Division of Surgeons

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A STUDY OF PROSTATE CANCER DETECTION RATES IN MEN UNDERGOING TRANS-RECTAL ULTRASOUND-GUIDED PROSTATE BIOPSY AT KATH, KUMASI
(MINTAH DOMINIC ANNOR, 2024-04-28) MINTAH, DOMINIC ANNOR
Introduction: Prostate cancer is the second most common cancer among men worldwide. The risk of developing prostate cancer increases with advancing age, elevated serum PSA level, a family history of prostate cancer, and being black or of African ancestry. The diagnosis of prostate cancer is made by histopathological evaluation of the prostate gland. TRUS-guided biopsy of the prostate gland is the gold standard technique for obtaining prostate gland specimen for histopathological evaluation of the prostate gland and for the diagnosis of prostate cancer. This study sought to evaluate the prostate cancer detection rate of TRUS-guided prostate biopsy and analyze its characteristics among the men undergoing prostate biopsy at Komfo Anokye Teaching Hospital, Kumasi. Method: A total of 218 men were referred on various indications for TRUS-guided prostate biopsies at the Urology Unit of the Directorate of Surgery of the Komfo Anokye Teaching Hospital from September 2022 to October 2023 participated in this study. The study participants were prospectively evaluated, and the data analyzed to determine the prostate cancer detection rate and its characteristics. Results: The mean age of the study participants was 69.84 + 8.10 years with a range of 45 - 89 years. Of the 218 men who underwent-guided prostate biopsy, 121 (55.5%) were detected to have adenocarcinoma of the prostate whilst 97 (44.5%) had no cancer. The indications for prostate biopsy from this study were elevated serum PSA level (61.5%), suspicious DRE findings (32.1%) and a combination of both (6.4%). The cancer detection rates for men who underwent biopsy with indications of suspicious DRE findings alone, abnormal serum PSA levels alone, and a combination of both were 14.3, 50.4 and 67.9%. The cancer detection rate was found in the study to increase with increasing serum PSA level and advancing age, and decreases with increasing volume of the prostate gland in the study population. Conclusion: TRUS-guided biopsy of the prostate gland detects more prostate cancer cases than non-cancer cases. The indication with the highest positive predictive value for prostate cancer was the presence of both elevated serum PSA level and suspicious DRE findings. The risk of diagnosis increases with increasing levels of serum PSA and advancing age in the study population. Whilst the risk of being diagnosed with prostate cancer decreases with increasing prostate volume (size).
ACCURACY OF FREEHAND VENTRICULAR CANNULATION USING KOCHER’S AND KEEN’S POINTS IN HYDROCEPHALUS PATIENTS AT A TERTIARY INSTITUTION IN GHANA
(HAGAN RICHMOND, 2023-10-15) HAGAN, RICHMOND
BACKGROUND Cerebrospinal fluid diversionary procedures are life-saving procedures in neurosurgical practice. It is also one of the most common procedures performed. Accuracy of ventricular cannulation as part of the diversionary procedure is of utmost importance as it reduces complications significantly, more so when some of the procedures like the ventriculoperitoneal shunting is lifelong. There have been various methods applied including freehand and image guided ventricular cannulation. AIM This study aims to determine how accurate the freehand cannulation of lateral ventricle is in patients with hydrocephalus using at Kocher’s and Keen’s points. METHODOLOGY This is a cross-sectional study of patients with hydrocephalus undergoing CSF diversion (external ventricular drain or ventriculoperitoneal shunt placement) in the Neuroscience unit of Korle Bu Teaching Hospital. A consecutive sampling method was used to select patients who presented to the emergency unit and outpatient department with hydrocephalus requiring CSF diversion. A total of 54 participants were recruited for this study. CT scan of the head was taken after CSF diversion using Kocher’s point of Keen’s point and catheter tip position was graded. The data collection was done using questionnaires and analysed with the Excel spread sheet and the IBM SPSS version 21 and 24. Patient’s demographic characteristics, the size of the dilated ventricles were obtained and Evan’s ratio calculated using the radiological imaging available, aetiology and type of hydrocephalus were also obtained and analyzed using descriptive statistics. The primary outcome which is accuracy grade was categorized as accurate and coded 1 or inaccurate and coded 0. Multivariable logistic regression was used to identify correlation of factors that may influence accuracy. RESULTS Out of the 54 participants, 61.1% were males and 38.9% were female with a mean age of 22.6 with a standard deviation of 26.01. Tumour was the commonest cause of hydrocephalus (38.9%) followed by congenital causes (27.8%). Post infectious causes accounted for the least (9.3%). Accuracy of the ventricle cannulation using Kocher’s point was 78.3% while that of Keen’s point was 25.8%. There was no statistically significant relationship between the Evans index (p=0.836) and accuracy and level of experience of surgeon and accuracy of ventricular catheter placement (p=0.437). vi CONCLUSION Freehand ventricular cannulation was more accurate using Kocher’s point than using Keen’s point. There was no significant correlation between the Evans ratio and level of experience of surgeon with the accuracy rate of ventricular cannulation using the Kocher’s and Keen’s point. Ventricular catheter placement can be significantly improved using a modification of technique (especially for Keen’s point access) in order to optimize outcome.
