Ghana Medical Journal最新文献

Objective: To determine the relationship between Vitamin D deficiency with Chest X-Rays severity score and Different Inflammatory Markers in Severe and Critical COVID-19 Patients.

Design: A cross-sectional study.

Setting: The study was conducted in COVID-19 isolation units at Mardan Medical Complex Teaching Hospital (MMCTH) and Bacha Khan Medical College, Pakistan.

Participants: 206 patients who tested positive for COVID-19 by PCR were included in the final analysis.

Data collection/intervention: We collected demographic, comorbidity, laboratory, and clinical outcome data from the electronic records of admitted, deceased, or discharged patients.

Main outcome measure: Frequency of symptoms, comorbidities, mortality and morbidity, chest x-ray severity scores, different inflammatory markers in Vitamin D deficient Covid-19 patients.

Results: 128(62.14%) were severe and 78(37.5%) were critical COVID-19 patients. The whole cohort had 82(39.80%) males and 124(60.20%) females, with a median age of 55 IQR (50-73). Study participants' median Vitamin D level was 14.01ng/ml, with a minimum of 7.5ng/ml and a maximum of 70.8ng/ml. 67/206 patients died, with a fatality ratio of 32.5%. 54/67(80.59%) suffered from one or more comorbid conditions.

Conclusion: Low Vitamin D levels were linked to a higher risk of death, higher x-ray severity scores, and different inflammatory markers. Vitamin D levels greater than 30ng/ml for older patients and greater than 40ng/ml in older patients with comorbidities were associated with reduced severity and mortality in patients with COVID-19.

Funding: None declared.

Objectives: Medical malpractice complaints are apparently on the rise in Ghana. Though it has been suggested that medico-legal training programmes should emphasise the kinds of legal problems that healthcare staff encounter most frequently in practice, no comprehensive study currently analyses the pattern and outcomes of existing case laws.

Design: Systematic content analysis.

Data sources: Medical malpractice case laws sourced from Ghanaian legal repositories, media platforms and other grey literature sources.

Results: Nine case laws were retained. Most of the cases (n=7) involved negligence. Emerging patterns of cases are complex, including patients' access to their medical records, practising without a license/ out of scope, refusal to treat, and the development of complications following surgical interventions. Obstetrics & Gynaecology, Surgery, and Paediatrics were the main clinical specialties involved in the malpractice cases identified.

Conclusions: The pattern of the cases suggests that all medical specialties are potentially at risk, although most of the cases emerged from Obstetrics & Gynaecology, Surgery, and Paediatrics. Medico-legal training for healthcare staff should emphasise the duty of care and adherence to the Ghana Health Service Patient Charter.

Funding: None declared.

Objectives: This study assessed the prevalence and risk factors of depression among undergraduate medical students at the University of Benin, Benin City, Nigeria.

Design: This was a cross-sectional study.

Setting: This study was carried out at the University of Benin.

Participants: Three hundred medical students were recruited for this study.

Methods: The Patient Health Questionnaire 9 (PHQ-9) and a structured pre-tested self-administered questionnaire were used to assess the prevalence and risk factors of depression, respectively.

Results: The students' age ranged from 15 - 34 years, with a mean age of 21.8 ± 3.3 years. Many risk factors which could predispose students to depression were identified. Overall, 96 (32.0%) students were found to have depression. Of these, 59 (19.0%) had mild depression, 4 (1.3%) had severe depression, 53 (39.3%) were pre-clinical students, and 43 (26.1%) were clinical students. Emotional problems (OR 2.205, 95% CI 1.122 - 3.749, p = 0.020), financial challenges (OR 3.971, 95% CI 2.170 - 7.269, p < 0.001) and smoking (OR 6.877, 95% CI 1.731 - 27.327, p = 0.006) were the significant independent predictors of depression.

Conclusion: The prevalence of depression was high among medical students. There is a need to include screening for risk factors of depression in the routine medical examinations for new students admitted into medical schools.

Funding: None declared.

Anorectal mucosal melanoma (AMM) is a rare, aggressive malignancy. The symptoms of AMM mimic common benign conditions in the anus, such as haemorrhoids; hence diagnosis is often made late, a third of patients having metastasis at first presentation. Surgical resection remains the standard of treatment, and adjuvant therapy is varied, including immunotherapy, brachytherapy, and chemotherapy. The prognosis is poor, with a 5-year survival of 20%. A 65year old woman presented with a five-year history of symptoms suggestive of haemorrhoids and was diagnosed with a malignant anorectal mucosal melanoma after symptoms worsened and further investigation was performed. She underwent surgical resection and is currently receiving adjuvant therapy. The prognosis of AMM, the lack of consensus on the treatment regimen to date, and the need for a high index of suspicion for early diagnosis are discussed.

Funding: None declared.

Objective: To identify the factors enabling and limiting family medicine (FM) programmes in Sub-Saharan Africa (SSA).

Design: A narrative review was conducted by searching a variety of databases. Papers focusing on the training, deployment, or contribution to healthcare systems of doctors with postgraduate training in FM in SSA, published in peer-reviewed journals from 2015 onwards and in English language were included. Included papers underwent qualitative analysis.

