PMJG VOL 3 No 2

Postgraduate Medical Journal of Ghana
Volume 3 Number 2

Articles in Volume 3 number 2

The Anaesthetist: A Perioperative Physician
Ernest Aniteye

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The Anaesthetist: A Perioperative Physician

Perioperative medicine has been defined as “the continuum of patient care involving preoperative evaluation and preparation, pre-anaesthetic assessment, intraoperative care, and the management of systems and personnel supporting these activities” and the Anaesthetist is said to be a physician trained in anaesthesia and perioperative medicine. The field of anaesthesia has changed over the years when the principal function of an anaesthetist was to render patients unconscious for surgery.
Anaesthetists’ extensive knowledge of physiology and pharmacology coupled with inroads into neuraxial blocks has opened other avenues for anaesthetists to operate. Anaesthetist-directed preoperative clinics have helped to prepare patients for surgery, reduced cancellation of cases, modified patient drug therapy, discovered other systemic disease and counselled patients when patients were confused or distressed because of scheduled surgery. This may reduce waiting lists in the hospital and help in the efficient management of theatre space and time. Advances in ultrasonography and x-ray technology have improved and expanded use of neuraxial blocks for anagement of acute and chronic pain. Anaesthetists are the pacesetters in most pain clinics/therapy units throughout the world.
Development of pain medicine have been slow in Ghana and at present Komfo Anokye Teaching Hospital in Kumasi is the only centre which provides routine chronic pain therapy services… “Please Download full article”

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HIV IN GHANA
Adu EJK, Koranteng A

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HIV IN GHANA

COMMENTARY
body’s immune cells and AIDS is the most advanced form of the HIV infection. The first case of the disease was detected in Ghana in 1986 in Accra and since then, it has spread throughout the country. Initially it was most prevalent in Eastern Region, and was linked to indigenes who had returned home after being infected in neighbouring countries notably, Cote d’Ivoire. The country established AIDS Control Programme (ACP) in the Ministry of Health with support from the World Health Organization (WHO).
Preparatory efforts started as the National Technical Committee on AIDS and later became National Advisory Council on HIV and AIDS in 1985. The Council evolved into the National AIDS Control Programme (NACP).
The initial emphasis of the programme was on Prevention, with the flagship slogan of “Abstinence, Being faithful to partner and Condom use” (ABC). The Ghana AIDS Commission (GAG) was established in 2000 and was placed directly under the office of the President, for policy guidance.

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A Review of National Programme Data on the HIV Epidemic in Ghana: 2005-2010
Addo NA, Yawson AE, Addo AS, Dornoo BT, Seneadza HNA

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A Review of National Programme Data on the HIV Epidemic in Ghana: 2005-2010

Key words: Antiretroviral therapy, HIV and AIDS, HIV sentinel survey, Ghana, Median HIV prevalence

ABSTRACT
Background: Enormous national efforts have gone into combating the HIV epidemic in Ghana. This study reviewed data from the National AIDS/STI Control Programme over the period 2005-2010, in terms of time, place and person characteristics of the epidemic. It focused on past and current efforts at combating the epidemic and what future efforts are required.

Methods: It was a descriptive review of data from HIV sentinel surveys (HSS) and annual reports of the National AIDS/STI Control Programme (NACP) from 2005 to 2010. The review was conducted in 2011. The analysis described reported HIV and AIDS cases in the general population, median prevalence of HIV among pregnant women (15-49years), and AIDS related mortalities. Also, number of clients on ART, and those lost to follow up was analyzed. These characteristics were disaggregated by sex, age groupings, location and by administrative regions.

Results: The review demonstrated an increasing trend in the annual new HIV+ cases. However, the median HIV prevalence amongst pregnant women over the period was declining. There were clear age and regional or urban/rural differences in HIV prevalence in the country. National coverage for ART was 26% in 2009 and 35.2% in 2010. Number of clients on ART lost to follow up increased over the period, especially from 2008 onwards; it was 4.9% in 2008 and 9.2% in 2009. Over the entire review period (2005-2010), number of patients lost to follow up was over a hundred fold.

Conclusion: Ghana has made good progress in combating the HIV and AIDS epidemic, however there are challenges. National coverage of ART was low, and patients lost to follow up were high. The unmet need for ART though comparable to that of other African countries, poses major challenges to Ghana’s quest to reverse the HIV epidemic. Policy measures to increase ART coverage and limit loss-to-follow up are still paramount.