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.
COMPARATIVE STUDY OF RE-DISPLACEMENT OF DISTAL FOREARM FRACTURES IN CHILDREN IMMOBILIZED IN ABOVE-ELBOW CAST VS BELOW-ELBOW CAST AT KORLE-BU TEACHING HOSPITAL.
(GHANA COLLEGE OF PHYSICIANS & SURGEONS, 2024-03-26) LARVIE, PRINCE GEORGE
INTRODUCTION Distal forearm fractures are among the commonest fractures seen in children. They typically are the result of fall on the outstretched hand during play. The mismatch between the rapid bone growth and mineral accrual, especially in the distal radius, makes the distal forearm susceptible to fractures from simple falls. These fractures are usually manipulated and stabilized in cast. The choice of cast for immobilizing distal forearm fractures-above elbow versus below elbow still remains controversial. There have been two systematic reviews with meta-analysis till date on the subject. They both recommended further studies on it. There is also paucity of published studies on the subject in West Africa. The literature suggests other factors may be more important in re-displacement of these fractures. AIM This study was to ascertain whether re-displacement in a below elbow cast is worse than in an above elbow cast in children with distal forearm fractures, managed at Korle-Bu Teaching Hospital. METHODS AND MATERIALS This was a non-blinded, randomized control trial, where 58 children between 4 and 13 years, attended to at Department of Orthopaedics, Korle-Bu Teaching Hospital, with closed displaced distal forearm fracture were assigned to one of 2 treatment groups, one receiving below-elbow cast and the other, above-elbow cast. Each child underwent manipulation of the fracture under conscious sedation in the Plaster Room. A below-elbow or an above-elbow POP backslab was applied. The pre- and post-manipulation angulation and apposition in the sagittal and frontal planes were assessed and recorded. A week later, the children came for a completion of the cast, before and after which the angulation and apposition, and the cast and three-point indices were recorded. The children were reviewed each week with new radiographs for 3 weeks. The radiographic parameters we measured again and complications noted and managed. Those who met the criteria for re-manipulation were manipulated. The data was analyzed using Statistical Package for the Social Sciences (SPSS) software, version 20. The categorical data was presented with graphs and tables, and differences assessed with Chi-square analysis. Continuous variables were analyzed with student t-test, using difference of means and multiple regression analysis to ascertain association. RESULTS There were no differences between the means for the two-groups with respect to sagittal angulation change (0.76±0.84 vs 0.82±2.02, p=0.88), frontal angulation change (0.49±0.75 vs 0.40±0.69, p=0.64), sagittal apposition change (0.99±1.11 vs 0.83±0.90, p=0.56), and frontal apposition change (0.87±0.82 vs 1.01±1.21, p=0.60). Multiple regression analysis showed a significant positive association between sagittal angulation change [β (95% Confidence Interval): 6.83(0.45-13.21), p=0.036], and cast index. Stepwise regression modelling also showed a positive association between the cast index and frontal apposition change [β (95% Confidence Interval): 4.69 (0.30-9.08), p= 0.036]. CONCLUSIONS The study found no difference in re-displacement between the below-elbow and above-elbow cast groups, for the management of distal forearm fractures in children. It did however find the cast index as a predictor of re-displacement, when the cut-off was set at 0.80.
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.
DETERMINANTS OF SIGNIFICANT VOIDING DYSFUNCTION AFTER IODINE-125 BRACHYTHERAPY FOR LOCALIZED PROSTATE CANCER AT THE KORLE BU TEACHING HOSPITAL.
