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Postgraduate Medical Journal of Ghana

Volume 8 Number 1

Articles in Volume 8 number 1

Breast cancer is curable
Clegg-Lamptey JA

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A Prospective Cohort Study Of Closed Foot Injuries In A Tertiary Hospital In Ghana
Konadu-Yeboah D, Konadu P, Smith H, Quansh RE, Addo AO

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A PROSPECTIVE COHORT STUDY OF CLOSED FOOT INJURIES IN A TERTIARY HOSPITAL IN GHANA

Key Words: Close Foot, Injuries, Management

ABSTRACT

Objective: Our objectives were to determine the proportion of closed foot injuries and their treatment outcomes at a large trauma hospital in Accra, Ghana.

Methods: A structured questionnaire was used to record, for each patient, the type of closed foot injury, the
mechanism of injury, any concomitant injuries, the time interval between injury and arrival at the KBTH for treatment as well as the type of treatment instituted. Enrolled patients were followed up for six months, complications resulting from the foot injury or its treatment were recorded for each patient. The function of the foot after healing of the injury was measured using the American Foot and Ankle Society Score.

Results: A total of 46 patients presented with closed foot injuries, males accounted for 58.7% and females 41.3%. Road traffic trauma was by far the most predominant cause of injury accounting for 63% of cases. Soft tissue contusions involving the foot had excellent outcomes after treatment; displaced metatarsal shaft fractures
treated with open reduction and internal fixation with Kwires had a good outcome; displaced metatarsal shaft fractures treated with cast immobilization had unfavorable outcomes. Non-operative treatment of Lanfranc fracture-dislocation with cast immobilization resulted in severe limitation of climbing stairs, shoe wear, walking on uneven surfaces and inability to return to previous occupation.

Conclusion: Displaced intra-articular calcaneal fractures cause significant persistent foot pain after treatment and Lisfranc fracture-dislocations have unfavorable outcomes if treated conservatively with cast immobilization alone. Fractures of the foot cause a longterm morbidity with residual foot pain, limitation of foot wear, climbing stairs, walking on uneven surfaces and difficulty integrating into previous occupation. The resulting foot dysfunction is worse if the fracture is not appropriately stabilized.

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Respiratory Viral Infections In Pediatric Acute Leukemia Patients Presenting With Febrile Neutropenia In A Tertiary Hospital In Ankara, Turkey

Alhassan Abdul-Mumin, Ates Kara, Ali Bulent Cengiz, Mehmet Ceyhan

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RESPIRATORY VIRAL INFECTIONS IN PEDIATRIC ACUTE LEUKEMIA PATIENTS PRESENTING WITH FEBRILE NEUTROPENIA IN A TERTIARY HOSPITAL IN ANKARA, TURKEY

Key WordsAcute leukemia, febrile neutropenia, children, nasopharyngeal aspirate, Polymerase Chain Reaction

ABSTRACT

Background: The prevalence and roles of respiratory viral pathogens in pediatric acute leukemia patients with
febrile neutropenia is not well understood and laboratory tests to detect viral agents are not a routine practice in the investigation of these patients.

Patients and methods: The medical records of 50 neutropenic episodes in pediatric acute leukemia patients in the Hacettepe University Children’s hospital, Ankara-Turkey, were reviewed. Blood samples were obtained for blood culture, aspergillus antigen and other routine tests. Nasopharyngeal aspirate samples were collected and transferred to the laboratory in a viral transport medium. Therapy for febrile neutropenia was initiated according to our institution’s protocols.

Results: Fifty (50) consecutive febrile neutropenic episodes in 44 pediatric ALL and AML patients were included in the study between 1st October 2009 and 31st August 2010. Microbiologically documented infections were found in 36% of the episodes, clinically documented infections in 16% of the episodes and 48% of the episodes were accepted as Fever of Unknown Origin. Twenty-two percent (22%) of the microbiologically documented infections were due to viral agents, 56 % were due to Gram positive bacteria, 21% were due to Gram negative bacteria (E. coli) and only one episode of fungemia was documented

Conclusion: Fever of Unknown Origin constituted nearly 50% of the febrile neutropenic episodes in this study despite the availability of advanced laboratory diagnostic methods. Among the episodes with microbiologically documented infections, bacterial pathogens were especially common. Presenting complaints like cough and rhinorrhea are not specific to a viral etiology and care should be taken not to miss potentially threatening bacterial pathogens in such episodes.