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ASYMPTOMATIC BACTERIURIA AND DRUG SUSCEPTIBILITY PATTERNS OF MID-STREAM URINE SPECIMENS AMONG PREGNANT WOMEN AT BOOKING IN A PRIVATE HOSPITAL IN KUMASI, GHANA
Addo VN

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ASYMPTOMATIC BACTERIURIA AND DRUG SUSCEPTIBILITY PATTERNS OF MID-STREAM URINE SPECIMENS AMONG PREGNANT WOMEN AT BOOKING IN A PRIVATE HOSPITAL IN KUMASI, GHANA

Key words: Pregnancy, Booking, Asymptomatic bacteriuria, Staphylococcus aureus

ABSTRACT

Background:Urinary tract infections (UTIs) are common during pregnancy. Asymptomatic bacteriuria(ASB) can lead to the development of cystitis or pyelonephritis if left untreated and could eventually result in very serious sequelae.

Objective: To determine bacterial isolates and drug susceptibility patterns of mid-stream urinary specimens among pregnant women who were asymptomatic for UTIat their first antenatal attendance (booking).

Methods: A retrospective review of urine results of antenatal attendants with no symptoms of UTI at booking from January 2010 to December, 2012 was done. As part of routine investigations at booking women provided mid-stream urinary specimens and bacterial isolates and drug susceptibility patterns were determined.

Results: The total number of women was 453 and significant bacteriuria was found in 45/453(9.9%). The commonest bacterial isolates were Staphylococcus aureus18/45 (40%) and E. coli 15/45 (33.3%). All the bacterial isolates were sensitive to nitofurantoin and the least sensitivities were to erythromycin 13/45 (28.9%) and ampicillin 11/45 (24.4%).

Conclusion: All pregnant women should be screened for bacteriuria at booking since the asymptomatic ones may have significant bacteriuria which could later result in serious infections and poor pregnancy outcomes. The choice of antibiotics used should be based on maternal factors and the gestational age.

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ADOLESCENT FEMALE GENITAL TRACT CONGENITAL ANOMALIES IN
NORTHERN GHANA

Gumanga SK, Kyei-Aboagye K, Seffah JD

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ADOLESCENT FEMALE GENITAL TRACT CONGENITAL ANOMALIES IN
NORTHERN GHANA

Key words: Congenital, Adolescent female, Genital Tract anomalies, Tamale Teaching Hospital.

ABSTRACT
Objective: To ascertain the types of adolescent female genital tract congenital anomalies and their management in the Tamale Teaching Hospital in Northern Ghana.

Methods: A cross-sectional study of adolescent female genital tract congenital anomalies that were managed at the Tamale Teaching Hospital from 1st January 2010 to 31st December 2012.

Results: : There were 19 cases of adolescent female genital tract congenital anomalies during the study period. The commonest female genital tract congenital anomaly was imperforate hymen 7(36.84%). Other congenital anomalies included transverse vaginal septum 4(21.05%), vaginal atresia 2(10.53%), vaginal agenesis 4(21.05%), didelphus uterus 1(5.26)% and bicornuate uterus 1(5.26%). The management of the adolescent female genital tract congenital anomalies included surgical procedures in 14 (73.68%), dilation of vaginal pouch, counseling and psychological support in 6 (31.57%).

Conclusion: While in resource limited settings, initial workup and management of adolescent female genital tract congenital anomalies may be done without sophisticated equipment, management of more complex cases are usually more challenging requiring referral to more appropriately staffed and equipped centres.

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PRIORITIES OF PROFESSIONAL POSTGRADUATE SPECIALIST TRAINING
Archampong EQ

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PRIORITIES OF PROFESSIONAL POSTGRADUATE SPECIALIST TRAINING

EXTRACT
Intoduction: I must thank the Chairperson of Council and the Council for the honour and privilege of inviting me here this morning to reminisce on our collective experiences over the past ten years, in the exercise of our basic right to determine the modalities of training and admission into our profession in this country. I sincerely hope that my emphasis strikes the right accord, i.e. less on the facts of history and more on how these events help to direct our efforts towards more effective strategies in training in the ensuing years. This is the reasoning for focusing our attention in this address on the Priorities of Professional Postgraduate Specialist Training.
The ideal health personnel for any population or community is one who is closely attuned to and therefore, most readily responsive to the health needs of the population. This is a universal truth which finds expression in the experiences of health services of many developing countries, and is echoed repeatedly in the exhortations of the World Health Organisation in its educational policies. The implication is that excellence is and should be defined by relevance. This has certainly been the Ghanaian experience in the training of all cadres of health personnel, but particularly of doctors from their basic training through vocational to postgraduate specialist training and education. The crucial issue is the mechanisms that set the priorities of these health needs. What then becomes of global excellence or the “Five star doctor or specialist?” There is no contradiction so long as the criteria of excellence are relevant to the local context.