(LAMPTEY JONATHAN CHARLES, 2024-04-27) LAMPTEY, JONATHAN CHARLES
Background: Prostate cancer is the second most commonly diagnosed cancer amongst men after lung cancer accounting for 14.1% of cancers in men. Both incidence and mortality vary tremendously across geographic regions and populations reflecting multifactorial impacts of genetic variation; diet, lifestyle, environmental factors, access to care and variations in use of prostate specific antigen (PSA)-based screening policies. With the increasing use of PSA as a screening tool in Sub Saharan Africa many more cases of localized cancer of the prostate are being diagnosed. Radical prostatectomy and radiation therapy remain the main options for active treatment of localized cancer of the prostate. Low dose rate brachytherapy has recently (2008) become available in Ghana. Patients are therefore able to participate in the decision making process on which form of treatment they should undergo. With largely similar oncologic outcomes from radical prostatectomy and brachytherapy, the complications associated with each procedure plays a major role in deciding on the treatment option. Studies in other jurisdictions have pointed at urinary morbidity as the main complication from brachytherapy. Furthermore, some studies point to different factors as predicting which patients are most at risk of significant urinary morbidity after low dose rate brachytherapy. Local data for this sub-region would be important to guide local practice. Objective: To determine the factors that are associated with significant voiding dysfunction at one month after I-125 prostate brachytherapy of men undergoing the procedure at the Korle Bu Teaching Hospital. Methodology: Patients presenting for prostate brachytherapy were recruited into this prospective study. Basic demographic and disease related data were taken including the pre –operative International Prostate Symptom Score(IPSS). Peri-operative data such as u30 and D90 were also documented. The post-operative IPSS were evaluated monthly for 4 months and documented together with any other complaints at one month. Post-operative follow up evaluation was done via phone interviews. Results: Significant voiding dysfunction at 1month post brachytherapy occurred in 67.7% of the study population. Two persons representing 2.8% had Acute Retention of Urine (AROU) with both occurring within 2 days of the procedure. The most common complaints at 1month were related to the urinary system. At one month, the median IPSS score had increased from 5 to 11. It gradually declined thereafter but did not reach pre-procedure levels during the four month follow up period. Digital Rectal Examination (p= 0.686), Gleason score (p= 0.799), prostate volume (p= 0.137), Pre-biopsy PSA (p= 0.949), number of needles used (p= 0.465), number of seeds implanted (p=0.724) and u30 (p= 0.9310) all showed no statistical correlation with the occurrence of significant voiding dysfunction at 1month. Pre-operative IPSS and the prior use of tamsulosin both showed statistical significance on bivariate regression analysis with p= 0.001 and p<0.011 respectively. However these two parameters failed to show statistical significance when subjected to multivariate regression analysis (p= 0.635 and p= 0.069 for pre-operative IPSS and prior use of tamsulosin respectively). D90 and pre-operative nocturia (as scored on IPSS) were predictive of occurrence of significant voiding dysfunction at one month both on bivariate and multivariate regression analysis. The D90 scores analysis yielded p=0.009 and p=0.037 on bivariate and multivariate analysis respectively. With regards the pre-operative nocturia score, p<0.001 and p=0.002 on bivariate and multivariate analysis respectively. Conclusion: The study confirmed that prostate brachytherapy significantly worsens voiding function at one month. D90 and preoperative nocturia value on IPSS scoring were predictors of significant voiding dysfunction at one month.
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.
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.
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.
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.
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.
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 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.
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.
FUNCTIONAL OUTCOME BETWEEN THE USE OF Z-PLASTY AND FULL THICKNESS SKIN GRAFTING IN THE RELEASE OF AXILLARY CONTRACTURES AT KOMFO ANOKYE TEACHING HOSPITAL (KATH) -KUMASI, GHANA.
