Context : Gallstone ileus is an uncommon condition with potentially serious complications including perforation and gangrene of the small bowel. Its diagnosis is difficult and surgery remains the mainstay of treatment. Here we are reporting the complications of this condition along with brief review of literature. Case Report : We report a case of intestinal obstruction due to gallstone in the small gut which was diagnosed preoperatively on ultrasonography and confirmed on exploratory laparotomy. Postoperative period was uneventful. Conclusion : Gallstone ileus is a rare cause of intestinal obstruction and it should be considered in patients who are suffering from gallstone disease and presenting with intestinal obstruction especially when no other obvious cause is seen.

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Background : There is still controversy about the choice of treatment of displaced fractures of the neck of femur which leads the best clinical and functional outcomes. Treatment options include internal fixation, unipolar or bipolar hemiarthroplasty, or total hip replacement. Aim : The aim of this study is to find out which treatment option can lead to the best clinical and functional outcomes. Patients and Methods : Fifty one consecutive patients admitted to Makassed General Hospital with a diagnosis of a displaced fracture of the femoral neck during the year 2006 were selected. Preoperative and operative data was retrieved from inpatient hospital files. The patients then were interviewed to fill a questionnaire form. Radiological data was retrieved from inpatient hospital files and outpatient files upon latest follow up visit in clinic. Functional outcomes were assessed with use of Harris hip score. The main clinical measures were mortality and a reoperation. Results : Postoperatively, Thirty three patients (89.2%) either returned to the functional level that they had had before the fracture or used only a cane, which they had not needed before. Conclusion : In our study, the bipolar hemiarthroplasty has served us well. Two-year results of total hip replacement appeared to be better than those of bipolar hemiarthroplasty, but this finding was based on relatively small numbers of patients.

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Context: Central pancreatectomy has gained popularity in the past decade as treatment of choice for low malignant potential tumor in the midpancreas due to its ability to achieve optimal preservation of pancreatic parenchyma. Simultaneously, advancement in minimally invasive approach has contributed to numerous novel surgical techniques with significantly lower morbidity and mortality. With the purpose of improving patient outcomes, we describe a laparoscopic assisted central pancreatectomy with pancreaticogastrostomy as an alternative method to the previously described open central pancreatectomy with roux-en-y pancreaticojejunostomy reconstruction. Case Report: A 39 year old man presented to our clinic with a 2.5 cm neuroendocrine tumor at the neck of the pancreas. Laparoscopic assisted central pancreatectomy with pancreaticogastrostomy reconstruction was successfully performed. Operative time was 210 minutes with blood loss of 200 ml. Postoperative course was uneventful except for a minimal pancreatic leak which was controlled by an intraoperatively placed closed suction drain. At 2 week follow up, patient was asymptomatic with well preserved pancreatic endo and exocrine functions. Permanent pathology findings showed a well differentiated neuroendocrine tumor with negative margins and nodes. Conclusions: Laparoscopic assisted central pancreatectomy with pancreaticogastrostomy reconstruction is feasible and safe for a centrally located tumor. Laparoscopic assisted technique facilitates application of minimally invasive approach by increasing surgical feasibility in typically complex pancreatic operations.

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Background : Azelaic acid (AzA) is the best known dicarboxilic acid to have pharmaceutical benefits and clinical applications and also to be associated with some diseases pathophysiology. Materials and Methods : We extracted and methylesterified AzA and determined its concentration in human plasma obtained from healthy individuals and also in mice fed AzA containing diet for three months. Results: AzA was detected in Gas Chromatography (GC) and confirmed by Liquid chromatography mass spectrometry (LCMS), and gas chromatography mass spectrometry (GCMC). Our results have shown that AzA can be determined efficiently in selected biological samples by GC method with 1nM limit of detection (LoD) and the limit of quantification (LoQ); was established at 50nM. Analytical Sensitivity as assayed by hexane demonstrated an analytical sensitivity at 0.050nM. The method has demonstrated 8-10% CV batch repeatability across the sample types and 13-18.9% CV for the Within-Lab Precision analysis. The method has shown that AzA can efficiently be recovered from various sample preparation including liver tissue homogenate (95%) and human plasma (97 %). Conclusions: Because of its simplicity and lower limit of quantification, the present method provides a useful tool for determining AzA in various biological sample preparations.

