Division of Surgeons

Permanent URI for this communityhttps://repository.gcps.edu.gh/handle/123456789/3

Browse

Now showing 1 - 20 of 30

TREATMENT AND OUTCOMES OF PEDIATRIC SUPRACONDYLAR HUMERAL FRACTURES IN KORLE-BU TEACHING HOSPITAL.
(BAIDOO PAA KWESI, 2015-12-01) BAIDOO, PAA KWESI
BACKGROUND Supracondylar humeral fractures are the most common elbow fractures in the pediatric population. These normally result from either a fall on the outstretched hand or the flexed elbow resulting in either the extension or flexion types respectively. They are usually associated with complications such as neurovascular injuries, compartment syndrome, pin tract infections and malunion which in the end after the cosmetic and functional outcomes according to the Flynn’s criteria. The objective of this study was to determine the treatment and outcomes of pediatric supracondylar fractures of the distal humerus at Korle Bu Teaching hospital. METHODOLOGY This was a prospective study carried out at the trauma and orthopedic unit of Korle Bu Teaching Hospital, Accra. Patients for this study were recruited over a year period from January 2014 to January 2015. An evaluation form was filled by the principal investigator and attached to patient’s folders. One hundred and one patients were entered into the study. Treatment of supracondylar humeral fractures in children were guided by the department’s protocol. Patients were followed up over a six (6) month period . Data collected during this period were entered into the REDCap data base, which is a secured web based data collection tool hosted by the University of California, San Francisco (UCSF). The results were then analysed using SPSS version 23. RESULTS The mean age was 5.2 years with a peak of 4-5 years. There were seventy three (73) males and twenty eight (28) females with a ratio of 2.6:1. Most of the injuries occurred at home (64.3%) followed by at school (27.7%). The left arm (non-dominant) was the most injured (62%) compared to the right (38%), though most of the patients seen were right hand dominant (92%). Gartland type III (43.6%) was the commonest fracture followed by type I (31.7%) and type II (24.7%) respectively. Outcomes of management of these fractures were satisfactory based on Flynn’s criteria in over 95 % of the patients. The pediatric quality of life outcome was significantly affected at three weeks after the injury. However, they returned to the population normal at six month. Pin tract infections (5 patients), nerve injury (3 patient), vascular (1 patient), cubitus varus (1 patient), elbow stiffness (1 patient) and myositis ossificans (1 patient) were the complications observed in the study and were mostly associated with high energy injuries (type III fractures). CONCLUSIONS Pediatric supracondylar humeral fractures are very common injuries and their diagnosis and treatment presents a major difficulty to us as orthopedic surgeons. However, through this study, it is concluded that the outcomes of treatment of these fractures at our institution is satisfactory and comparable to other places where they manage such fractures.
EPIDEMIOLOGY AND TREATMENT OUTCOME IN PATIENTS PRESENTING WITH PLANTAR FASCIITIS AT THE KORLE BU TEACHING HOSPITAL
(NGISSAH, REUBEN KWESI SAKYI, 2015-12-01) NGISSAH, REUBEN KWESI SAKYI
Background Plantar fasciitis (PF) is a common cause of heel pad pain. The pain associated with this clinical condition can result in impairment of activities of daily living. Although the diagnosis of this condition is easy to clinch, the aetiology remains unclear with numerous treatment options, because no single treatment has strong scientific evidence to support its use to improve outcome. For most patients presenting with this condition at the Orthopaedic unit of Korle-Bu Teaching Hospital (KBTH), the main treatments offered are plantar fascia stretching exercises and corticosteroid injection if the former fails. The rationale of this study was to describe the epidemiology of this clinical condition, identify some of the risk factors common in patients presenting to the Orthopaedic unit of the Korle Bu Teaching Hospital and to determine baseline outcome of KBTH treatment protocol for PF and compare it to those reported in the literature. Methods This was a longitudinal study on patients presenting with plantar fasciitis to the unit between September, 2014 and August, 2015. Those who met the inclusion criteria were recruited in this study. All newly diagnosed patients were offered plantar fascia stretching exercises; those who failed to respond to treatment based on the Visual Analogue Scale for pain and a modification of foot function index after a month or two were offered corticosteroid injection in addition to plantar fascia stretching exercise. Results Forty four patients met the inclusion criteria for this study with an incidence of 2.75% of all new cases reporting at the Orthopaedic OPD of the KBTH over the study period. At the end of the 12th week, thirty seven patients were available for follow up. Majority of the patients seen were females (thirty eight), leading to a female to male preponderance of 6.3:1. Twenty three patients representing 52.5% belonged to the age group of 41-50%. The mean age was 47.9 years with a standard deviation of 9.7 years. All the patients seen responded ‘yes’ to morning pain marked after a few couple of steps and to pain after prolonged periods of inactivity. Twenty six patients (59.1%), admitted to be involved in occupations that involved prolonged weight bearing. No significant structural risk factors in terms of pes planus, pes cavus, and leg length discrepancy were detected. Ninety percent of the patients seen were either overweight, obese or morbidly obese. Thirty five patients (79.4%) had a heel spur on X-ray. At four weeks, out of the 42 patients available for follow up, only 5(11.9%) required steroid injection in addition to physiotherapy. At eight weeks, only one (2.56%) of the 39 patients available for follow up had steroid injection in addition to the physiotherapy. By the end of the 12 weeks, 37 patients were available for follow up. All the 37 patients had significant improvement in their VAS scores as well as their modified foot function index scores. The means and (standard deviations) for VAS scores at baseline, 4th week, 8th week and 12th week were, 7.05 (2.2); 5.05 (2.5); 3.15 (1.6); 1.9 (1.2) respectively. The means for the modified FFI at baseline, 4th week, 8th week and 12th week were, 16.0, 11.4, 6.8, 3.7 respectively, with corresponding standard deviations of 4.0, 5.6, 4.6, and 3.0 respectively. These results shows a trend in improvement of symptoms with time. Conclusions Plantar Fasciitis was found to be common in females. Majority of the patients were middle aged 41 to 50 years with a mean age of 47.9 years and a standard deviation of 9.7 years. Early morning pain at the heel which is marked with few couple of steps is characteristic of plantar fasciitis. Not all patients with plantar fasciitis have a heel spur on X-ray. Structural risk factors in terms of pes cavus, pes planus, and leg length discrepancy were uncommon in this study. Elevated BMI, happened to be a major risk factor in this study; ninety percent of the patient were either overweight, obese or morbidly obese. Stretching exercises should be employed as the first line of treatment for patients presenting with plantar fasciitis
FACTORS CONTRIBUTING TO LATE PRESENTATION OF PATIENTS WITH STRABISMUS TO THE KOMFO ANOKYE TEACHING HOSPITAL, GHANA
(AMANKWAA-FREMPONG DOREEN, 2020-11-26) AMANKWAA-FREMPONG, DOREEN
Introduction Strabismus is an ophthalmic condition that refers to the misalignment of the eyes. It is a common eye problem in both children and adults resulting in reduced visual acuity, abnormal binocular vision and low self-esteem. Anecdotally, most patients with strabismus present late to the Eye Clinic at the Komfo Anokye Teaching Hospital (KATH). Factors contributing to this late presentation have not been studied. This study sought to determine the factors contributing to late presentation of patients with strabismus at KATH. Methods This was a hospital-based cross-sectional study of factors contributing to late presentation of patients with strabismus at KATH. Patients with strabismus who met the inclusion criteria were examined after informed consent and assent. Socio-demographic characteristics of the patients such as age, sex, place of residence, education, etc., were recorded using a structured questionnaire. Clinical findings (age at onset of strabismus, age at presentation, deviating eye, type of deviation, etc.) were documented on the questionnaire. Data collected was analysed using SPSS Version 20 and presented using descriptive and inferential statistics. Chi-square test, odds ratios and 95 % confidence intervals were computed. P-values less than 0.05 were considered statistically significant. Results A total of 330 (males-180, 54.5 % and females-150 (45.5 %) patients were recruited into this study. The mean age at onset and presentation of strabismus were 4.0±1.2 years and 10.1±9.4 years. Age of patient, education of patient, having no relative with strabismus, monthly income level of family and having no knowledge about strabismus were associated with late presentation of patients with strabismus (p-values = 0.002, 0.001, 0.025, 0.001 and 0.001 vi respectively). There was no association between type of strabismus, type of deviation, presenting visual acuity, angle of deviation and late presentation of patients with strabismus (p-values = 0.423, 0.196, 0.446 and 0.624). Children were 0.1 times less likely to present late compared to adults [OR = 0.1; CI = (0.01-0.8); p-value = 0.032]. Participants with lower education were 1.6 times more likely to present late with strabismus compared to those having higher education [OR = 1.6; CI = (1.1-2.3); p-value = 0.006]. Beneficiaries of National Health Insurance Scheme (NHIS) were 0.4 times less likely to present late compared with non-beneficiaries of NHIS [OR= 0.4; CI = (0.2 -0.9); p-value = 0.037]. Patients with no knowledge about strabismus were 2.9 times more likely to present late compared with those who have knowledge about strabismus [OR= 2.9; CI = (1.5 -5.8); p-value = 0.002]. Patients who have no relatives with strabismus 2 times more likely to present late compared with those having relatives with strabismus [OR= 2.0; CI = (1.0 -4.3); p-value = 0.042]. Conclusions Age, education of patient, having no relative with strabismus, monthly income level of family and having no knowledge about strabismus were associated with late presentation of strabismus. Being an adult, having a lower level of education, not having NHIS and knowledge about strabismus, not having relatives with strabismus could predict late presentation of patients with strabismus.
