Breast cancer is the leading cause of cancer death in women and the second most common cancer in the Jamaican population. Additionally, Jamaican women have a significant incidence of locally advanced cancer that has been shown to be associated with significant morbidity and inferior treatment outcomes. Delays in presentation and diagnosis further contribute to this treatment dilemma. On this background, a consensus group of healthcare practitioners involved in breast cancer care was convened by a joint initiative of the University of the West Indies and the Association of Surgeons in Jamaica. The objective of this body was to outline management guidelines to assist Jamaican physicians with management of patients with breast cancer. These guidelines are published below and are divided into four main headings: Screening, Making the diagnosis, Treatment and Aftercare. This document is aimed at both specialist and non-specialist physicians and includes an easy-to-follow algorithm as a brief summary of the treatment recommendations.

Objective: The prevalence of asymptomatic bacteriuria (ASB) in sickle cell disease (SCD) in Jamaica is 5.3%. This study sought to determine the association between ASB and anatomical urological abnormalities and symptomatic urinary tract infections (UTIs). Methods: A matched case-controlled study of 11 patients with a history of ASB from the Jamaican Sickle Cell Cohort and 11 controls who did not have a history of ASB or recurrent UTIs but who had SCD was conducted. Midstream urine collected aseptically was obtained for urinalysis and culture and sensitivity analysis. Serum creatinine was measured. Voiding cystourethrogram (VCUG) and kidney-ureter-bladder ultrasound were done. History of UTIs was recorded in all cases. Results: The mean +/- sd age of the group (cases and controls) was 34.2 +/- 7.2 years. All VCUGs were normal. There was no difference in mean cortical thickness or renal scarring between cases and controls. All serum creatinine values were normal: cases (mean +/- sd: 55.9 +/- 15.3; min-max: 32-90 mu mol/L) and controls (mean + sd: 59.6 + 18.5; min-max: 41-95 mu mol/L). There was no difference in symptomatic UTIs between cases and controls. Conclusion: There was no association between anatomical urinary tract abnormalities and ASB in patients with SCD. Asymptomatic bacteriuria in SCD was not associated with increased numbers of symptomatic UTIs.

Spontaneous pneumothorax is a well-recognized entity with a classical presentation of acute onset chest pain and shortness of breath. It may be complicated by the development of a tension pneumothorax or a haemopneumothorax. We report an interesting case of a spontaneous tension haemopneumothorax which presented atypically and was diagnosed on computed tomography (CT) scan of the chest. The clinical and pathophysiological characteristics and treatment of this unusual entity is discussed.

UNLABELLED:A retrospective analysis was done of all patients referred for MRI of the lumbar spine at the University Hospital of the West Indies, Kingston, Jamaica, during the three-year period January 1, 2005 and December 31, 2007. Data were collected to determine patients 'age, gender, weight and the presence or absence of degenerative disc disease (DDD). The patients' presenting symptoms were not evaluated. There were 362 patients examined: 154 males, 204 females and four uncharacterized, aged between 8 and 87 (mean age = 50.45) years. Degenerative Disc Disease (DDD), was found in 283 (78.2%) patients: 121 males, 159 females and three unidentified, with a total of 669 degenerate discs. L 4/5 and L 5/S 1 were most frequently affected accounting for 31.2% and 30.6% of degenerate discs respectively. Patients with DDD were significantly heavier and significantly older than patients without disc disease. Gender was not predictive of DDD in general nor of involvement of any particular disc though a marginally significant tendency was found for males to more frequently have DDD at L1/2 and L5/S1.CONCLUSION:Degenerative disc disease of the lumbar spine occurred more frequently in older and heavier patients. Gender did not affect the presence or the extent of the disease; compared to females, males showed a marginally increased tendency to have DDD at L1/2 and L5/S1.

