PMJG Vol 4 no 1

Postgraduate Medical Journal of Ghana
Volume 4 Number 1

Articles in Volume 4 number 1

EBOLA HEMORRHAGIC FEVER: LESSONS FOR OUR STATES.
JD Seffah

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TEBOLA HEMORRHAGIC FEVER: LESSONS FOR OUR STATES.

Pandemics of global proportions in modern times have included Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) and Severe Acute Respiratory Syndrome (SARS). The most recent one, Ebola is associated not only with high fatality and morbidity rates but also stigmatization and desolation in individuals, communities and nations. By the close of December 2014, a total of 18 603 confirmed, probable, and suspected cases of Ebola virus disease (EVD) have been reported in five affected countries (Guinea, Liberia, Mali, Sierra Leone, and the United States of America), and the three previously affected countries (Nigeria, Senegal and Spain). There have been 6915 reported deaths3. The disease can wipe out a weak and dysfunctional public health system. However if the public health system is strong and functional, most of the dying patients can be saved. Some countries in West Africa namely, Guinea, Liberia and Sierra Leone have experienced the largest epidemic of the Ebola hemorrhagic fever ever, since the initial description of the disease in 1976 in the Democratic Republic of Congo. Following this discovery, about 20 isolated cases and outbreaks of various forms of the virus have been reported over the past 38 years in Sudan, Uganda, Ivory Coast and the Philippines with no significant public health consequences. Hardly 100 people have been affected by the disease in any of these previous outbreaks… “Please Download full article”

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BARRIERS TO SKILLED BIRTH ATTENDANCE IN INDONESIA: ANY NEW LESSON FOR GHANA?
Dr PE. Sefogah

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BARRIERS TO SKILLED BIRTH ATTENDANCE IN INDONESIA: ANY NEW LESSON FOR GHANA?

EXTRACT
The presence of a skilled birth attendant at childbirth, backed-up by transport in case emergency referral is required, is perhaps the most critical intervention for making motherhood safer1. Defined as the process by which a woman is provided with adequate care during labour, delivery and early postpartum period1, skilled birth attendance is critical in reducing the high Maternal Mortality Rates in Indonesia and many developing countries. There must be a health worker with midwifery skills and an enabling environment including infrastructure, equipment and logistics with efficient and effective communication and referral systems. The enabling environment broadly includes geographic, political, policy and socio-cultural context in which the skilled personnel operates; as well as the pre- and in-service training, supervision, deployment, regulation, and healthcare financing systems in place1. Minimum important skills are those for detailed history and examination, antenatal care, patient education on pregnancy’s danger signs, recognition of maternal and fetal complications and appropriate intervention, life saving skills when needed, appropriate and timely referral including transport arrangement; and care during transportation.

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BURN INJURIES IN KUMASI: A TEN-YEAR REVIEW
Adu E J K, Koranteng A

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BURN INJURIES IN KUMASI: A TEN-YEAR REVIEW

Key words: Burn injuries, scalds, electrical, chemical, contractures

ABSTRACT
Objective: To document the clinical and epidemiological features; and the outcome of management of patients with burn injuries at Komfo Anokye Teaching Hospital in Kumasi, Ghana, from January 2003 to December 2012

Methods: Data on all burn patients managed within the study period were retrieved from the records of the Burns Intensive Care Unit (BICU), theatre and Surgical Outpatient Department (SOPD) and analyzed. Data included name, age, sex, cause of burn, medical and surgical treatment given, post burn complications and the outcome of the treatment.

Results: 1361 patients were treated for burn injuries and their complications at KATH, comprising 707 males and 654 females (M: F = 1.08:1). Ages ranged from 0.25 to 92 years; mean 15.5 (SD 14.1) years, median 11.9 years. About 77% of the patients were aged 20 years or less; 45% were children aged 10 years or younger. The highest annual admission was 172 patients in 2005; the lowest 104 in 2007. Scalds comprised 60% of the injuries, hot water accounting for 45%. Dry heat was responsible for 37% of the burn injuries. Chemical burns accounted for 28 (2%) injuries which led to loss of vision in two cases and one death; all of which were through assault. Electrical burns accounted for 12 (0.9%) of the injuries and led to six limb amputations and three deaths, all of them workers of electricity companies. A total of 162 patients died of burn injuries, giving an overall mortality of 11.9%. The highest annual mortality of 32 (29%) occurred in 2008, which coincided with 4 major burn disasters. Perioperative deaths occurred in four epileptic patients.

