Guyana experiences health challenges related to both communicable and non-communicable diseases. Cardiovascular disease (CVD) is the most common non-communicable disease in Guyana. The main causes of the increased prevalence of non-communicable diseases are modifiable risk factors (e.g. obesity, hypertension, elevated cholesterol, unhealthy dietary patterns) and non-modifiable risk factors (e.g. age and genetics).
The aim of this review is to understand CVD and risk factor data, in the context of ethnicity in Guyana.
A review of the published literature as well as government and international health agency reports was conducted. All publications from 2002-2018 describing CVD and related risk factors in Guyana were screened and extracted.
The population of Guyana is comprised of six ethnic groups, of which East Indian (39.8%) and African (29.3%) are the majority. CVD accounts for 526 deaths per 100,000 individuals per year. Among Indo-Guyanese and Afro-Guyanese, CVD is the primary cause of death affecting 32.6% and 22.7% of the populations, respectively. Within the Indo-Guyanese and Afro-Guyanese communities there is a high prevalence of hypertension and diabetes among individuals over the age of 50. There is a lack of available data describing ethnic disparities in CVD and related risk factors such as obesity, smoking, alcohol, physical activity and diet in Guyana.
Important knowledge gaps remain in understanding the ethnic disparities of CVD and related risk factors in Guyana. Future research should focus on high risk populations and implement widespread screening and treatment strategies of common risk factors such as hypertension, diabetes, and elevated cholesterol to curb the epidemic of CVD in Guyana.

The Canadian Network for International Surgery (CNIS) hosted a workshop in May of 2020 with a goal of critically evaluating Trauma Team Training courses. The workshop was held virtually because of the coronavirus disease 2019 (COVID-19) pandemic. Twenty-three participants attended from 8 countries: Canada, Guyana, Kenya, Nigeria, Switzerland, Tanzania, Uganda and the United States. More participants were able to attend the virtual meeting than the traditional in-person meetings. Web-based videoconference software was used, participants presented prerecorded PowerPoint videos, and questions were raised using a written chat. The review proved successful, with discussions and recommendations for improvements surrounding course quality, lecture content, skills sessions, curriculum variations and clinical practical scenarios. The CNIS\'s successful experience conducting an online curriculum review involving international participants may prove useful to others proceeding with collaborative projects during the COVID-19 pandemic.

BACKGROUND: More than 1500 scorpion species exist worldwide, with a few scorpion species potentially lethal to humans. About 1 million stings annually result in >3000 deaths, but the incidence and mortality vary greatly by species and location. Physicians working internationally must recognize that resulting toxidromes vary significantly by region. Over the past few decades, South America has reported relatively few deaths and low case mortality rates from envenomations. In Guyana, a small tropical country on its northeast coast, they have been extremely rare. A sudden fatal case cluster suggests an extension of the black scorpion\'s habitat, an increase in venom toxicity, or both.
METHODS: During a 12-month period, Guyana experienced 3 deaths, including 1 adult, from black scorpion (Tityus obscurus) envenomation. The 30-year-old man and 2 young children experienced the same symptom complex, initially appearing well except for pain at the sting site. They soon developed persistent emesis and leukocytosis. All were flown from remote jungle areas to the only public tertiary care hospital where they received maximal available medical support. They gradually developed profound cardiopulmonary failure requiring ventilation and, eventually, dysrhythmias. None had hyperglycemia or pancreatitis, and they had no neurologic abnormalities until developing progressive obtundation immediately before intubation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Scorpion envenomation symptoms, outcomes, and treatment are geographically specific. Patients benefit when clinicians recognize the worldwide variations in grading systems and treatment options, which we discuss and compare to our patients.

BACKGROUND: Diabetes mellitus signifies a major public health threat worldwide. Type 2 diabetes has been reported as the fourth leading cause of death and has affected 15.5% of the adult population in Guyana, South America. Diabetes has also led to major lower extremity amputation at the only referral public hospital in Guyana. Diabetic foot and related complications are known to be multifactorial.
CONCLUSIONS: In this review, we highlight the information on the diabetic foot and related complications with an emphasis on Guyanese background.