CHARACTERISTICS AND OUTCOMES OF PAEDIATRIC TRAUMATIC BRAIN INJURIES PRESENTING TO KOMFO ANOKYE TEACHING HOSPITAL.
(EKREMET, KWAME, 2021-03-08) EKREMET, KWAME
Introduction: Traumatic Brain Injury (TBI) in children is a major cause of morbidity and mortality in many countries. Despite the magnitude of this problem in children, there are limited studies to characterise paediatric TBI in Ghana. The primary objective of this study was to determine the characteristics and outcomes of children less than 15 years presenting to a tertiary academic teaching hospital with acute traumatic brain injury at discharge and three months post-injury. The secondary objective was to identify the factors which accounted for the variation in the outcomes of children presenting with TBI. Methods: This was a hybrid study consisting of a prospective cross-sectional study of consecutive children, less than 15 years of age, who presented with TBI to the Komfo Anokye Teaching Hospital Emergency Department (KATH ED): in addition, an embedded cohort study was performed which followed up for three months those patients discharged from the hospital. Socio-demographic and injury characteristics were collected. Participants were followed until hospital discharge. Mortality as an outcome at hospital disposition was determined. Another outcome, the Paediatric Glasgow Outcome Scale- Extended (GOSE), was assessed within 24 hours of discharge and repeated at three months post-TBI. Research Electronic Data Capture (REDCap) was used to enter the data into a secured database electronically. Data was exported to Microsoft Excel ® for data cleaning, after which STATA 13.1 was used for the analysis. Results: A total of 369 patients presented with paediatric trauma to the KATH ED during the study. 136 of these children were managed for traumatic brain injury (TBI) giving a prevalence of 36.86%. Males predominated (63.24%) with the 5- to 9-year age group mostly (41.91%) affected. Road traffic crashes (69.12%) with pedestrian-vehicle collision (67.02%, 63/94) were the most frequent mechanisms of paediatric TBI. The majority (94.12%) of the children with TBI were managed conservatively with a neurosurgical operative rate of 1%. Paediatric TBI mortality rate was 10.29%. Most (61.98%, 75/121) were discharged with a moderate-to-severe disability according to the paediatric GOSE. At three months post-TBI, the majority (91.18%, 93/102) of the discharged patients had a good recovery from the TBI. Severe TBI (adjusted OR [AOR] 136.02, 95% CI 2.76 to 6,706.22) and the development of complication on the ward (AOR 29.03, 95% CI 2.44 to 344.91) were independent positive predictors of mortality for children with TBI, whereas anti- seizure requirement was less likely to predict a good recovery at 3 months post- TBI (AOR, 0.15; 95% CI, 0.03 to 0.72). Interpretation: A significant number of children with TBI were discharged with an acquired disability; however, by three months post-TBI, most of the children had made a good recovery. For many children with TBI, conservative management may be sufficient as the definitive management plan. Conclusions: Paediatric TBI was common affecting 1 in 3 children presenting with paediatric trauma to KATH ED. It mainly affected males, those aged between 5 and 9 years, with RTCs being the principal mechanism of injury. Although most children with TBI were discharged with moderate-to-severe disability from the TBI, three months following the injury, most of them had recovered adequately. Successful long-term follow-up of paediatric trauma, and specifically paediatric TBI, is feasible in LMICs such as Ghana. The paediatric TBI care in Ghana could inform such care in High-Income Countries.
COMPARISON OF EFFECTIVENESS OF COUNSELLING ONLY, SUPPOSITORY DICLOFENAC AND LIDOCAINE SPRAY AT INTRAUTERINE DEVICE INSERTION
(YANNEY HENRY EKOW, 2021-09-30) YANNEY, HENRY EKOW
Background In Ghana, only 0.8% of married and 0.4% of unmarried women are on IUD. The perception of pain at IUD insertion is one of the main barriers of its uptake. Several pharmacological and non-pharmacological interventions have been studied. Despite these attempts, there is currently no consensus on the best form of pain management at IUD insertion. The aim of this study was therefore to compare the effectiveness of counselling only (standard of care), 10% lidocaine spray of the cervix and 100mg suppository diclofenac sodium in reducing pain at IUD insertion. Methodology A prospective study involving women of reproductive age who presented at the Family Planning Unit, Korle Bu Teaching Hospital and had accepted IUD method of contraception was conducted. Clients who met the inclusion criteria were randomized into 3 arms; suppository diclofenac, lidocaine spray and counselling only arms in a ratio of 1:1:1. A calculated sample size of 99 participants, 33 in each arm was used. All participants had a baseline counselling on the procedure and then those on diclofenac arm were given 100mg diclofenac sodium suppository 30 minutes whilst the 10% lidocaine spray arm were given 4 pumps on the cervix before the insertion. Using a 10cm- Visual Analog Scale (VAS), the pain experienced at various stages of IUD insertion, the overall pain experienced after IUD insertion, 5 minutes and 4 hours post procedure were assessed. Mean pain scores were compared using a one way ANOVA and a Post-Hoc test used to compare which two groups were significantly different from each other. Categorical variables between groups were compared using a chi-square test. The statistical significance was set at p < 0.05 and confidence interval at 95%. Results Ninety nine participants were recruited for the study. The average age of the participants was 33.6+ 6.2 years whilst the average BMI was 29.5+ 5.7kg/m2. There were 11/99 (11.11%) of respondents who were single, 3/99 (3.03%) who did not have formal education, 39/99 (39.39%) of them who had tertiary education; and 34/99 (34.34%) who were professionals. Traders and artisans represented 31/99 (31.31%) each and majority 93/99 (93.94%) were Christians. Suppository diclofenac was superior to counselling only at pain control during speculum insertion, tenaculum insertion, uterine sound insertion, IUD placement, immediately after procedure and 5 minutes after procedure. Lidocaine spray of the cervix on the other hand, was superior to counselling only throughout the procedure and up to 4 hours post procedure. Again, Lidocaine spray of the cervix was found to be superior to suppository diclofenac at pain control 5 minutes after procedure (mean pain score 0.6 versus 1.5) and 4 hours after procedure (0.7 versus 0.9) Conclusion Lidocaine spray (10%) of cervix is more effective compared to 100mg Diclofenac Sodium in reducing pain at IUD insertion. The use of 10% lidocaine spray of cervix at insertion of IUD will therefore greatly enhance clients’ satisfaction at IUD insertion and in the long run help to increase the uptake of the IUD, a highly effective long acting reversible contraceptive.