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Menstrual Hygiene Management And Resources For Adolescent Girls In An Urban Setting In Accra, Ghana

Emmanuel B, Yawson AE

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MENSTRUAL HYGIENE MANAGEMENT AND RESOURCES FOR ADOLESCENT GIRLS IN AN URBAN SETTING IN ACCRA, GHANA

Key Words: Menstruation, Menarche, Adolescent girls, Accra, Sanitary products, Resources Basic Schools

ABSTRACT

Background: Menstruation is the recurring peeling of the inner part of the uterus or the shedding of the uterine lining on a regular basis in the reproductive-aged females during the monthly menstrual cycles. Menstrual hygiene management (MHM) is an everyday challenge to the adolescent girl child globally, and in developing countries like Ghana. Positive menstrual hygiene management is important because it helps in preventing several health challenges which may be associated with poor menstrual hygiene management. The aim of this study was to determine the state of MHM among adolescent girls in Accra.

Methods: Quantitative cross-sectional study was conducted using self-administered questionnaires to collect data which was analysed to evaluate the sanitary provisions in the school. Two Basic Schools in Legon, Accra were identified and random sampling procedure was used to select research participants.

Results: Findings revealed that the mean age at menarche of adolescent girls in Basic Schools in Legon was 11.9 ±1.2 years; and that MHM was promoted at home and in schools. In all, 68% and 21% of the adolescent girls routinely bathed two and three times daily respectively during menstruation; 50% of the respondents changed sanitary products three times daily when menstruating, this was followed by 47% who changed twice daily. More than half of them disposed of their used sanitary products by wrapping and putting in the dustbins. Sanitary facilities were seen to be available and in use during the time of survey.

Conclusion: Menstrual hygiene practices among the Basic School girls were good, with socio-economic factors contributing to the use of good disposable menstrual products during menstruation. Sanitary facilities were seen to be available and in use although resources such as running water, soap for hand washing, and sanitary products in the event of an emergency were unavailable.

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Outcomes In Elective Induction Of Labour With 50 μg Intravaginal Misoprostol In Postdate Singleton Live Pregnancy At Korle-Bu Teaching Hospital

Kaboré SY1 Nuamah MA, Koranteng IO, Akoto-Ampaw E, Nkyekyer K

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OUTCOMES IN ELECTIVE INDUCTION OF LABOUR WITH 50 μG INTRAVAGINAL
MISOPROSTOL IN POSTDATE SINGLETON LIVE PREGNANCY AT KORLE-BU TEACHING HOSPITAL

Key Words: Misoprostol; Labour induction; Postdate, Intravaginal.

ABSTRACT

Background: Induction of labour is indicated when the risk associated with expectant management of labour is
higher. The most common indication for labour induction is postdate pregnancy and induction for this indication has been shown to reduce perinatal death. Misoprostol is the most commonly used drug for labour induction at the Korle-Bu Teaching, the leading national referral centre in Ghana.

Method: To assess the outcomes in Elective Induction of Labour using 50 μg of intravaginal misoprostol in postdate singleton live pregnancies at Korle-Bu Teaching Hospital. This was a prospective cohort study carried out to measure the rates of vaginal deliveries and factors affecting vaginal deliveries during labour induction. One hundred and sixteen pregnant women of at least 41 weeks gestation. Women were included and followed up from the first insertion of misoprostol to delivery.

Results: Eighty-six patients (74.1%) had vaginal delivery and 30 (25.9%) were delivered by caesarean section. Among those who delivered vaginally, 77 (89.5%) delivered within 24 hours. There was a significant association between mode of delivery and Bishop Score (P=0.002). The highest Apgar score at the
first minute was 7 in 55 babies (47.4%) and the lowest was 3 in 2 babies (1.7%).