(Ghana College of Physicians and Surgeons, 2023-09-30) ADAE-ABOAGYE, KWADWO
Axillary post-burn scar contracture is a challenging problem to the reconstructive surgeon owing to the wide range of movement with respect to the shoulder joint. Axillary post-burn contracture is disturbingly common and severe in developing countries and a significant problem in developed nations as well. Age related injuries abound as well as possible gender disparities. Most injuries have been found to be domestic related and when diagnosed, intervention need to be instituted at the earliest opportunity. The aim of this study was to compare the functional outcome between the use of z- plasty and the use of skin grafting in the release of axillary contractures in patients presenting to the Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana. Methods: The study was longitudinal, prospective and comparative to assess the functional outcome of axillary contractures release of patients presenting to Komfo Anokye Teaching Hospital, Kumasi. Study subjects included patients with axillary contractures presenting at KATH over a period of one (1) year. Data management and analysis: Data was collected from the patients, using a case reporting form, after informed consent was sort, coded and analysed with SPSS software. Outcome of the study was presented in tables and charts and Chi-square and these were used to establish the relationship between dependent and independent variables to test the hypothesis. Results: The median age for the sampled data was 13.5 years with 58% females and 42% males. The commonest aetiology was flame burns (50%), scald injury (31.6%), chemical burns (10.5%)and electrical burns (7.9%). The median angle changed from a mean of 92.9 degrees pre-operatively to 175 degrees immediate post-operatively, 170 degrees at two (2) weeks and 168 v degrees at four (4) weeks post-operatively. With a p-value of 0.72 at the end of the study, the difference in change in abduction when the two modalities were compared was found not to be statistically significant. Conclusion: The functional outcomes achieved in using z-plasty or full thickness skin grafting in the release of post-burns anterior and posterior axillary contractures are comparable and can be employed interchangeably.
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
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.
MANAGEMENT OF SPINAL ANAESTHESIA-INDUCED HYPOTENSION DURING CAESAREAN SECTION; A COMPARISON OF EPHEDRINE AND NOREPINEPHRINE
(ADJEPONG, PATIENCE, 2024-05-09) ADJEPONG, PATIENCE
Introduction For the majority of caesarean sections, spinal anaesthesia is the preferred anaesthetic technique due to its better safety profile. Hypotension has been the most common adverse effect of spinal anaesthesia for decades. Spinal anaesthesia-induced hypotension if not managed promptly and appropriately could lead to poor maternal and neonatal outcomes. Common vasopressors used in the management of hypotension during spinal anaesthesia include phenylephrine and ephedrine. Currently, norepinephrine is being studied as an alternative to phenylephrine and ephedrine for the management of spinal anaesthesia-induced hypotension. This study sought to compare the effectiveness of intravenous ephedrine and norepinephrine in the aversion of spinal anaesthesia-induced hypotension. Methods This was a prospective, randomised, double-blind controlled study. After ethical clearance and informed consent, parturients were randomised into A (Ephedrine group) and B (Norepinephrine group). The Ephedrine group received prophylactic ephedrine 5mg, augmented with rescue boluses of ephedrine 5mg intravenously. The Norepinephrine group received prophylactic norepinephrine 5μg, augmented with rescue boluses of norepinephrine 5μg intravenously. The primary outcome was the incidence of spinal anaesthesia-induced- hypotension in the two groups. Secondary outcomes included, the incidence of maternal reactive hypertension, bradycardia, nausea and vomiting, and first and fifth-minute Apgar scores of the neonate. A systematic sampling method was used to select all participants. The chi-squared test was used to analyse categorical data, which were presented as numbers and percentages. Shapiro's rank test was used to determine whether continuous data were normally distributed. STATA version 17 (College Station, Texas) statistical software was used for all computations. A p-value of less than 0.050 with a 95% confidence interval was used as the threshold for statistical significance in all tests. Results The study involved 138 participants, 69 in each group. The mean demographics of the participants were age (31.99±5.04) years, parity (2.82±1.49), gestational age (38.56±0.75) weeks, and body mass index (BMI) (26.58±3.52) kg/m². The incidence of spinal anaesthesia-induced hypotension was 62.32% in the ephedrine group and 42.03% in the norepinephrine group (p= 0.017). The incidence of reactive hypertension was 13.04% in the ephedrine and 8.82% in the norepinephrine group (p= 0.429). The incidence of bradycardia was 4.35% in the ephedrine group and 4.35% in the norepinephrine group (p= 0.612). The incidence of nausea and vomiting was 8.70% in the ephedrine and 10.14% in the norepinephrine group (p= 0.710). The Apgar scores of neonates in the first and the fifth minutes were not statistically different between the two groups (p= 0.878 and p= 0.827 for the first and the fifth minutes respectively). Conclusion Norepinephrine maintained maternal systolic arterial pressure better than ephedrine during spinal anaesthesia for caesarean section. However, the outcomes for nausea and vomiting, reactive hypertension, and bradycardia, as well as neonatal outcomes obtained for parturients who received either norepinephrine or ephedrine were similar.