POSTOPERATIVE PAIN MANAGEMENT IN EMERGENCY ABDOMINAL SURGERY: BIMODAL VERSUS UNIMODAL ANALGESIA
(GYAMFI, FRANK ENOCH, 2022-03-01) GYAMFI, FRANK ENOCH
Introduction Emergency abdominal surgery may be the right intervention for patients who have traumatic abdominal injuries or surgically correctible abdominal disease processes. The pain after surgery can be distressful to patients if not optimally managed. Postoperative pain management in developing countries like Ghana is considered to be suboptimal. In Ghana, there is a paucity of data comparing the efficacy of parenteral opioids as unimodal analgesia with a combination of paracetamol and opioids in postoperative pain management. Aim This study compared the efficacy of intramuscular (i.m.) morphine as unimodal analgesic with bimodal administration of i.v paracetamol and i.m. morphine in managing postoperative pain in emergency abdominal surgery. Methods/Design This study was conducted at the Surgery Directorate of Komfo Anokye Teaching Hospital, Kumasi, Ghana. It was a single-blinded randomised controlled trial (RCT). Participants were randomised into two arms: those receiving i.m. morphine only and those receiving a combination of i.v. paracetamol and i.m. morphine. Inclusion criteria were patients between 18 and 80 years undergoing emergency abdominal surgery. Elective surgery, contraindications to morphine or paracetamol were exclusion criteria. Pain intensity was measured at intervals of one, three, six, twelve and twenty-four hours after a patient received the first dose of analgesia at the recovery ward, using the Numeric Rating Scale for pain. Data were collected with a structured questionnaire, using an electronic data capturing system and extracted onto STATA 13 for analysis. Chi-Square test and multivariate logistic regression analysis were carried out, putting into consideration odd ratios where statistical significance was derived with p<0.05. Results A total of 110 participants were recruited and data from 108 were analysed of which 75% were males and 25% were females. Mean pain scores were lower at six hours, twelve hours and twenty-four hours after the administration of the first dose of analgesia with statistical significance (P-value 0.02, 0.002 and 0.001 respectively) for those who received only Morphine as opposed to morphine with paracetamol. There was no statistically significant difference between the length of stay and whether a participant received morphine or morphine with paracetamol (P-value 0.33). Those who received only morphine had their first bowel movement earlier than those who received a combination of morphine and paracetamol (P-value 0.03). Nausea and/or vomiting was likely to occur if a participant received only morphine as opposed to receiving morphine with paracetamol ( P-value 0.02). Conclusion Receiving morphine alone or morphine with paracetamol provided adequate pain relief after emergency abdominal surgery even though those who received morphine alone had a lower mean pain score. Whether a patient received morphine alone or morphine with paracetamol did not have any statistical difference in the length of stay. Nausea and vomiting were common in those who received morphine only.
EFFECT OF PERINEURAL DEXAMETHASONE ON ULTRASOUND GUIDED TRANSVERSUS ABDOMINIS PLANE BLOCK FOR POST CAESAREAN ANALGESIA AT KORLE-BU TEACHING HOSPITAL
(SOTTIE AKWANFO YAW DANIEL, 2022-04-01) SOTTIE, AKWANFO YAW DANIEL
INTRODUCTION Caesarean delivery (CD) is a common surgical procedure with associated significant post-operative pain. Adequate post caesarean analgesia enables the new mother to take care of the new born while preventing the debilitating effects of uncontrolled post-operative pain. The most frequent negative response to caesarean delivery in Ghanaian women is pain. Analgesic options following CD in Korle-Bu Teaching Hospital include the use of intrathecal opioids (fentanyl), parenteral opioids (intramuscular pethidine), intravenous paracetamol and rectal diclofenac. The addition of the bilateral transversus abdominis plane (TAP) block with dexamethasone as an adjunct to the existing pain management modalities will provide adequate post caesarean delivery analgesia and improve patient satisfaction. AIM The aim of this study was to assess the effectiveness and safety of perineural dexamethasone in ultrasound guided bilateral TAP block in providing post-operative analgesia in parturients who underwent caesarean delivery under spinal anaesthesia at Korle-Bu Teaching Hospital. METHODS This was a prospective, randomized, double blind study of 99 electively booked patients for caesarean delivery under spinal anaesthesia. These were divided into three groups of 33 each after meeting inclusion/exclusion criteria and giving informed consent. Ultrasound guided bilateral TAP block was administered immediately after caesarean delivery under spinal anaesthesia (using either bupivacaine + dexamethasone (group A), only bupivacaine (group B) or only saline (group C)). Time to request for first analgesia, systemic opioid consumption, numerical rating scale (NRS) pain scores, incidence of pruritus, nausea and vomiting and participants’ satisfaction were recorded. This was entered into Microsoft Excel spread sheet and Statistical Package for the Social Scientists (SPSS) software version 25 used for data analysis. RESULTS The time to first analgesic request was significantly prolonged in the bupivacaine group (327.5 ± 98.69 minutes) compared to the saline group (256.5 ± 72.33 minutes) (p-value = 0.023); with addition of dexamethasone resulting in further prolongation (485.2 ± 143.03 minutes) (p-value < 0.0001) of the time to first rescue analgesic. There was a significantly lower consumption of systemic opioids in the bupivacaine group (269.1 ± 64.44mg) compared to the saline group (380.6 ± 39.21mg) (p-value < 0.0001); with further significant lowering of opioid analgesic requirements (113.6 ± 81.58mg) on addition of dexamethasone (p-value < 0.0001). NRS pain scores at rest and on coughing were lower in the intervention groups compared to the control group. Lower NRS pain scores were recorded with addition of dexamethasone although they were not always significant. The incidence of adverse events of pruritus, nausea and vomiting and sedation was not significantly different amongst the three groups. Participants who had dexamethasone + bupivacaine had higher satisfaction scores than participants who had bupivacaine; who in turn had higher satisfaction scores than participants who had saline. CONCLUSION Addition of dexamethasone to bupivacaine for a TAP block is safe, has opioid sparing effect and provided better postoperative analgesia after Caesarean delivery compared to control and bupivacaine alone TAP at Korle-Bu Teaching Hospital.
PERIOPERATIVE ANALGESIC EFFECT OF SERRATUS ANTERIOR PLANE BLOCK ON BREAST SURGERY. A PROSPECTIVE, RANDOMIZED, CONTROLLED DOUBLE BLIND STUDY CONDUCTED AT THE KORLE BU TEACHING HOSPITAL, ACCRA, GHANA.
(MENSAH KOFI DAVID, 2022-04-01) MENSAH, KOFI DAVID
INTRODUCTION Breast cancer is the most common cancer in women both in the developed and less developed world, according to World Health Organisation. The mainstay of treatment for breast cancer is breast surgery. Pain after breast surgery has been described as moderate to severe. Inadequately treated post-operative pain after breast surgery invariably leads to greater postoperative morbidity, higher hospital cost and persistent post-operative pain. Opioids have been the drugs of choice for management of postoperative pain after breast surgery, however, they are associated with many undesirable side effects. Serratus anterior plane (SAP) block is a new interfascial injection technique for analgesia of the chest wall. There is paucity of data with regards to its use for pain relief and possible opioid-sparing in the West Africa subregion. AIM The aim of this study was to determine whether serratus anterior plane block administered for breast surgery has analgesic effect during the perioperative period in patients undergoing elective breast surgery at the Korle-Bu Teaching Hospital. METHODOLOGY This was a prospective, randomized, double-blinded study. Following Ethical Committee approval, patients who fulfilled the inclusion criteria and gave informed consent were consecutively enrolled into the study. A total of fifty-two (52) patients were enrolled into the study and were randomly assigned into one of two groups. The intervention group (n=26) and the placebo group(n=26). Patients demographic characteristics were recorded. Their pre-induction blood pressure, heart rate, respiratory rate and oxygen saturation were also noted. All patients underwent standard general anaesthesia and their airways secured with laryngeal mask airways. After induction of anaesthesia a blinded anaesthetist performed ultrasound guided serratus anterior plane block with 0.25% plain bupivacaine or 0.9% normal saline. Intraoperatively, heart rate and mean arterial blood pressure were maintained within 20% of the preoperative baseline values by giving intravenous bolus doses of morphine. Intraoperatively, patients’ blood pressure, heart rate and respiratory rate were recorded every five minutes. After surgery, a blinded investigator assessed and noted the numerical rating scale (NRS) score of pain at the recovery ward when patients were conscious and alert, at 1, 4, 8 and 24 hours postoperatively. The incidence of PONV was recorded immediate postoperative period and at 1, 4, 8 and 24 hours postoperatively. Patient satisfaction was also assessed using a simple questionnaire. RESULTS Patients receiving SAP block had lower NRS scores at all measured time points but this was only statistically significant at 4 hours postoperative time(p-value=0.002). The mean intraoperative opioid consumed (morphine equivalent) was slightly higher in the control group (11.9±1.5mg) than it was in the intervention group(11.3±1.5mg), however the difference was not statistically significant (p value = 0.131) There was statistically significant difference in the postoperative opioid consumption in the intervention group and the control group (4.6±5.7mg versus 10.5 ± 6mg) respectively (p value=0.001). Most participants in this study did not experience PONV. Those who had PONV, the highest incidence occurred 4 hours postoperatively but this was not statistically significant between the two groups (p-value = 0.098). No participant experienced severe PONV. No adverse effects were noticed in those who had the SAP block. Generally, patients in both groups were very satisfied with their postoperative pain management. CONCLUSION Serratus anterior plane block reduces NRS pain scores postoperatively. It also significantly reduces postoperative opioid consumption but does not significantly reduce intraoperative opioid consumption.
