the pelvic, abdominal, and thoracic cavities were found on exploratory laparotomy. He survived through prompt surgical intervention and aggressive resuscitation during his postoperative intensivist care, a resource often unavailable in this setting. The patient's prognosis would have been guarded even in a developed country setting. This case highlights the potential that Caribbean healthcare institutes possess, and that given an improvement in resources, we can aim to match a developed country's standard of healthcare.

The Pushing Sign for Early Skin Tethering in Breast Cancer.

Skin tethering (ST) is regarded as a classical clinical feature of breast cancer. In many cases, ST is not evident on inspection, with the arm raised and skin pinching over the lump. We have observed that pushing the lump in one or another direction may elicit skin dimpling that was not otherwise evident. In these cases, there is normal fat, grossly and histologically, between the tumor and the skin. Thus, the dimpling is not due to cutaneous infiltration. We believe that it is caused by tumor involvement of the ligaments of Cooper and present suggestions as to why it might be so. It may be that this is very early involvement of these ligaments, long before ST becomes very obvious. We report our experience with six such cases.

Operating During the COVID-19 Pandemic: An Emerging Indication for Minilaparotomy Cholecystectomy.

COVID-19 has required changes in the practice of surgery to reduce the risk of transmission of the virus. Proposed mitigation strategies include avoidance of aerosol-generating procedures such as laparoscopy. We report two cases where minilaparotomy cholecystectomy was employed to treat benign biliary disease during the pandemic. A review of the literature supports the use of this surgical technique during the COVID-19 pandemic until laparoscopy can be proven to be safe.

Adult Intestinal Malrotation in a Non-Paediatric Hospital in Trinidad: A Case Report and Literature Review.

Intestinal malrotation (IM) is a congenital aberrancy of midgut rotation during development, which manifests among neonates more than adults. Older reports have estimated an incidence of one in 6,000 live births, which is now as high as one in 500. This congenital anomaly is generally indolent in the adult population. Recent literature research has failed to reveal any publications regarding the incidence within a Caribbean population. This paper aims to discuss the isolated case of a patient with this rare condition, who presented to a non-paediatric centre in Trinidad. This case highlights the implications of the initial radiological interpretation in conjunction with perioperative and intraoperative decision making. An 18-year-old male presented with a one-day history of abdominal pain, radiating to the epigastrium with nausea and excessive vomiting. Vital signs and blood investigations were normal. Initial CT scan results were interpreted as an internal hernia, which was surgically managed as such. Repeat imaging and a second laparotomy were required to correctly diagnose and perform the appropriate Ladd procedure. IM occurs due to the arrest of rotation of the midgut during fetal maturation. The incomplete rotation variant was seen in this case and is predominantly responsible for the symptomatology and morbidity associated with adult intestinal malrotation (AIM). Stringer has classified these anomalies based on the stage of embryonic development that is disrupted. CT helps with diagnostics in 97.5% of cases. This case highlights the implication of incorrect assessment on imaging and how it may misguide the interpretation of the findings at laparotomy leading to inappropriate surgical procedures. As many as 20% of cases undergo surgery without adult intussusception diagnosed. The incidence of IM seems to have increased but is scarcely encountered in the adult setting. When encountering this condition at a low-volume centre in the Caribbean, the adult specialist may be blindsided, and unknowingly underprepared without a high index of suspicion. Diagnosis at childhood should be discussed with the family and again with the patient on approaching adulthood. Patient education may help with the surgical assessment.

Cybersuicide and the adolescent population: challenges of the future

Cybersuicide is a term used in reference to suicide and its ideations on the internet. It is associated with web sites which lure vulnerable members of society and empower them with various methods and approaches to deliberate self-harm. Ease of accessibility to the internet and the rate at which information is dispersed; contribute to the promotion of offing one's self which is particularly appealing to adolescents. This study aims to explore this phenomenon which seems to be spreading across generations, cultures and races. Information and articles regarding internet suicide and other terminology as well as sub classifications concerning this new form of suicide were reviewed. Through search engines such as Google, Yahoo and Wikipedia differentiations between web cam suicide, net suicide packs, sites which merely offer advice on how to commit suicide and sites which are essential in providing the means of performing the act were investigated. Also, materials published in scientific journals and data published by the Public Health Services, Centers for Disease Control, and materials from private media agencies were reviewed. Resources were also sourced from The Faculty of Medical Sciences Library, UWI at Mt. Hope. Cybersuicide is a worldwide problem among adolescents and is a challenge of the future.

Cybersuicide and the adolescent population: challenges of the future?

Cybersuicide is a term used in reference to suicide and its ideations on the Internet. Cybersuicide is associated with websites that lure vulnerable members of society and empower them with various methods and approaches to deliberate self-harm. Ease of accessibility to the Internet and the rate at which information is dispersed contribute to the promotion of 'offing' one's self which is particularly appealing to adolescents. This study aims to explore this phenomenon, which seems to be spreading across generations, cultures, and races. Information and articles regarding Internet suicide and other terminology, as well as sub-classifications concerning this new form of suicide, were reviewed. Through search engines such as Google, Yahoo and Wikipedia, we investigated the differentiations between 'web cam' suicide, 'net suicide packs', sites that merely offer advice on how to commit suicide and sites that are essential in providing the means of performing the act. Additionally, materials published in scientific journals and data published by the Public Health Services, Centers for Disease Control, and materials from private media agencies were reviewed. Resources were also sourced from The Faculty of Medical Sciences Library, UWI at Mt. Hope. Cybersuicide is a worldwide problem among adolescents and a challenge of the future.