Conclusions: The high rate of vaginal delivery and absence of induction related perinatal mortality confirmed the effectiveness and safety of misoprostol in postdate singleton live pregnancy at Korle-Bu Teaching Hospital

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Transmittance Characteristics Of Dimethacrylate Resin Based Dental Composites

Quartey-Papafio N.

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TRANSMITTANCE CHARACTERISTICS OF DIMETHACRYLATE RESIN BASED DENTAL COMPOSITES

Key Words: Transmittance, Dental resin-composites, Light wavelength, Dimethacrylate, Attenuation coefficient

ABSTRACT

Background: The transmission of light through dental composites is a major factor responsible for photo activation polymerisation and optical properties of these materials. The extent of the light transmission depends on their formulations.

Objectives: The purpose of this study was to determine the transmittance of dental resin-composites and investigate the effect of material thickness and light wavelength.

Methods: Four photo-cured disc samples (Φ20mm) with different material thicknesses (ranging from x=0.11mm
to x=1.46mm) of three different nanohybrid dental resin–composites (Regular, Flowable and Sealant) of the same shade, A3 and matrix but different filler loading were prepared. Transmittance measurements (n=3) were made using an Ocean Optics USB 4000 fibre optic Spectrometer operated by a Spectra Suite software. Data were analysed by One-way analysis of variance (ANOVA) combined with Tukey multiple test.

Results: Differences were found in transmittance values as both material thickness and light wavelength
increases. Transmittance (T) increase significantly (P<0.05) with increasing wavelength and decrease with
increasing thickness. Linear regression analysis of In (T) with material thickness for light wavelength, gave R2
values ranging from 0.81 to 0.99. Correlation of attenuation coefficient with light wavelength for the materials indicated significant correlation (p<0.05, r=0.94) with Grandio Seal but not with Grandio (p>0.05, r=0.77) and Grandio Flow (p>0.05, r =0.79).

Conclusions: The significant differences in the transmittance with increasing light wavelength and material thickness of the materials may affect their clinical appearance.

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Prevalence And Factors Associated With Self-Reported Hearing Loss Among Registered Pensioners In Ghana

Nuertey BD, Addai J, NuerteyAD, Kabutey C, Adongo V, Mensah IA

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PREVALENCE AND FACTORS ASSOCIATED WITH SELF-REPORTED HEARING LOSS AMONG REGISTERED PENSIONERS IN GHANA

Key Words: Hearing loss, Self reported hearing loss, Hearing aid, Pensioners

ABSTRACT

Background: Hearing loss affects quality of life. Prevalence of hearing loss varies across various
geographical regions. The aim of the study is to determine the prevalence and factors associated with self-reported hearing loss among the registered pensioners in Ghana.

Method: the study was a cross-sectional nation-wide study among members of the national pensioners association. It was carried out in thirteen study sites with at least a study site in each region capital of Ghana. Questionnaire administration, physical examination, urine and blood examinations were the method for data collection.

Results: Overall prevalence of self-reported hearing loss among the pensioners was, 4.1%. Pensioners below 65years of age had a prevalence of 3.6% (95% CI, 2.7 – 4.5) whiles those above 80 years of age had an overall prevalence of 5.6% (95% CI, 1.5 – 9.6). Also, 14 pensioners per 10,000 pensioners in Ghana use hearing aids whereas 31 pensioners per 1000 reporting hearing loss, use hearing aid. The following factors were found to be associated with hearing loss; raised urine nitrates (AOR 2.3, 95% CI, 1.1 – 5.0), history of allergies (OR 1.9, 95% CI, 1.2 – 2.8), history of chronic bodily pain (OR 1.7, 95% CI, 1.3 – 2.4), use of eyeglasses (OR 1.8, 95% CI, 1.3 – 2.6) current alcohol intake (OR 1.5, 95% CI, 1.0 – 2.2) underweight (OR 1.7, 95% CI, 1.0 – 2.9)

Conclusion: The prevalence of self-reported hearing loss is low in Ghana compared to its regional and global estimates. The uptake of hearing aid use among pensioners in Ghana is very low.