TYPES, PRESENTATION AND CHALLENGES WITH THE MANAGEMENT OF ANORECTAL MALFORMATIONS AT KOMFO ANOKYE TEACHING HOSPITAL, KUMASI, GHANA.
(AGYEI FAREEDA, 2022-06-08) AGYEI FAREEDA
Introduction: Anorectal malformations remain a significant challenge to the child and the paediatric surgeon. Clinical outcomes depend on the surgeon's skill, the type of anorectal malformation, associated anomalies and the availability of perioperative and rehabilitation facilities. Anorectal malformation is rare, occurring in about 2-6 per 10000 live births. ⁠ However, its rarity becomes relative in Sub-Saharan Africa, where few surgeons are paediatric surgeons, and only a handful of these few surgeons handle these cases. The burden of treating these patients falls on the few paediatric surgeons available in the region. The paediatric surgeon is faced with challenging clinical scenarios; some children present with complications, either as a result of late presentation or from the initial surgery, done mainly by a local surgeon as a lifesaving procedure. Understanding the challenges the patient, the parents and caregivers, and the paediatric surgeon face in this resource-limited setting is essential. Aim: The aim of the study was to assess the types, modes of presentation, the challenges carers of patients with anorectal malformation encounter during management and the cost implication in a resource-challenged tertiary teaching hospital, Komfo Anokye Teaching (KATH), in Kumasi, Ghana. Methods: The study was a cross-sectional descriptive study carried out on Anorectal malformations at the Paediatric Surgery Unit of Komfo Anokye Teaching Hospital (KATH) over a period of eight months. It employed both qualitative and quantitative study design which was taken at the same time period; a concurrent mixed methodology. Data on all children with anorectal malformation being managed by the Paediatric Surgery Unit of the Department of Surgery, KATH, were obtained. The ARM types, presentation, associated anomalies, surgical interventions, peri operative challenges; challenges with managing and taking care of a child with anorectal condition, and the cost of managing the condition were captured using a structured questionnaire (quantitative study). In-depth interviews of guardians of the children with anorectal malformations who were being managed were also conducted (qualitative study). Results: A total of 61 patients (male: female ratio 1:0.96) were included in the study. A majority, 35 (57.38%), of the patients with anorectal malformations were observed between days 2 and 5. The average birth weight was 3.12kg (SD =0.51). Most of the patients, 88.52% reported late (> 24hrs). Majority of the patients 55.74% presented in a stable state at the emergency department. Acute intestinal obstruction accounted for 32.79% of presentations. All the 61 patients with anorectal malformation underwent a staged procedure. The majority, 60 (98.63%) out of the 61 patients, underwent a three-staged procedure; an initial colostomy, definitive repair, and colostomy closure. Only 1 patient underwent a two-stage procedure in which colostomy + PSARP was done on day 1 of presentation. Closure of colostomy was done 14 months later. The definitive repair for all the children who underwent the three-staged procedure was PSARP. For this study, 45 (75%) had had PSARP, and 29 (48.33%) had closure of colostomy done at the end of the study. Overall complication after all surgeries was 39.3%. There was no significant association between, birth weight (p-value = 0.596), the presence of a fistula (p-value = 0.061), when the malformation was detected (p-value = 0.349) and time of presentation to KATH, (p-value = 0.306). Overall Complications at the initial colostomy, PSARP and colostomy closure were 21.6%, 26.7%, and 27.59%, respectively. The mean duration between a colostomy and PSARP was 7.02 +/- 2.05 months, while between PSARP and colostomy closure was eight months. The mortality rate at the end of the study was 3.3%. The length of stay in the hospital was 11.89 +/- 8.93 days, 29.95 +/- 9.26 days, and 17.51+/- 7.0 days for the initial colostomy, PSARP and the closure of colostomy respectively. The mean cost for the complete three-staged procedure was GHC11604.93 ($2053.90) (1$ = GHC5.65), with out-of-pocket payments accounting for 61.91% of the total cost. 44.3% of the caregivers rated the cost as moderate. Findings from the qualitative study indicated that most caregivers lacked adequate knowledge regarding anorectal malformations. Most respondents highlighted the stigma associated with having a child with ARM and having a colostomy. Rescheduling surgeries, financial constraints, increased out-of-pocket payments, and lack of psychological support were some challenges caregivers had with managing anorectal malformations. Conclusion: Anorectal malformation is challenging to the paediatric surgeon, the patient and the carer. There is a general lack of awareness about the condition among health professionals and carers. The stigma attached to having a child with colostomy is rife and it is associated with a lot of psychological trauma to the carers and family members. The cost of managing anorectal malformation is high and steps must be taken to help carers pay for the cost. Improving public awareness of the condition and our referral system, providing psychological support, training more stoma therapists, increasing the partial amount the NHIS pays for this condition will all go a long way to improve the management and the lives of children born with this congenital abnormality.
TYPES, PRESENTATION AND CHALLENGES WITH THE MANAGEMENT OF ANORECTAL MALFORMATIONS AT KOMFO ANOKYE TEACHING HOSPITAL, KUMASI, GHANA.
(AGYEI, FAREEDA, 2022-06-08) AGYEI, FAREEDA
Introduction: Anorectal malformations remain a significant challenge to the child and the paediatric surgeon. Clinical outcomes depend on the surgeon's skill, the type of anorectal malformation, associated anomalies and the availability of perioperative and rehabilitation facilities. Anorectal malformation is rare, occurring in about 2-6 per 10000 live births. ⁠ However, its rarity becomes relative in Sub-Saharan Africa, where few surgeons are paediatric surgeons, and only a handful of these few surgeons handle these cases. The burden of treating these patients falls on the few paediatric surgeons available in the region. The paediatric surgeon is faced with challenging clinical scenarios; some children present with complications, either as a result of late presentation or from the initial surgery, done mainly by a local surgeon as a lifesaving procedure. Understanding the challenges the patient, the parents and caregivers, and the paediatric surgeon face in this resource-limited setting is essential. Aim: The aim of the study was to assess the types, modes of presentation, the challenges carers of patients with anorectal malformation encounter during management and the cost implication in a resource-challenged tertiary teaching hospital, Komfo Anokye Teaching (KATH), in Kumasi, Ghana. Methods: The study was a cross-sectional descriptive study carried out on Anorectal malformations at the Paediatric Surgery Unit of Komfo Anokye Teaching Hospital (KATH) over a period of eight months. It employed both qualitative and quantitative study design which was taken at the same time period; a concurrent mixed methodology. Data on all children with anorectal malformation being managed by the Paediatric Surgery Unit of the Department of Surgery, KATH, were obtained. The ARM types, presentation, associated anomalies, surgical interventions, peri operative challenges; challenges with managing and taking care of a child with anorectal condition, and the cost of managing the condition were captured using a structured questionnaire (quantitative study). In-depth interviews of guardians of the children with anorectal malformations who were being managed were also conducted (qualitative study). Results: A total of 61 patients (male: female ratio 1:0.96) were included in the study. A majority, 35 (57.38%), of the patients with anorectal malformations were observed between days 2 and 5. The average birth weight was 3.12kg (SD =0.51). Most of the patients, 88.52% reported late (> 24hrs). Majority of the patients 55.74% presented in a stable state at the emergency department. Acute intestinal obstruction accounted for 32.79% of presentations. All the 61 patients with anorectal malformation underwent a staged procedure. The majority, 60 (98.63%) out of the 61 patients, underwent a three-staged procedure; an initial colostomy, definitive repair, and colostomy closure. Only 1 patient underwent a two-stage procedure in which colostomy + PSARP was done on day 1 of presentation. Closure of colostomy was done 14 months later. The definitive repair for all the children who underwent the three-staged procedure was PSARP. For this study, 45 (75%) had had PSARP, and 29 (48.33%) had closure of colostomy done at the end of the study. Overall complication after all surgeries was 39.3%. There was no significant association between, birth weight (p-value = 0.596), the presence of a fistula (p-value = 0.061), when the malformation was detected (p-value = 0.349) and time of presentation to KATH, (p-value = 0.306). Overall Complications at the initial colostomy, PSARP and colostomy closure were 21.6%, 26.7%, and 27.59%, respectively. The mean duration between a colostomy and PSARP was 7.02 +/- 2.05 months, while between PSARP and colostomy closure was eight months. The mortality rate at the end of the study was 3.3%. The length of stay in the hospital was 11.89 +/- 8.93 days, 29.95 +/- 9.26 days, and 17.51+/- 7.0 days for the initial colostomy, PSARP and the closure of colostomy respectively. The mean cost for the complete three-staged procedure was GHC11604.93 ($2053.90) (1$ = GHC5.65), with out-of-pocket payments accounting for 61.91% of the total cost. 44.3% of the caregivers rated the cost as moderate. Findings from the qualitative study indicated that most caregivers lacked adequate knowledge regarding anorectal malformations. Most respondents highlighted the stigma associated with having a child with ARM and having a colostomy. Rescheduling surgeries, financial constraints, increased out-of-pocket payments, and lack of psychological support were some challenges caregivers had with managing anorectal malformations. Conclusion: Anorectal malformation is challenging to the paediatric surgeon, the patient and the carer. There is a general lack of awareness about the condition among health professionals and carers. The stigma attached to having a child with colostomy is rife and it is associated with a lot of psychological trauma to the carers and family members. The cost of managing anorectal malformation is high and steps must be taken to help carers pay for the cost. Improving public awareness of the condition and our referral system, providing psychological support, training more stoma therapists, increasing the partial amount the NHIS pays for this condition will all go a long way to improve the management and the lives of children born with this congenital abnormality.