The Orinoco Andes and northwestern Guiana Shield (Essequibo, Orinoco, Branco, and upper Negro) were found to contain 11 species of Ancistrus, six of which are new. We additionally examine A. brevifilis from the Río Tuy of Venezuela and A. trinitatis from the island of Trinidad. The species in the region can be broken up into dorsoventrally flattened species (A. leoni new species, A. lithurgicus, and A. macropthalmus), white to yellow-dotted species (A. kellerae new species, A. nudiceps, and A. patronus new species), wide-jawed species (A. amaris new species and A. yutajae new species), and white-spotted species (A. brevifilis, A. leucostictus, A. trinitatis, A. saudades new species, and A. triradiatus). Distributions of Ancistrus support the Proto-Berbice hypothesis as A. saudades is found in the upper reaches of the Ventuari, Caura, and Caroni rivers, which were thought to have once flowed into the Proto-Berbice. In addition, although A. nudiceps does not appear to have split once the Takutu River was captured by the Branco, the progenitor of A. leucostictus and A. saudades did speciate with the populations on either side of the Rupununi Portal differing by 7% sequence divergence of the mitochondrial Cytochrome b gene. Besides the descriptions of the new species, we redescribe the others occurring in the area, and adjacent watersheds. We provide a key for their identification, and a preliminary hypothesis of relationships based on DNA sequences of the few species for which tissue samples are available.

Breast cancer is the leading cause of cancer deaths among women in the Caribbean and accounts for >1 million disability adjusted life years. Little is known about the social inequalities of this disease in the Caribbean. In support of the Rio Political Declaration on addressing health inequities, this article presents a systematic review of evidence on the distribution, by social determinants, of breast cancer risk factors, frequency, and adverse outcomes in Caribbean women.
MEDLINE, EMBASE, SciELO, CINAHL, CUMED, LILACS, and IBECS were searched for observational studies reporting associations between social determinants and breast cancer risk factors, frequency, or outcomes. Based on the PROGRESS-plus checklist, we considered 8 social determinant groups for 14 breast cancer endpoints, which totalled to 189 possible ways (\'relationship groups\') to explore the role of social determinants on breast cancer. Studies with >50 participants conducted in Caribbean territories between 2004 and 2014 were eligible for inclusion. The review was conducted according to STROBE and PRISMA guidelines and results were planned as a narrative synthesis, with meta-analysis if possible.
Thirty-four articles were included from 5,190 screened citations. From these included studies, 75 inequality relationships were reported examining 30 distinct relationship groups, leaving 84% of relationship groups unexplored. Most inequality relationships were reported for risk factors, particularly alcohol and overweight/obesity which generally showed a positive relationship with indicators of lower socioeconomic position. Evidence for breast cancer frequency and outcomes was scarce. Unmarried women tended to have a higher likelihood of being diagnosed with breast cancer when compared to married women. While no association was observed between breast cancer frequency and ethnicity, mortality from breast cancer was shown to be slightly higher among Asian-Indian compared to African-descent populations in Trinidad (OR 1.2, 95% CI 1.1-1.4) and Guyana (OR 1.3, 95% CI 1.0-1.6).
Study quantity, quality, and variability in outcomes and reporting limited the synthesis of evidence on the role of social determinants on breast cancer in the Caribbean. This report represents important current evidence on the region, and can guide future research priorities for better describing and understanding of Caribbean breast cancer inequalities.