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.
OCULAR BIOMETRIC PARAMETERS AND THEIR RELATIONSHIP WITH AGE, GENDER, REFRACTION AND BODY MASS INDEX IN HEALTHY GHANAIAN CHILDREN.
(BOSOMPEM ABIGAIL NYARKO, 2024-04-30) BOSOMPEM, ABIGAIL NYARKO
Background Ocular biometry involves measurement of axial length, keratometry-value (K-value), anterior chamber depth, lens thickness, and vitreous chamber depth. These biometric values are of importance in clinical decision making in paediatric cataract surgeries, diagnoses of myopia, paediatric laser surgeries and others. Currently, values used in our clinical setting are based on research from other parts of the world. This is due to the dearth of normative data for ocular biometric values for the Ghanaian paediatric population. Published data on paediatric ocular biometry exist abundantly for other populations, however, there is a dearth of published data on this topic in sub-Saharan Africa. This necessitates the need to establish the normative ocular biometric value in the Ghanaian population to optimise our clinical decisions. Aim The study was carried out to determine ocular biometric parameters and their relationship with age, gender, refraction, and body mass index(BMI) in normal Ghanaian school children in the Ablekuma South sub-Municipality. Materials and methods This was a prospective cross-sectional study which measured the ocular biometric values, refraction, and BMI of Ghanaian school children aged 6 to 15 years in the Ablekuma South sub-Municipality.. Informed written consent was obtained from parents/ guardians and assent obtained from children aged 8 years and above. Children with normal eye exam and no history of known eye disease were included in the study. An interviewer-administered pre-designed questionnaire was used to record demographic data such as age, sex, ethnic origin, data on ocular biometric measurements (axial length, anterior chamber depth, lens thickness, vitreous chamber depth,keratometry-value, and cornea radius), and outcome of cycloplegic refraction. Data handling and statistical analysis The data was analysed with SPSS version 25. Descriptive statistics were performed for demographic and ocular biometric parameters and results presented with appropriate charts and and tables. Relationship between ocular biometric parameters and demographic and anthropometric factors were assessed with the independent t-test for differences in continuous variables, 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 Data on 352 children were analysed (704 eyes). They were aged 6 to 15 years, with 55% being female and 45% being male. They had a mean axial length of 22.73±0.75mm, anterior chamber depth of 3.28±0.29mm, lens thickness of 3.65±0.27mm, vitreous chamber depth of 19.44±0.70mm, cornea radius of 7.79±0.28mm and K-value of 43.39±1.56D. Axial length was 22.99±0.78mm in males and 22.51±0.69mm in females; anterior chamber depth was 3.34±0.32mm in males and 3.34±0.21mm in females; vitreous chamber depth was 19.66±0.78mm in males and 19.27±0.58mm on females; and cornea radius was 7.85±0.32mm in males and 7.74±0.20mm in females. K-value was 43.65±1.61D in females compared to 43.06±1.38D in males. Axial length (p=0.001, F=9.366), anterior chamber depth (p=0.001, F=6.447) and vitreous chamber depth (p=0.001, F=5.937) increased with increasing age. Cornea radius (p=0.644, F=0.556) and lens thickness (p=0.379, F=1.030) did not increase significantly with increasing age. Axial length (p=0.001, r=0.281), anterior chamber depth (p=0.001, r=0.228) and vitreous chamber depth (p=0.029, CI=0.01-0.11) had a significant positive relationship with BMI. Axial length (p=0.007, CI=0.00-0.20), anterior chamber depth (p=0.004, CI=0.00-0.20) were significantly related to hyperopia. while myopia and emmetropia had significant relationships with axial length, anterior chamber depth and vitreous chamber depth Conclusion Ocular biometric parameters increased with age, higher in males compared to females. There was a positive relationship between ocular biometry and BMI. Ocular biometry positively correlated with myopia and negatively correlated with hyperopia. Results from this study were similar to that from other studies conducted in sub-Saharan Africa. The findings could support future large population-based study on ocular biometric parameters in the paediatric population to help in the diagnosis and management of serious eye diseases.

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