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A preliminary Study On Living With Low Vision: Emotional And Psychosocial Experiences
And Challenges Of Patients In A Tertiary Health Facility In Ghana

Abaidoo B, Ackuaku-Dogbe E, Mokawol R, Yawson AE

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A PRELIMINARY STUDY ON LIVING WITH LOW VISION: EMOTIONAL AND PSYCHOSOCIAL EXPERIENCES AND CHALLENGES OF PATIENTS IN A TERTIARY HEALTH FACILITY IN GHANA

Key Words: Low vision, emotional and psychosocial experiences, depression, coping strategies

ABSTRACT

Background: Low vision usually results in difficulties in independent mobility with associated emotional and
psycho-social challenges and impairment in overall quality of life of sufferers. This study explored the psychosocial experiences and challenges of adult low vision patients at the Korle Bu Teaching Hospital.

Methodology: A qualitative exploratory research was conducted to explore the psychosocial experiences and
challenges of patients at the Low Vision Clinic at the Korle Bu Teaching Hospital, Ghana. Adult low vision patients aged ≥18 years were selected for a face-to-face in-depth interview and a focus group discussion. An interpretive content analysis of the data was performed to identify themes and sub-themes from the respondent’s narrations.

Results: A total of 15 participants aged between 24 years and 75 years were involved in the study. There were 9 males and 6 females with a mean age of 50.5± 17.9 years. Themes generated from the study include; emotional reactions, loss of hope in life, social support, low vision rehabilitation and coping strategies. Emotional feeling, depression, fear of eventual blindness, dependency on family and society, difficulties in coping with low vision, loss of hope in life, lack of support from family and friends and reduced quality of life were found to be the most challenging psychosocial issues surrounding the low vision patient in their daily living. Burden of care and cost for
rehabilitation of persons with low vision is borne by the individual and not covered by the National Health Insurance Scheme.

Conclusion: The NHIS could include basic and less expensive devices for improving the everyday lives of persons with low vision in the benefits package of the scheme. Structured counselling sessions should be included as part of the care package for persons with low vision and role of the clinical psychologist in the care team is essential.

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Challenges In The Management Of Retinoblastoma At Peripheral Eye Clinics In Ghana

Essuman VA, Braimah IZ, Essuman A, Ndanu TA, Ntim-Amponsah CT

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CHALLENGES IN THE MANAGEMENT OF RETINOBLASTOMA AT PERIPHERAL EYE CLINICS IN GHANA

Key Words: eye tumours, leukocoria, ophthalmologists, peripheral eye hospitals, retinoblastoma.

ABSTRACT

Introduction:Retinoblastoma is the commonest childhood intraocular tumour with fatal consequence if untreated. The study purposed to determine, from general ophthalmologists at peripheral eye clinics in Ghana, the clinical stage of the disease at presentation to such centres, the challenges associated with its management and to seek recommendations for improvement in the management of retinoblastoma.

Methods: A comparative, cross-sectional study was conducted among general ophthalmologists over two time periods: Period 1 (2005-2007) and Period 2 (2014-2016). One ophthalmologist from each peripheral eye clinic in Ghana was interviewed face-to-face, by telephone or email using a structured questionnaire after verbal informed-consent.

Results: Responses were received from 24 out of 26 general ophthalmologists in Period 1 and from 35 out of 37 in Period 2. On the average 82 and 95 cases were seen respectively for the two periods. Specifically, 69 cases were seen in the year 2007 and 64 in 2016. The estimated age-specific incidence rates (ASR) for Periods 1 and 2 were 20.3 and 17.3 per million person-years respectively. The common clinical presentations reported by the ophthalmologists were leukocoria followed by proptosis and redness of eyes in both study periods. Diagnosis of retinoblastoma using clinical features supported by imaging (ultrasonography and CT-Scan) was done by 10 out of 24 (41.7%) in Period 1, as compared with 18/35 (51.4%) in Period 2 (p=0.461). Majority of ophthalmologists referred all their patients for treatment elsewhere in both periods on account of lack of resources for management including lack of general anaesthesia. Management challenges included abandonment of treatment by caretakers, lack of resources for management and refusal of treatment by caretakers with reasons such as cost, distance, fear of surgery and fear of bigger hospitals. Recommendations for improvement in management included need for standardized treatment guidelines, early detection through health education and funding for care.