On September 8, 2001 around 2 h UT, the largest uranian moon, Titania, occulted Hipparcos star 106829 (alias SAO 164538, a V=7.2, K0 III star). This was the first-ever observed occultation by this satellite, a rare event as Titania subtends only 0.11 arcsec on the sky. The star's unusual brightness allowed many observers, both amateurs or professionals, to monitor this unique event, providing fifty-seven occultations chords over three continents, all reported here. Selecting the best 27 occultation chords, and assuming a circular limb, we derive Titania's radius: RT=788.4±0.6km (1-σ error bar). This implies a density of ρ=1.711±0.005gcm−3 using the value GM=(2.343±0.006)×1011m3s−2 derived by Taylor [Taylor, D.B., 1998. Astron. Astrophys. 330, 362–374]. We do not detect any significant difference between equatorial and polar radii, in the limit req−rpo=−1.3±2.1km, in agreement with Voyager limb image retrieval during the 1986 flyby. Titania's offset with respect to the DE405 + URA027 (based on GUST86 theory) ephemeris is derived: ΔαTcos(δT)=−108±13 mas and ΔδT=−62±7 mas (ICRF J2000.0 system). Most of this offset is attributable to a Uranus' barycentric offset with respect to DE405, that we estimate to be: ΔαUcos(δU)=−100±25mas and ΔδU=−85±25 mas at the moment of occultation. This offset is confirmed by another Titania stellar occultation observed on August 1st, 2003, which provides an offset of ΔαTcos(δT)=−127±20 mas and ΔδT=−97±13 mas for the satellite. The combined ingress and egress data do not show any significant hint for atmospheric refraction, allowing us to set surface pressure limits at the level of 10–20 nbar. More specifically, we find an upper limit of 13 nbar (1-σ level) at 70 K and 17 nbar at 80 K, for a putative isothermal CO2 atmosphere. We also provide an upper limit of 8 nbar for a possible CH4 atmosphere, and 22 nbar for pure N2, again at the 1-σ level. We finally constrain the stellar size using the time-resolved star disappearance and reappearance at ingress and egress. We find an angular diameter of 0.54±0.03 mas (corresponding to 7.5±0.4km projected at Titania). With a distance of 170±25 parsecs, this corresponds to a radius of 9.8±0.2 solar radii for HIP 106829, typical of a K0 III giant.

A prospective study was done during a six-month period on 104 consecutive patients who were seen at the Accident and Emergency (A&E) Department of the UHWI and referred for CT scans of the head within 24 hours of sustaining head injuries. There were 74 (71.1%) males and 30 (28.8%) females. The mean age for females was 40.6 years and 32.4 years for males. Patients were clinically assessed for the presence or absence of vomiting, amnesia, loss of consciousness. bleeding of ear nose and throat (ENT) and Glasgow Coma score (GCS).Negative predictive values were calculated for each parameter individually as well as the combination of all five. The absence of vomiting, amnesia, "loss of consciousness" (LOC) or ENT bleed had negative predictive values of 68%, 73%, 76% and 61.6% respectively. An assessment of Glasgow Coma Scale (GCS) of 15 had-a 77.5% negative predictive value. When the history was indeterminate, the negative predictive values were 19%, 25%, 60% and 18% respectively for vomiting, amnesia, LOC and ENT bleed.When all four clinical indicators were absent in the history and examination and the GCS score 15, the negative predictive value for intracranial injury was 89.4%. In summary, the clinical indicators reviewed, alone or in combination, cannot exclude the presence of intracranial injury.

We report observations of the largest optical outburst in 20 years in the quasar OJ 287. In some ways it was expected, due to the well-known quasi-periodic 12 yr outburst cycle of OJ 287. In other ways the timing of the outburst was surprising, since calculations based on the periodicity were predicting such an outburst in late 2006. Here we point out that, in the precessing binary black hole model, first proposed by Sillanpaa et al., and later refined by Lehto & Valtonen and Sundelius et al., the precession shifts the first outburst of each outburst season progressively to earlier times relative to the mean period. Thus, in this model, the timing of the outburst is quite acceptable, even if it was not predicted. The next test of the model comes in 2007 September when the second brightness peak is due. It may then be possible to detect the shortening of the binary period due to emission of gravitational waves from the system.