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CONSENT TO MEDICAL TREATMENT: A DOCTOR’S VIEW ON HOW THE GHANAIAN COURTS MAY RESOLVE CONSENT RELATED INFORMATION DISCLOSURE DISPUTES.
Adwedaa E

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TCONSENT TO MEDICAL TREATMENT: A DOCTOR’S VIEW ON HOW THE GHANAIAN COURTS MAY RESOLVE CONSENT RELATED INFORMATION DISCLOSURE DISPUTES.

Key words: Consent, negligence, information disclosure, material risk, standard of care, patient autonomy

ABSTRACT
Summary: Many doctors may be unaware of how the courts may rule on disputes on ‘consent to medical treatment’ in Ghana. The knowledge of how the courts may resolve an allegation of failure to obtain consent brought by a patient against a doctor may help doctors improve on how they communicate with their patients and consequently improve patient care.
The primary purpose of consent for medical treatment is respect for individual autonomy. There is no evidence that the Ghanaian society values respect for individual autonomy any less than anybody in any other culture. There are no specific legislations in Ghanaian law or reported cases from Ghanaian courts that establish how a ‘valid or informed consent is defined in Ghanaian law. The Ghanaian legal system operates the ‘common law’. If a patient brings a claim alleging that his doctor did not seek his consent prior to treatment or that the information provided to him prior to granting his consent was inadequate, the Ghanaian court’s approach to resolving it is likely to be patient focused and similar to the approach used in other common law jurisdictions. Good doctor-patient communication is therefore, very important.

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AIRWAY ASSESSMENT BY NON-ANAESTHETISTS
Amponsah G

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AIRWAY ASSESSMENT BY NON-ANAESTHETISTS

Key words: Airway assessment, preoperative difficult airway, non-anaesthetist, Mallampati score

ABSTRACT
Summary: Patients who may require surgery, visit our hospitals daily. Various forms of anaesthesia are given for these surgeries, which include local, regional and general anaesthesia. General anaesthesia may involve the use of devices to maintain a secure and safe airway. The improper management of the airway is still an important cause of morbidity and even mortality in anaesthetic practice. This paper seeks to give guidelines for the non-anaesthetist to be able to identify patients whose airway may be difficult to manage during surgery, since the surgeons see the patients first, long before the anaesthetist does. These airway assessment guidelines have been given based on the various surgical specialties such as general surgery, maxillofacial and neurosurgery. Specific surgical disorders which have a relatively high percentage of difficult airway have been discussed. They include goitre, mediastinal masses, abscesses and burns around the head and neck. Medical conditions such as diabetes mellitus with expected difficult airway have also been discussed. A simple algorithm has been added as an additional guide. The paper ends with recommendations which include the establishment of difficult airway database and the running of regular workshops for anaesthetists and non-anaesthetists as a means of maintaining skills in the management of the airway of the surgical patient and thus improve on their outcome.

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DIAGNOSING ANAEMIA: AN OVERVIEW
Dei-Adomakoh YA, Ekem I, Segbefia CI, Atiase Y

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DIAGNOSING ANAEMIA: AN OVERVIEW

Key words: Anaemia, classification, investigation

Extract
SUmmary: The World Health Organisation (WHO) provides a definition for anaemia in both adults and children based on haemoglobin values determined in the laboratory. However, not all patients with haemoglobin values lower than these thresholds warrant investigation. The decision to investigate those with minor abnormalities must be based on clinical judgement, and from what is known about the individual’s previous blood counts. Anaemia is therefore said to be present when the blood haemoglobin (Hb) value is below the reference value for the age, sex and place of residence (altitude) of the individual. Anaemia is a public health problem in most developing countries including Ghana and therefore important to thoroughly investigate these patients. This paper discusses the different types of anaemia and provides a simple overview of issues related to the investigation of different types of anaemia. It should serve as a guide for the practicing doctor in Ghana and elsewhere.

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ANORECTAL MALFORMATION IN A TEENAGER IN GHANA- A CASE REPORT
Yifieyeh AC, Ameyaw E, Duduyemi BM, Amoah M1, Nimakoo B

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ANORECTAL MALFORMATION IN A TEENAGER IN GHANA- A CASE REPORT

Key words: Anorectal malformation, Rectovestibular fistula, Anovaginoplasty, Colostomy

ABSTRACT
Anorectal malformation is a congenital anomaly comprising a wide spectrum of diseases, which can affect male and female and can involve the distal anus and rectum as well as the urinary and genital tracts. The late presentation of patients with anorectal malformations especially in adolescence is known but rare. This is particularly true in females with rectovestibular fistulas. We present the case of a 17-year old female who underwent a posterior sagittal anoplasty on this account with satisfactory outcome.

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