Conclusion: Though injuries from hot liquids account for most admissions for burns at KATH, significant morbidity and mortality also result from dry heat. Electrical and chemical burns and epilepsy are increasingly becoming responsible for most burn morbidity.

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PERIPHERAL INTRAVENOUS CANNULATION AND PHLEBITIS RISK AT CAPE COAST TEACHING HOSPITAL
Osei-Tutu E, Tuoyire D A, Debrah S, Ayetey H

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PERIPHERAL INTRAVENOUS CANNULATION AND PHLEBITIS RISK AT CAPE COAST TEACHING HOSPITAL

Key words: Phlebitis, IV cannulation, Cannula, Routine replacement

ABSTRACTIntravenous (IV) cannulation is the commonest invasive procedure among hospitalised patients. It is however associated with risks and complications that can have an adverse impact on the clinical outcome of the patient.

Aim: To assess the incidence of and risk factors for development of phlebitis following peripheral IV cannulation at Cape Coast Teaching Hospital (CCTH), and establish the optimal day for routine replacement of IV cannulas in our setting.

Methods: A prospective observational study was conducted over a period of three months from September 2013 to December 2013 at the Medical and Surgical Wards at CCTH. Patients were assessed using the Visual Infusion Phlebitis (VIP) Score. Results were analysed and chi square was used to test associations and significance level set at p value ≤ 0.05.

Results: A total of 224 patients were assessed. The incidence rate of phlebitis was 52.2%. Phlebitis was higher among patients who had cannulas in situ beyond day four (66.3%) compared to those who had cannulas for up to four days (44.4%)(p=0.002). Phlebitis was also higher among patients with ongoing infections (69%) (p=0.023).

Conclusion: Over half of cannulated patients studied developed phlebitis. Phlebitis rates were significantly increased four days post-cannulation and in patients with ongoing infections. Routine replacement of cannulas by day four is therefore recommended.

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PROSPECTIVE EVALUATION OF HOSPITALIZED PATIENTS WITH ATRIAL FIBRILLATION IN SENEGAL
Tamatey MN, Sereboe LA, Tettey MM, Edwin F, Entsua-Mensah K, Gyan B, Aniteye EA, Ofosu-Appiah EA, Okyere I, Mohammed I, Adzamli IK, Offei-Larbi G

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PROSPECTIVE EVALUATION OF HOSPITALIZED PATIENTS WITH ATRIAL FIBRILLATION IN SENEGAL

Key words: Atrial fibrillation, epidemiology, evaluation, Dakar

ABSTRACT
Background: The purpose of this study was to determine the prevalence, complications and therapeutic strategy in the management of atrial fibrillation.

Methods:This was a prospective, descriptive study conducted at the Cardiology Department of the Aristide Le Dantec University Hospital in Dakar, Senegal which included all patients with atrial fibrillation, admitted between September 2006 and June 2007. We studied the clinical, para-clinical variables as well as the therapeutic strategy adopted. For the comparison of parameters we used the student t-test with significant values considered when p < 0.05.

Results: One hundred patients with atrial fibrillation were admitted during the study period giving a prevalence of 14.2% among admitted cases. The average age of our study cohort was 47.7±18.4years. In our study population, there was heart failure in 58%, stroke in 15%, left atrial thrombus in 2% and acute is chemia of the leftleg in one patient. Transthoracic echocardiography showed dilated left atrium in 61% of patients, left ventricular systolic dysfunction in 25 of patients and two cases of left intra-atrial thrombus. Valvular heart diseases was found in 53% of cases. Anticoagulation therapy with low molecular weight heparin and with vitamin K antagonist was given in 80% and 95% of patients respectively. Pharmacological cardioversion and direct current (DC) cardioversion were performed in 11% and 22% of patients respectively.

Conclusion: Atrial fibrillation was more prevalent in young adults with rheumatic valvular heart disease, with rate control the most commonly used therapeutic strategy. The findings justify the need for primary prevention.