EFFECTS OF STEROID EYE DROPS ON INTRAOCULAR PRESSURE IN PATIENTS POST CATARACT SURGERY AND ASSOCIATED RISK FACTORS AT A TERTIARY FACILITY AND ITS OUTREACH CENTRE
(MENSA-BONSU, AKOSUA BADU, 2022-06-14) MENSA-BONSU, AKOSUA BADU
Introduction Topical corticosteroids are routinely used after cataract surgery to decrease inflammation, relieve pain, and improve visual outcomes. However, they are known to have significant side effects, whether topically or systemically administered. Not much is known about the incidence of Steroid-Induced Ocular Hypertension (SiOH) in adult Ghanaians undergoing cataract surgery. Considering the immense negative impact visual impairment has on the quality of life of those affected, it is imperative to know the incidence of SiOH in the Ghanaian population. This would help in outlining preventive measures for potential ocular complications among patients undergoing cataract surgery. General Aim To determine the effect of steroid eye drops on intraocular pressure in patients post-cataract surgery and its associated risk factors. Methods This is a prospective cohort study of the effect of steroid eyedrops in patients post-cataract surgery at Korle Bu Teaching Hospital and Emmanuel Eye Centre. Patients undergoing cataract surgery were recruited into the study after informed consent. Demographic information, history and findings from ocular examinations were documented using a structured questionnaire. Baseline intraocular pressures were recorded. Post-operative intraocular pressures were measured on day one, weeks one, five and thirteen after surgery. Continuous numerical data were summarized as mean and Standard deviation (SD) and categorical data as percentages (%). Mean change in intraocular pressure from baseline was computed. Risk factors for SiOH were analysed using a Binary Logistic Regression Model and presented as Odds ratios and 95% Confidence Intervals. Kaplan-Meier survival function was used in calculating the average time (days) to develop SiOH among study participants. P-values less than 0.05 were considered statistically significant. Results A total of 124 patients participated in this study with a mean age of 66.1±13.6 years. Majority 75 (60.0 %) of the study participants were females. The overall mean pre-operative intra ocular pressure (IOP)in the study eyes was 17.8±4.4 mmHg with a 5.3% increase in IOP from baseline which was not statistically significant (p = 0.061). The incidence of SiOH in the study was 29% on post-operative day one and reduced to 1.6% at 13 weeks. In a univariate and multivariate analysis, there were no risk factors associated with the development of SiOH . A sub analysis of the ocular responses however picked up age as a risk factor for responding to the use of topical steroids. Participants aged 70 years and above were more likely to respond to the use of topical steroids after cataract surgery though this did not translate to a significant likelihood of developing SiOH in this cohort of patients undergoing cataract surgery. From Kaplan-Meier analysis, the overall mean time (days) to develop SiOH among the study participants was 55.3 days (95% CI= 47.3 – 63.3 days). Conclusion SiOH post-cataract surgery is a common complication in this study cohort with an incidence of 36.3 %; most of which (29%) occurred within the first month post-operation. There were no risk factors associated with the development of SiOH in this study. Patients undergoing cataract surgery should have their IOP monitored closely during their early postoperative visits to prevent ocular complications associated with prolonged raised IOP.
DETERMINATION OF NORMATIVE VALUES FOR CENTRAL CORNEAL THICKNESS IN GHANAIAN CHILDREN IN THE ABLEKUMA SOUTH SUB-METROPOLITAN AREA
(BEYUO, VERA MAWUSIME, 2022-06-14) BEYUO, VERA MAWUSIME
Background The thickness of the cornea has importance in ocular health. Several studies including the work done by the Ocular Hypertension Treatment Study (OHTS) have demonstrated the significance of Central Corneal Thickness (CCT) measurements in the accurate assessment of intraocular pressure (IOP), accurate diagnosis and prognosis of glaucoma. The variation of CCT with age, gender and race have also been confirmed in studies. CCT has been shown to increase gradually with age in children stabilizing after the age of 10 years and has been shown to be thinner in African/Americans compared to whites. In the adult population, CCT values have been shown to affect the accurate diagnosis and management of glaucoma resulting in the need for assessment of the normal CCT values for any given population. The racial and ethnic variation in CCT values does not support extrapolation of normal population values from one geographic location to the other. In Ghana, data on normal CCT values in children is lacking, resulting in assessment of intraocular pressure based on reference values from populations with potentially different CCT values. It is therefore imperative that CCT values be assessed in healthy Ghanaian children to determine normal values for our population. This will provide baseline data for assessment of deviations from the mean values in the Ghanaian population in future studies to better correlate CCT with IOP values in Ghana. Aim The overall aim of this study was to measure the CCT in healthy Ghanaian children and determine the normal values of defined age-groups. Materials and methods A prospective cross-sectional study was conducted to measure the CCT of 420 children (840 eyes) aged 6 to 15 years. Informed written consent was obtained from parents/ guardians and assent obtained from children aged 8 years and above. An interviewer-administered questionnaire was used to obtain demographic data followed by an anterior and posterior ocular exam. One drop of 0.5% amethocaine was instilled in the eye 1 minute prior to measurement after which a hand-held pachymeter was used to take 3 measurements from the central 3mm of the cornea of the eye. Data handling and statistical analysis plan Statistically significant differences were assessed with the independent t-test for differences in continuous variables such as CCT, analysis of variance (ANOVA) for differences between groups such as age and gender and linear regression for differences in trends. Statistical significance was set at a p value of less than 0.05. Results: The overall mean CCT was 538.8 ± 27 µm (420 children, 840 eyes) and among children aged 6-8 years was 541.4±24.9 µm., for children aged 8-10 years 534.9±25.8 µm and those 10-15 years 538.3±28.6 µm. ANOVA (Analysis of variance with the F statistics) with the Post Hoc tests showed no significant difference in mean CCT among the age groups for both eyes. There was found to be a weak negative correlation between CCT and age. Thus, CCT decreased with age. Though CCT was higher in males, the difference was not statistically significant. Our study also demonstrated that there was a weak positive correlation between CCT and IOP. CCT was higher in hyperopes compared to emmetropes and thinnest in myopes and the difference was statistically significant. Conclusion: CCT in healthy Ghanaian children was found to be 538.8 ± 27 µm and did not vary significantly among age groups or sex. Results of this study provide baseline data for larger national studies that could ultimately lead to the development of national reference ranges for CCT values in the Ghanaian paediatric population. Secondary benefits of this study include improvement in the diagnosis, prognostic prediction, and management of glaucoma in children.