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Context: Herpes simplex virus (HSV) infection of the skin represents a common challenge in dermatology; however, currently the port of viral entry remains obscure. HSV is known to induce an immunoglobulin-binding cell surface receptor in infected cells that utilizes a non-immune mechanism. The replication of HSV in cultured cells is accompanied by the appearance of surface receptors with an affinity for the Fc region of immunoglobulin G. Case Report : We describe a 43 year old African American male who presented with a generalized rash, including intense pruritus and umbilicated vesiculopustules. The patient had been previously diagnosed and treated for psoriasis with methotrexate and prednisone. Methods : Hematoxylin and eosin demonstrated keratinocytes with ballooning degeneration within the epidermis. Direct immunofluorescence (DIF) results resembled the pattern of paraneoplastic pemphigus, with negative indirect immunofluorescence (IIF) results on rat bladder. Immunohistochemistry revealed deposits of the complement membrane attack complex within dermal sweat glands, as well as the presence of herpes simplex virus 1 on the skin. We report a case of Kaposi varicelliform eruption, a cutaneous eruption caused by a virus infecting patients with pre-existing dermatoses. Conclusion: HSV virus infection with over-expression of the junctional adhesion molecule close to herpetic infection sites may preferentially increase viral entry through the skin, possibly triggering a Kaposi varicelliform eruption.

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Background : HIV/AIDS is a problem in developing countries including Jamaica. There are several studies dealing with HIV/AIDS in Jamaica but given the increasing rate of the infection, ongoing studies are necessary. Aims : This study examines the sexual behavior and attitude of non-HIV testers in Jamaica in order to provide research evidence that will direct public health policies and interventions. Materials and Methods : This study extracts a sample of 1,192 participants who indicated not having done a HIV test from 1,800 respondents from a 2004 HIV/AIDS/STD National KABP Survey. A detailed questionnaire was developed and used to collect data from people ages 15-49 years old. Results : Some 20.3 % of the variances, which is self reported positive HIV test results, are a function of relationship status, using protection against HIV, having sex with a commercial sex worker, having STIs, the age at which the participant first had sex and age at last birthday. These findings hold across gender, occupational status and education. The majority (87.9%) of the participants said they had little or no chance of getting HIV, and 59.7% did not want to know their HIV status. However, 46.6% did not wear a condom the first time they had sex with current partner, 32% do not wear a condom with their current partner and 16.3% reported having had STIs. Conclusion : The existing HIV prevention programs need to be expanded and fortified to target young Jamaicans, particularly those who do not engage in safe sexual practices.

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Context : Intestinal intussuception in an adult is a rare entity that differs in etiology from its pediatric counterpart owing to underlying pathologic lead points in adults, mostly neoplasms. The main clinical presentation in chronic intussuception in adults remains dull abdominal pain, and acute intussuception is uncommon. Computed tomography (CT) remains the diagnostic modality of choice and surgical resection is the optimal treatment. Case Report : We report a case of chronic intussuception in a young adult presenting with severe anemia and chronic abdominal pain in right hypochondrium and lumbar region. Pre operative diagnosis of chronic ileocolocolic intussuception was made on the basis of ultrasound, barium and CT scan findings. Exploratory laparotomy was done and right hemicolectomy with end to end anastomosis was performed. Histopathological examination of resected specimen revealed presence of tuberculosis in the mass along with mesenteric lymph nodes involvement. Postoperative recovery was uneventful and he was put on antitubercular drugs. In follow-up the patient is asymptomatic. Conclusion : Chronic ileocolocolic intussuception due to tuberculosis should be considered as a possible cause of intestinal obstruction in young patients presenting with vague abdominal pain and severe anemia even in the absence of any specific medical history.