One new genus (Eurhynchoribates n. gen.) and three new subgenera (Rhynchoribatodes n. subgen., Parhynchoribates n. subgen. and Tectorhynchoribates n. subgen.) are proposed on the basis of review of known species of genus Rhynchoribates Grandjean, 1929 and on the basis of description of three new species-Rhynchoribates (s. str.) danbartai n. sp., Rhynchoribates (Tectorhynchoribates) jurobales n. sp. and Rhynchoribates (Rhynchoribatodes) dynastes n. sp.-from the territory of French Guyana. All known species of Rhynchoribates are discussed and their position into newly defined genera and subgenera proposed. Detailed differential diagnoses are given for all new taxons.

Research on mammals in the Guianas of northern South America has had a checkered history. In this review, I summarize the notable contributions to mammalogical study in Guyana, Suriname and French Guiana. These studies began in the mid-18th century with the binomial nomenclature system of scientific classification created by the Swedish naturalist Carl Linnaeus, who described 23 species new to science based on holotype specimens from the Guianas. Notwithstanding popular accounts by amateur naturalists visiting this region, over the next 7 decades there was only sporadic taxonomic work done on Guianan mammals primarily by researchers at European museums. The first comprehensive biological exploration took place in the 1840s during a geographic survey of the boundaries of British Guiana. However, it was not until almost half a century later that scientific publications began to regularly document the increasing species diversity in the region, including the prodigious work of Oldfield Thomas at the British Museum of Natural History in London. Another lull in the study of mammals occurred in the mid-1910s to the early 1960s after which foreign researchers began to rediscover the Guianas and their pristine habitats. This biological renaissance is still ongoing and I give a prospectus on the direction of future research in one of the last frontiers of tropical rainforest. An initiative that would be greatly beneficial is the establishment of a university network in the Guianas with graduate-based research to develop a cadre of professional experts on biodiversity and evolution as seen in other countries of South America.

The species of Lutrochidae from the Guianas, and the Lesser Antilles are reviewed, including the first reports of the family from Guyana, Suriname, and Grenada. Four species are described as new: Lutrochus funkae n. sp. and L. wao n. sp. from Guyana and French Guiana, L. grenadensis n. sp. from Grenada, and L. leeanneae n. sp. from Suriname. Photographs, genitalia illustrations, and distribution maps are provided for all species, and habitat photos and notes are presented for the species for which they are available.

BACKGROUND: Intravenous lidocaine infusion has been clearly demonstrated as effective for pain in randomized controlled trials, but the belief that cardiac monitoring is required for safe administration is a barrier to access in the palliative care setting. There are also multiple infusion protocols reported in the literature. We have been administering lidocaine infusions for severe cancer pain at the BC Cancer Agency (BCCA) since 2003, without electrocardiographic (ECG) monitoring. Our simple protocol is for 5 mg/kg to be infused over 1 hour, with the option for subsequent doses to be increased if necessary, up to a maximum of 10 mg/kg. Our aim with this study is to share 11 years of our experience with this protocol.
METHODS: This is a retrospective case series. Records of patients who received at least one lidocaine infusion for pain between 2003 and 2013 at the BCCA were reviewed. The primary end points were the documentation of clinical benefit and adverse effects.
RESULTS: A total of 122 lidocaine infusions were administered in 51 individual patients. Twenty-five (49%) had a major response, 12 (23.5%) had a minor response, and 14 (27.5%) were considered nonresponders. Twenty-two (43.1%) patients were noted to have some adverse effect during at least one of the infusions, but only 1 (1.9%) patient had the infusion permanently discontinued. The most common side effects were drowsiness (30.7%), perioral numbness (13.4%), nausea (5.7%), and minor fluctuations of blood pressure (3.8%).
CONCLUSIONS: This case series demonstrates that our protocol of infusional lidocaine can be beneficial to patients with cancer with severe opioid-refractory pain, and can safely be administered with close observation and vital sign monitoring, without ECG monitoring. Lidocaine infusion is a useful option to consider when other pain treatments have not been successful. Although only approximately half of patients will respond well, there is little harm to be expected from a trial of lidocaine infusion and responders can be repeatedly treated. This treatment could be delivered in palliative care units, hospices, or even patients\' homes, providing suitable nursing supervision can be provided.