LOW DOSE ASPIRIN PROPHYLAXIS USE AMONG PRE-ECLAMPTIC/ECLAMPTIC WOMEN WITH HISTORY-BASED RISK FACTOR(S) IN A TERTIARY HOSPITAL IN GHANA
(OWUSU, YAW GYANTEH, 2022-09-29) OWUSU, YAW GYANTEH
Background Pre-eclampsia/eclampsia remains a top cause of maternal morbidity and mortality as well as a major cause of perinatal morbidity and mortality at Komfo Anokye Teaching Hospital and the world over. Starting low dose aspirin before 16 weeks in high-risk women prevents preterm preeclampsia. Anecdotal evidence suggests that it is common to find patients admitted with preeclampsia/eclampsia with risk factors at the beginning of pregnancy who would have benefited from low dose aspirin but never received it. Objective This study assesses the use of prophylactic low dose aspirin among women admitted to Komfo Anokye Teaching Hospital with pre-eclampsia/eclampsia who had history-based risk factors in early pregnancy. Methods This is a cross-sectional analytical study. Women admitted to the obstetric high dependency unit with preeclampsia/eclampsia were recruited consecutively till the sample size of 271 was attained. A structured questionnaire, antenatal care records, hospital in-patient records and discharge notes were used to obtain the relevant data which were analyzed using IBM SPSS version 26.0. Chi square was used to assess associations of adverse maternal and fetal/neonatal outcomes among women that received low dose aspirin compared to those that did not receive low dose aspirin. P-values less than 0.05 were considered statistically significant. Results 59% of the women with preeclampsia/eclampsia had the risk factors warranting prophylactic low dose aspirin in early pregnancy with only 26.9% of these high-risk women receiving prophylactic low dose aspirin. Low dose aspirin prophylaxis was significantly associated with estimated gestational age of pre-eclampsia/eclampsia diagnosis (p < 0.0001). Low dose aspirin prophylaxis was significantly associated with a reduction in the incidence of intra- uterine growth restriction (p = 0.008), intra-uterine fetal death/termination of pregnancy (p = 0.001), prematurity (p = 0.001), neonatal intensive care unit admission (p = 0.001), neonatal mortality (p = 0.023) as well as the composite adverse neonatal outcome (p = 0.001). Low dose aspirin prophylaxis significantly reduced maternal organ dysfunction (P = 0.001) with no significant reductions observed for other maternal outcomes of caesarean section, eclampsia, CVA, maternal mortality as well as the composite adverse maternal outcomes. Conclusion Whiles the risk factors for preeclampsia do exist in our women at booking, majority of these high-risk women are not receiving prophylactic low dose aspirin. Prophylactic low dose aspirin reduces the incidence of early onset preeclampsia with a reduction in adverse fetal outcomes but no reductions in adverse maternal outcomes except for maternal organ dysfunction.
OCCUPATIONAL NOISE EXPOSURE AND HEARING LOSS AMONG CEMENT BLOCK FACTORY WORKERS: A COMPARISON OF TWO ASSESSMENT METHODS
(AMOO-QUAYE, GRACE NAA AGOWA, 2022-10-18) AMOO-QUAYE, GRACE NAA AGOWA
Introduction Occupational exposure to excessive noise leading to sensorineural noise induced hearing loss is becoming more pertinent in developing countries as industrialization and infrastructure development increase. The need to develop a tool that efficiently detects this phenomenon as well as the need to, map out noise exposure by industry to enable stronger preventive measures’ enforcement is becoming more relevant. Hence, the aim of the study was to determine and compare the prevalence of hearing loss among cement block factory workers using two hearing assessment methods, evaluate their knowledge of the effects of noise on hearing, noise level exposure and assess their knowledge and use of hearing protection devices (HPDs). Methods A comparative cross-sectional study was designed to investigate hearing loss among a group of 143 cement block factory workers and 132 controls from March 2021 to December 2021. A semi-structured questionnaire was used to assess knowledge of the effects of noise on health and use of HPDs. Pure tone audiometry (PTA) (conventional and extended high frequency (EHFA) was used to measure hearing threshold levels to determine prevalence of hearing loss and distortion products otoacoustic emissions (DPOAEs) were measured to determine reduced amplitudes. Comparisons of the pure tone averages between the noise exposed and the nonexposed groups was done by independent t-tests, whilst comparisons of percentages of individuals with hearing loss was done using chi-square tests. Statistical significance was set at p<0.05. Results The mean age of the cases was 29.3 years ±9.2 years compared to that of the controls which was 28.6years ± 6.7 years. The mean duration of work for cases and controls was 3.0years ± 3.2years and 4.4years ± 3.57 years respectively. About half (51.6%) had awareness of the effects of noise on health among block factory workers with usage of hearing protective devices among very few (16.1%). The mean maximum noise level in the block factories was very high (101.8± 4.5dBA). The prevalence of hearing loss was significantly higher among cases than controls by all methods. For the better hearing ear, it was 14.7% among cases and 3% among controls. Extended high frequency audiometry yielded 41.6% hearing loss prevalence among the noise exposed but 15.9% among the nonexposed. Low amplitude DPOAE was recorded 43% among cases and 31.8% in the control group and this was significantly higher than for pure tone audiometry (p<0.05) in both groups. Conclusion Hearing loss prevalence was higher among cases than controls. DPOAEs detected the most abnormalities as compared to conventional PTA and EHFA. Though roughly half of the block factory workers had some knowledge of the effect of noise on their health and of HPDs, only few of them used the protective devices. The current study also showed that noise levels in all the block factories exceeded the permissible industrial noise levels.
LABOUR INDUCTION: TRANSVAGINAL SONOGRAPHIC CERVICAL LENGTH VERSUS BISHOP SCORE IN PREDICTING VAGINAL DELIVERY AT KORLE-BU TEACHING HOSPITAL
(GHANA COLLEGE OF PHYSICIANS & SURGEONS, 2023) MENSAH, TERESA ABA
BACKGROUND Induction of labour is a common and important obstetric intervention for averting caesarean section whiles optimizing pregnancy outcomes. Traditionally, cervical assessment for favourability of induction has been done using the Bishop Score which involves invasive digital vaginal examination; with a score greater than 6 out of 13 considered favourable. Transvaginal sonographic cervical assessment of the cervix is considered a useful stand-alone tool for cervical assessment. It is less invasive and may be comparable to the Bishop Score in predicting successful induction, given the limitations of the Bishop Score. The main objective of this study was to compare the transvaginal sonographic cervical length and the Bishop Score in the prediction of successful induction among pregnant women with low risk postdate pregnancies induced at Korle- Bu Teaching Hospital. METHODOLOGY This was an analytical cross-sectional study conducted between 1st July 2022 and 30th April 2023. The study population comprised women with low risk postdate pregnancies admitted to the maternity unit of Korle- Bu Teaching Hospital for a scheduled induction of labour. The Bishop Score and transvaginal sonographic cervical assessments were done for all participants before the start of induction. The primary outcome was the predictive abilities of the transvaginal sonographic cervical length and the Bishop Score in predicting vaginal delivery within 24 hours. Secondary outcomes included the pain scores post assessment, number of hours from induction to delivery and adverse maternal and perinatal outcomes. Data analysis was done using STATA 17. Appropriate statistical tests for comparison of categorical and continuous values were used (independent t test, Wilcoxon Rank Sum test, Chi-square test and Fisher’s exact test). Optimum cut off values were identified with Receiver Operator Characteristic Curves and the predictive values determined for both successful induction of labour and vaginal delivery. RESULT Of 184 women recruited, 168 participants were included in the final analysis. The rate of vaginal delivery was 82.1%. Successful induction occurred in 117 out of 168 participants (69.9%) with a confidence interval of 62.1-76.5. vii Bishop Score ³ 4 was predictive of both successful induction and vaginal delivery. Transvaginal sonographic cervical length £ 2.31cm was predictive of successful induction and transvaginal sonographic cervical length £ 2.5cm was predictive of vaginal delivery. The predictive values of transvaginal sonographic cervical length were (sensitivity: 48.7%, specificity: 66.7%, Area under Receiver Operator Characteristic curve: 0.5769). The predictive values of Bishop Score were (sensitivity: 80.3%, specificity: 41.2%, Area under Receiver Operator Characteristic curve: 0.6076). Ninety five percent of women preferred the transvaginal sonographic cervical length. CONCLUSION Bishop Score and transvaginal sonographic cervical length were shown to be comparable in predicting both successful induction and vaginal delivery when used for pre induction cervical assessment. Transvaginal sonographic cervical length measurement was better tolerated by patients than Bishop Score assessment. In a tertiary setting where expertise for and availability of transvaginal ultrasound exist, transvaginal sonographic cervical length may be the more desirable pre-induction cervical assessment tool or a viable alternative for patients who cannot tolerate the pain of Bishop Score assessment. vii