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IMPROVING EMERGENCY CARE IN GHANA
Oduro GD

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IMPROVING EMERGENCY CARE IN GHANA

EXTRACT
Introduction: It is an immeasurable honour to be in the company of His Excellency the Vice President of the Republic of Ghana Vice President Kwesi Amissah-Arthur, and with you all today, and to share my humble thoughts on “Improving Emergency Care in Ghana”. It is also an inestimable honour to be in the company of so many highly-skilled health professionals, and I feel an even greater honour that I have been asked to deliver this year’s College Lecture. I never for once thought that one day I would give a lecture to those who taught me in Medical School, but there you are; in the audience I see a number of my former lecturers! Last year in Lome I was a facilitator on a Trauma management session held by the West African College of Surgeons. I wanted to make the point that in these austere times we as health workers should be looking for ways to improve care without expecting more money or more resources from government. I took the liberty to quote from His Excellency President John Dramani Mahama’s State of the Nation address in February 2013. The President had stated, and I quote, “Mr. Speaker, the meat is now down to the bones, and it is time for serious rethinking about the level of wages in relation to our national competiveness and the related productivity issues

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RESPECT FOR PATIENT AUTONOMY: A PATIENT PERSPECTIVE
Adwedaa E

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RESPECT FOR PATIENT AUTONOMY: A PATIENT PERSPECTIVE

Key words: Autonomy, Patient autonomy, Self-determination, Doctor-patient relationship, paternalism

EXTRACT
Introduction: The last few decades has seen an increased emphasis on respect for ‘human rights’ in many countries in the world. This has led to changing attitudes and expectations in society. Individuals in society increasingly expect their human rights to be respected in every walk of life, including in their health care. In health care respect for human rights translates into respect for patient autonomy. Respect for patient autonomy has been interpreted to mean a number of different things in different circumstances. However the ways that patients universally appear to want their autonomy respected are; to be listened to, be provided with information about their health condition, and be involved in the management decisions about their health care. A number of studies conducted in Ghana have shown these expectations to be true of Ghanaian patients. Respect for patient autonomy, which is believed by some to be the most important of the four principles of modern medical ethics is also a major determinant of patient satisfaction in health care which in turn is a measure of the quality of health care delivered.

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BASIC LABORATORY INVESTIGATION OF THE CRITICALLY ILL EMERGENCY PATIENT
Osafo T D

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BASIC LABORATORY INVESTIGATION OF THE CRITICALLY ILL EMERGENCY PATIENT

Key words: Free maternal care, Policy, Impact

EXTRACT
Introduction: During the past 10 to 20 years, the demand for emergency medical service has grown almost exponentially and major hospitals throughout the world have set up emergency medical units. Recognition of Emergency Medicine as a specialty has also catalysed this development.
In Ghana, the Komfo Anokye Teaching Hospital (KATH) in Kumasi took the lead in setting up an Emergency Department a few years ago. A new Emergency Department will soon replace the Central Out-patient Department (COPD) at Korle-Bu Teaching Hospital.
The National Cardio-Thoracic Center at the KorleBu Teaching Hospital has run an Intensive Care Unit (ICU) for many years. The ICU cares not only for cardio-thoracic patients but also for patients suffering from a wide variety of emergency ailments such as acute renal failure, cerebral malaria and stroke. The theme for this year’s (2014) Annual General and Scientific Meeting (AGSM) of the Ghana College of Physicians and Surgeons is “Improving Emergency Care in Ghana.”

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CLEIDOCRANIAL DYSOSTOSIS- A CASE REPORT
Yeboah-Agyapong M A, Nuamah I K, Horgli Y.A

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NICOLAU SYNDROME: A CASE REPORT OF A RARE DEBILITATING COMPLICATION FOLLOWING INTRAMUSCULAR INJECTION OF PENICILLIN

Key words: Cleidocranial dysostosis, Ghana, genetic, disorder, jaws, dentition

ABSTRACT
Objective: First report of cleidocranial dysostosis (CCD), a rare genetic disorder, in Ghana.

Case report and interventions: The condition presented in a 13 year old boy with most of the classical features. He had cranial features in the form of open fontanelles, underdeveloped paranasal air sinuses and hypertelorism. Thoracic features were severely underdeveloped clavicles which allowed him to appose both shoulders in the midline. He had an open bite, several unerupted permanent teeth and several retained teeth most of which were discoloured which was why he was seen at the Dental department. After restoration of some of these teeth the patient was very satisfied.

Conclusion: Though the definitive treatment in these patients can be sophisticated major craniofacial surgery, early restoration of malformed teeth can help ease patient’s anxiety and improve quality of life.

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