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Background : Diabetes and kidney failure are chronic diseases that are associated with cardiovascular complications, while dyslipidaemia is a strong risk factor. Hyperviscosity is believed to be associated and managed with antiplatelet, but not routinely assessed. Aims : This work investigates the prevalence of hyperviscosity in diabetes, dyslipidaemia and renal failure with a view to determine the proportion of patients who may not require antiplatelet therapy. Materials and Methods : Archived clinical pathology data for the period of 1999 to 2008 were utilized. 50,162-cases concomitantly tested for blood sugar, creatinine and lipid profile, as well as haematocrit and total proteins in five alternate years were extracted. The prevalence of different viscosity ranges associated with positive results was evaluated. Results : Hyperviscosity is about 4% prevalent in hyperglycemia and hyperlipidaemia, less in hypercreatinaemia. Hypoviscosity has statistically significantly the least <2.5% prevalent, while normoviscosity is most prevalent. Reverse analyses affirm that higher levels of hyperglycemia and hyperlipidaemia are statistically significant more associated with fourth compared to first quartile viscosity (p < 0.01). Conclusion : Previous report demonstrated that hypoviscosity is synonymous to high international normalized ratio where anticoagulant/antiplatelet is not recommended. This study demonstrates that up to 97.5% of cases investigated for chronic diseases could benefit from antiplatelet medication. This report corroborates with previous reports that hyperviscosity may not be very frequent. However, the level of stasis associated with laboratory evidence-based chronic disease affirms that the subclinical vasculopathy should be managed, and laboratory monitoring will provide clinical evidence base.

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Background : Orthostatic hypotension (OH) is common among older people and is more prevalent in elderly with various disorders and on medications. Aims: The objective of the study was to know the prevalence of orthostatic hypotension in healthy geriatric subjects. Subjects and Methods : The study group comprised of healthy non hypertensive, non diabetic elderly individuals aged 60 years and above (n=80) and another group, healthy aged 30 to 50 years age (n=80, mean age39.2±5.3). Orthostatic hypotension was defined as a decline in systolic/diastolic blood pressure of ≥20/10 mmHg when an individual changed from a supine to a standing position within 3 minutes of standing. Systolic and Diastolic blood pressure was measured in supine position and within 3 minutes of standing. Results: 1 out of 80 (1.25%) in the elderly subjects was found to have orthostatic hypotension . Conclusion : The study concluded that the orthostatic hypotension is less prevalent in healthy elderly subjects without any illness or without on any medications.

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Background: Breastfeeding is an established mode of transmission of human immunodeficiency virus (HIV) infection resulting in clash between socio-cultural values and medical practice. Aims: This study aims to determine the effect of post-natal maternal antiretroviral therapy on transmission of HIV through breastfeeding. Patients and Methods: A total of 318 pregnant women were followed from pregnancy to 6 months post- partum. The women were divided into breast-fed and those who did not breast-feed, while the breast-fed were further divided into those on antiretroviral (ARV) and those not on ARV. After 6 months post-partum, dried blood spots were collected from infants born to these women and tested for HIV using polymerase chain reaction. Results: Generally, breast-feeding had 4 to 13 fold increase risk of transmission of HIV to infants (OR =7.079 95% CI = 3.768, 13.300; P <0.0001). However, among breast-fed infants, post-natal maternal ARV resulted in reduced prevalence of HIV compared to mothers who did not use ARV during breast-feeding (17.31% VS 92.00%; P<0.0001). Conclusion: The study demonstrates the effectiveness of post-natal maternal ARV. However, research into better feeding options to prevent mother to child transmission of HIV via breast-feeding is advocated.

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