Conclusion: Patients with retinoblastoma present with clinically advanced disease to ophthalmologists in peripheral eye clinics in Ghana. There is abandonment and refusal of treatment by caretakers in these centres citing cost and distance as some reasons, and very little improvement over the past decade. Early detection, health education among the general public and health workers, and standardised treatment guidelines are needed to improve on patients’ management and survival.

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The Role Of The Clinical Chemistry Laboratory Physician In Health Care Delivery

Osafo TD

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Diagnosis And Management Of Twin Reversed Arterial Perfusion Sequence 65 At The Korle Bu Teaching Hospital, Ghana

Swarray-Deen A, Mensah-Brown SA, Nkyekyer K

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DIAGNOSIS AND MANAGEMENT OF TWIN REVERSED ARTERIAL PERFUSION SEQUENCE AT THE KORLE BU TEACHING HOSPITAL, GHANA

Key Words: TRAP sequence, monochorionic, twin gestation, acardiac twin, pump twin, congenital anomalies

ABSTRACT
Twin Reversed Arterial Perfusion (TRAP) sequence is a rare complication of twin gestation unique to monochorionic twins, reported to occur in about 1% of all monochorionic pregnancies. In this condition, an acardiac twin, with an absent or non-functioning heart, is perfused by its co-twin (referred to as the “pump” twin) via placental anastomoses. It is associated with a high mortality for the pump twin without intervention. We report two cases of TRAP sequence diagnosed prenatally by ultrasound at the Korle Bu Teaching Hospital. We describe how this rare anomaly can be diagnosed and managed successfully even in a low resource setting to yield good perinatal outcomes.

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Acute Myelogenous Leukemia In Pregnancy In A 32yr Old Woman

Sayibu SS, Sefogah PE, Coleman J

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ACUTE MYELOGENOUS LEUKEMIA IN PREGNANCY IN A 32YR OLD WOMAN

Key Words: Acute, Leukemia, Non-Lymphocytic, Promyelocytic, Myelogenous, Myeloid.

ABSTRACT

Background: Generally a disease of the elderly, Acute Myelogenous Leukemia (AML) very rarely occurs in pregnancy with an estimated incidence of 1 in 75,000 – 100, 000 pregnancies1, 2. There is hardly any data on the difference in its incidence between pregnant women and non-pregnant women in the reproductive age. However, management options are more in the non-pregnant, as they are in the elderly. Because there is yet no globally agreed standard way of managing this clinical dilemma in pregnancy, various institutions have proposed different management protocols depending on the AML type, degree of symptomatology, gestational age at diagnosis and the patient’s wishes. The objective of this publication is to present our experience with this condition at the Korle Bu Teaching Hospital, to bring attention to the possibility of the condition in our environment as part of differential diagnoses of anaemia or coagulopathy in pregnancy.

Case: We report the case of a 32yr old G3P1+1A, at 32weeks 2days gestation diagnosed with and managed for Acute Myeloid Leukemia at the Korle Bu Teaching Hospital, and review of the available literature on this condition in pregnancy.

Conclusion: Acute Myelogenous Leukemia is a very rare condition in pregnancy that lacks universally accepted treatment protocols. Management can pose a challenge to clinicians, patients and their relatives. Early accurate diagnosis is difficult in resource-constrained settings, and management options are limited when trying to save both fetus and mother. Early accurate diagnosis and prompt referral for appropriate interventions are key in improving outcomes, even in the face of other obstetric complications.

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