ELASTIC VERSUS INELASTIC COMPRESSION BANDAGING IN LYMPHOEDEMA MANAGEMENT; A COMPARATIVE ANALYTIC STUDY IN KORLE BU TEACHING HOSPITAL
(Ghana College of Physicians and Surgeons, 2023-03-31) TETTEH, NATHANIEL
Background Lymphoedema is a long-term chronic condition requiring a comprehensive multidisciplinary approach as there is no cure for it. Management is therefore aimed at reducing its symptoms and improving on the aesthetics and function of the body part involved. Currently the first line of lymphoedema management is the Complete Decongestive Therapy (CDT), which comprise of manual lymphatic drainage (MLD), compression bandaging, exercise and skin care. CDT is cumbersome, uncomfortable, inconvenient and time-consuming making compliance a big problem. Hence most institutions place emphasis on compression therapy. The prescription of the appropriate compression is a real challenge, since one must choose between inelastic and elastic bandages. It must be adapted to the patient and its pathology as well as provide comfort and ensure good compliance. The diversity of modalities of compression therapy is reflected by the different schools of compression within countries. In France, elastic compression is commonly prescribed whiles in Germany, Netherlands and Austria the standard treatment is inelastic compression. In UK the 4-layer system with an elastic bandage is the choice and in the USA a plaster type inelastic bandage (Unna’s boot) is favoured. The large discrepancies among treatment modalities underline the need of a research into what type of compression therapy is best suited for lymphoedema patients in our centre and to an extent in the Ghanaian population. Aim The study aims to compare the clinical outcomes of treating lymphoedema of the limbs with elastic compression bandaging and inelastic compression bandaging in Ghanaian patients. Methodology The study was a prospective randomized study involving 23 Ghanaian patients with lymphoedema of the upper or lower limbs. Using defined inclusion and exclusion criteria, patients with extremity lymphoedema seen at the Physiotherapy Unit of the National Reconstructive Plastic Surgery and Burns Centre, Korle Bu Teaching Hospital, were selected by simple random sampling into two groups. (Group A – Inelastic bandage, Group B – Elastic bandage). Informed consent was obtained from each patient after clinical assessment. Measurements for both the affected and unaffected limbs were taken using a tape at specific parts of the limb. Manual lymphatic Drainage was done by the physiotherapist and then the appropriate bandage applied based on patient’s group. Limb measurements (affected limb) and Physiotherapy sessions were repeated every two weeks for eight weeks to complete the intensive phase of Compression Bandaging. Quality of life assessment score was taken before and after the 8 weeks of compression bandaging. Data was collected and analyzed using ANOVA to compare the percentage change in the total circumference and volume of the limb with lymphoedema in each of the groups. The quality of life score was compared before and after treatment for each group. Results The mean age of the participants was 48.61 years. There was a statistical significant difference in the occupational status and level of education of the patients. 70% of patients had upper limb lymphoedema and the mean age at diagnosis was 46.26 years. 82.6% 0f patients had secondary lymphoedema with malignancy being the commonest cause. Both inelastic and elastic compression bandages were effective in reducing the circumference and volume of the affected limb. Compression bandaging in all resulted in a statistically significant difference in the quality of life before and after treatment (p< 0.0001). Conclusion Compression bandaging using either elastic or inelastic compression bandages are effective in the treatment of limb lymphoedema with a better quality of life outcome. There is no statistical significant difference in the efficacy of both inelastic and elastic bandages. However inelastic compression bandage gives a better reduction in limb volume.
DIABETIC KETOACIDOSIS IN PREGNANCY AND MATERNAL AND FETAL OUTCOMES IN KORLE BU TEACHING HOSPITAL
(Ghana College of Physicians and Surgeons, 2023-03-31) AGYAPONG, JEFF OSEI
Introduction Diabetic ketoacidosis (DKA) is a state of relative or absolute insulin deficiency that results in major metabolic changes including increased glucose production accompanied by decreased peripheral uptake and enhanced protein catabolism and lipolysis. It affects 1 to 3% of diabetic pregnancies. It most commonly complicates type 1 diabetes mellitus (DM) but also affects type 2 DM and more occasionally gestational DM. The incidence is higher in the second and third trimesters of pregnancy when insulin resistance peaks. Diagnosis is based on a triad of hyperglycaemia, ketonaemia or ketonuria, and metabolic acidosis. In pregnancy, DKA tends to occur at lower blood glucose levels. Euglycaemic DKA is a rare condition in which ketoacidosis occurs at normal blood glucose levels. This occurs more commonly in pregnancy. DKA in pregnancy significantly increases the risk of maternal and fetal morbidity and mortality. Management can be very challenging and must involve a multidisciplinary team in a high-dependency or intensive care unit. Maternal complications include acute kidney injury, adult respiratory distress syndrome, cerebral oedema, coma, and death. Fetal complications include fetal heart rate abnormalities, fetal demise, prematurity, and long-term neurodevelopmental delay. The objective of this study was to determine the incidence of DKA in pregnancy in KBTH and maternal and fetal outcomes. Methods This was a prospective cohort study. The study population was pregnant women with diabetes admitted at KBTH. Pregnant women who met the eligibility criteria were screened for ketonuria every time they were seen at the obstetrics emergency room or admitted to the maternity ward or labour ward. Women with urine ketones ≥2+ were tested for bicarbonate and/or pH. Women with pH<7.3 or bicarbonate <15mmol/l became the DKA cases. All the women were followed up for maternal and fetal outcomes including maternal mortality, fetal demise, preterm birth, etc. The association between DKA and maternal and fetal outcomes was determined with logistic regression using a confidence interval (CI) of 95%. Odds ratios were obtained and measurements with p-value <0.05 were deemed statistically significant. Multivariate analysis was done to control for confounders and adjusted odds ratios were determined. viii Results We screened 234 women, representing 91% of pregnant women with diabetes who were admitted at KBTH from 1 st September 2021 to 28th February 2022. Forty-four of them had significant ketonuria and six had DKA, giving an incidence of 2.6%. Two-thirds of the cases occurred in the second and third trimesters. Half occurred in women with GDM. A third had euglycaemic DKA. All the cases were managed according to the KBTH management protocol for DKA in pregnancy. They all recovered. There was no maternal mortality among the DKA cases. We found no significant effect of DKA on maternal and fetal outcomes. Conclusions The incidence of DKA in pregnancy in KBTH is similar to what has been reported in other parts of the world. Universal screening of all pregnant women with diabetes for DKA led to early diagnosis and prompt treatment. The pregnancy outcomes in pregnant women with DKA were comparable to those without DKA.
FACTORS ASSOCIATED WITH ABNORMAL CERVICAL CYTOLOGY AMONG 6 POSTPARTUM WOMEN IN THE ACCRA METROPOLIS
(Ghana College of Physicians and Surgeons, 2023-05-22) AMOH, MICHAEL YAW
Background Cervical cancer is a growing global health issue that significantly increases morbidity and mortality among women, particularly those in sub-Saharan Africa. The extended pre-invasive stage of the disease characterized by cervical cytological abnormalities can be detected early and prevented from developing into invasive tumors with the aid of robust screening procedures such as Pap (Papanicolaou) smear. Ghana does not have a national programme on screening for cervical cancer. The postpartum period presents a golden opportunity for a Pap smear to be done as most women will go through this stage at least once in their lifetime and also, a large cohort of women can be evaluated at that time. Aim To determine the prevalence and the types of abnormal cervical cytology as well as the associated factors among 6 weeks postpartum women in selected hospitals in the Accra Metropolis. Methodology In this cross-sectional study, 370 women who were 6 weeks postpartum and attended postnatal clinics at Korle Bu Teaching Hospital and the Greater Accra Regional Hospital were assessed for the prevalence and the types of abnormal cervical cytology as well as the associated factors. Participants were recruited via consecutive sampling after ethical approval and informed consent had been obtained. Pretested researcher administered questionnaire was used to collect the socio-demographic, obstetric and gynaecologic characteristics of the participants. Conventional Pap smears were taken and analyzed for all the study participants. Those with abnormal results underwent colposcopy. Data collected were summarized and analyzed using Statistical Package for the Social Sciences version (SPSS) 20. Descriptive statistics such as frequencies, mean and standard deviation were used. Bivariate analysis and multivariate analysis with logistic regression were used to model associations between the dependent and independent variables. A p-value of <0.05 was considered statistically significant at a confidence interval of 95%. Results In all data on 370 participants were included in the analysis. The prevalence of abnormal cervical cytology among the participants was 39/370 (10.5%) at a confidence interval of 95% (7.6%-14.1%). ASCUS (Atypical Squamous Cell of Undetermined Significance) was the most common abnormal cervical cytology representing 31/370 (8.4%). A multiple logistic regression analysis showed that a history of Sexually Transmitted Infection (aOR = 34.88; 95% CI = 13.75 – 88.48; p < 0.001) and a history of irregular condom use (aOR = 4.95; 95% CI = 2.03 – 12.05; p < 0.001) were significantly associated with abnormal cervical cytology. Colposcopy was performed on all participants with abnormal cervical cytology, excluding ASCUS, and the results were adequate and normal. Conclusion The prevalence of abnormal cervical cytology in the post-partum period is 10.5%. The factors associated with abnormal cervical cytology are a history of Sexually Transmitted Infection and a history of irregular condom use. Colposcopy was adequate and normal for all the participants who had abnormal cervical cytology. Efforts must be made to include routine cervical precancer screening in the care given to women during their six-week postpartum visit.
SELECTED ADMISSION SERUM ELECTROLYTE LEVELS AND ASSOCIATED CLINICAL OUTCOMES IN CRITICALLY ILL PATIENTS ADMITTED TO THE KORLE-BU TEACHING HOSPITAL, ACCRA
(Ghana College of Physicians and Surgeons, 2023-07-15) BAFFOUR-AWUAH, LORRAINE
INTRODUCTION Electrolytes are minerals that carry an electric charge when dissolved in body fluids (serum) such as blood. Disturbances in serum electrolyte levels are associated with multiple organ system dysfunction; cardiac, respiratory, neuromuscular, immunologic and haematologic function. It is therefore important for clinicians to understand the electrolyte pathophysiology in critical illness. This study therefore seeks to determine some selected serum electrolyte (Phosphate, Magnesium, Calcium, Sodium, Potassium and Chloride) levels and their effect on critically ill patients. AIM To determine the admission levels of selected serum electrolytes (Phosphate, Magnesium, Calcium, Sodium, Potassium and Chloride) and their association with clinical outcomes in critically ill patients at the Korle-Bu Teaching Hospital (KBTH), Accra. METHODOLOGY This was a longitudinal study involving 26 critically ill patients admitted to the Surgical Ground Floor Intensive Care Unit (ICU) and High Dependency Units (HDUs) of KBTH. Laboratory determination of serum electrolytes (Phosphate, Magnesium, Calcium, Sodium, Potassium and Chloride) of the critically ill patients was done at admission and their SOFA scores calculated. Clinical outcomes such as Length of ICU stay (LOS), duration of mechanical ventilation, duration of inotropic support and mortality were measured upon follow up of the patients. The relationship between the measured electrolytes and their association with clinical outcomes was determined using the Pearson correlation co-efficient. Fisher’s Exact test was used to determine the effect of the measured serum electrolytes on mortality. RESULTS The mean admission serum electrolyte levels were: Phosphate (1.35(± 0.84) mmol/l), Magnesium (0.83 (± 0.25) mmol/L), Calcium (1.12 (±0.12) mmol/l), Sodium (139 (± 5.3) mmol/L), Potassium (4.32 (±1.06) mmol/L) and Chloride (104 (±6) mmol/L). There was a positive significant association between serum phosphate and serum magnesium (p-value=0.011) and a non-significant positive association with serum calcium levels (p-value=0.748). There was however a non-significant negative association between serum calcium and serum magnesium levels at admission (p-value=0.175). There was a significant positive correlation between serum phosphate and SOFA scores (p-value=0.041) and mortality (p-value=0.110). A non-significant negative correlation was found between serum phosphate and duration of ventilatory support (p-value=0.638), inotropic support (p-value=0.718) and LOS (p-value=0.683). There was a non-significant positive correlation between serum magnesium and SOFA scores (p-value=0.912) and mortality (p-value=0.199). A non-significant negative correlation was noted between serum magnesium levels and duration of inotropic support (p-value=0.655) and LOS (p-value=0.772). There was a non-significant positive correlation between serum calcium levels and SOFA scores (p-value=0.912), LOS (p-value=0.439), and duration of inotropic support (p-value=0.333). A non-significant negative correlation was found between serum calcium levels and mortality (p-value=0.240). Hypernatraemia and hypophosphataemia were associated with high mortality, though not statistically significant. CONCLUSION Derangements in admission serum electrolyte levels had an effect on SOFA scores, LOS, duration of inotropic support, duration of ventilatory support and mortality in critically ill patients. Hypernatraemia and hypophosphataemia were associated with hundred percent mortality.
PREVALENCE AND OUTCOMES OF INTRA-ABDOMINAL HYPERTENSION IN CRITICALLY ILL PATIENTS IN A MIXED INTENSIVE CARE POPULATION
(BANDOH IRENE, 2023-09-30) BANDOH, IRENE
Intra-abdominal hypertension (IAH) is a condition with significant morbidity and mortality risks in ICU patients, particularly when it escalates to Abdominal Compartment Syndrome (ACS). IAH and ACS can have detrimental effects like, reduced cardiac output, decreased splanchnic blood flow, and renal impairment. Notably, the prevalence of IAH can be as high as 50.5% among ICU patients. Nevertheless, this condition still demands attention in numerous healthcare facilities, including Ghana. The main objective of this study was to investigate the prevalence and prognostic implications of IAH in a mixed surgical and medical ICU environment MATERIALS AND METHODS The study participants were adult patients admitted to the Main ICU of Komfo Anokye Teaching Hospital. Intra-abdominal pressure was measured on admission and every six hours during the initial 48 hours of admission or until the patient's discharge or demise. The modified Krohn's method was employed to carry out these measurements. The Sequential Organ Failure Assessment (SOFA) scores of the participants were calculated daily to evaluate the extent of organ dysfunction. The baseline SOFA score on admission served as the reference point for comparisons. This allowed for a comparison between the group with IAH and the group with normal intra-abdominal pressure, aiming to ascertain whether IAH significantly impacted SOFA scores as a metric for organ dysfunction. The impact of intra-abdominal pressure on critical outcome measures such as ventilator-free days and length of stay in ICU were also measured. RESULTS AND ANALYSIS Ninety participants were enrolled in the study consecutively. The results of the same were analysed. The mean age of participants was 44.3(S. D 17.9, CI=40.4-48.03). Males represented the majority of participants with 53.3% while females formed 46.6%. Intra-abdominal hypertension was defined as “IAP ≥ 12mmHg” according to the WSACS consensus guidelines while abdominal compartment syndrome was defined as “IAP ≥ 20mmHg with new onset organ failure”. The prevalence of IAH was 47% (95% CI 0.36-0.57) and that of ACS was 1.1% of the general population and 2.38% of the cohort that developed intra-abdominal hypertension. Identified risk factors for IAH included Mechanical Ventilation (p-value 0.004), positive fluid balance (p-value 0.028), obesity (p-value 0.073) and massive fluid resuscitation (p-value 0.012). Other identified risk factors included abdominal surgery, major trauma, Acidosis and sepsis but these were not statistically significant. The mean SOFA score on day one for all participants was 7.3±3.9 which was lower than that of the group that developed IAH and higher than the normal IAP group. Mean SOFA scores worsened significantly in the IAH group over the first 48 hours but reduced in the normal IAP group. IAH did not significantly prolong the ICU length of stay. However, the IAH group had significantly less ventilator-free days than the normal IAP group. CONCLUSION The prevalence of IAH was 47% in the KATH ICU. IAH increased mean SOFA scores and increased ventilator dependence. It is crucial to have protocols for identifying and managing intra-abdominal hypertension to improve ICU outcomes.

Browse

Browsing Division of Surgeons by Issue Date