Results: Seventy-one papers were included in the review. 38% focussed on South Africa, while papers focussing on FM in a further 15 countries in SSA were identified. Key factors enabling FM programmes are support from key stakeholders, recognition of family practitioners (FP) as specialists, international collaboration, and dedicated FPs. Key factors limiting FM programmes are a lack of sufficient and well-trained faculty, inappropriate training settings, higher rates of trainee attrition, lack of FM in undergraduate curriculums, lack of career pathways, inappropriate deployment, and a lack of a critical mass.

Conclusions: Support from national stakeholders, the recognition of FPs as specialists, and sustainable international collaboration promote FM programmes. The absence of a defined role within the healthcare system, low numbers of FM faculty, a poor presence in undergraduate curriculum, high attrition rate of trainees and the lack of a critical mass limit FM programmes. The standardisation of the role of FM and the implementation of undergraduate and postgraduate FM programmes with national and international collaboration could enable FM to reach a critical mass and realise its full potential in strengthening primary healthcare in SSA.

Funding: None declared.

Objective: Cirrhosis is common in Ghana because of its high risk factors prevalence. However, information on cirrhosis in Ghana is lacking. This study aimed to study the clinical, and laboratory characteristics of cirrhotic patients in a tertiary hospital in Ghana.

Design: This was a retrospective study of sociodemographic characteristics, symptoms and signs, biochemical and fibrotic indices, treatments, and complications data of 247 patients with cirrhosis who died on admission.

Setting: This study was carried out at the Gastroenterology Unit of the Korle-Bu Teaching Hospital, Ghana.

Results: Two-thirds (68.0%) of the patients were within 30 to 60 years, with more than half (73.7%) being males. The most common aetiological factors among the patients were Hepatitis B virus infection (53.8%), alcohol use (31.6%) and Hepatitis C virus infection (4.9%). More than half (55.0%) of the patients reported late for admission, and 67.2% died within the first two weeks of admission. The most common clinical feature was abdominal distension (61.1% of patients), and the least was upper-abdominal mass (14.2%). The levels of most liver test parameters were elevated, fibrotic indices were high, and haemoglobin and albumin levels were reduced. More than half (53.8%) of the patients were in Child Pugh class B. The most common complication was hepatic encephalopathy; the least was hepato-renal syndrome. Definite treatment for complications of cirrhosis was lacking.

Conclusion: Deaths from cirrhosis at the hospital were mostly of young males with chronic hepatitis B infection. Implementation of hepatitis B prevention and treatment guidelines can help reduce cirrhosis deaths.

Funding: None declared.

Objective: The study assessed willingness to accept the COVID-19 vaccine among out-patient department (OPD) attendants in the Bono Region in Ghana.

Design: This was an analytical cross-sectional study.

Setting: The study was conducted at the Wenchi Methodist Hospital (WMH) OPD, Bono Region, Ghana. The region had not yet been earmarked for vaccination at the time of the study.

Participants: Three hundred and twenty-five (325) participants aged ≥18 years, accessing care at the OPD of WMH and willing to give informed consent, were interviewed.

Main outcome measures: The proportion of participants willing to accept the COVID-19 vaccine and its determinants.

Results: Of 325 participants interviewed, 32 (9.8%) had been vaccinated already. 82.6% (242/293) indicated COVID-19 vaccine acceptance among the unvaccinated. The major reason for vaccine acceptance was "it could protect against COVID-19" (96.7%, 234/242). "Fear of vaccine side effects and "perception of not being susceptible to COVID-19" were among the reasons for vaccine refusal. Perceived susceptibility to COVID-19 (AOR 4.09, 95% CI 1.79, 9.34), knowledge of COVID-19 and COVID-19 vaccine (AOR 3.62, 95% CI 1.14, 11.46) and willingness to pay for the vaccine (AOR 5.20, 95% CI 2.49, 10.43) were associated with vaccine acceptance.

Conclusions: Adequate knowledge of COVID-19 and the vaccine may drive vaccine acceptance in the study area and possibly other areas in Ghana. Campaign messages aimed at increasing COVID-19 vaccine coverage must emphasise its safety, likely side effects and management in order to help rid the population of misconceptions.

Funding: None indicated.

The co-existence of pheochromocytoma and pregnancy is rare, with poor maternal and foetal outcomes. This is a case report of a young Ghanaian woman with a pre-existing diagnosis of recurrent pheochromocytoma who became pregnant and experienced elevated blood pressure in the third trimester with proteinuria and abnormal liver function. She was managed as an in-patient and delivered a live baby via caesarean section at 34 weeks after detecting intra-uterine growth restriction. Management of such cases by a multidisciplinary team is recommended for optimal outcomes.

Objectives: To determine the birth prevalence, trend, and characteristics of external structural birth defects occurrence in Enugu Metropolis, Nigeria.

Design: Cross-sectional study involving review of delivery records.

Setting: The study was conducted at three tertiary hospitals, one public and two missionary, in Enugu Metropolis.

Participants: Mothers and their babies delivered between 1 January 2009 and 31 December 2016 in the study facilities.

Main outcome measures: Birth prevalence of defects presented as frequency/10,000 births. Other descriptive variables are presented as frequencies and percentages.

Results: There were 21530 births with 133 birth defects (birth prevalence: 61.8/10,000 births) and 1176 stillbirths (stillbirth rate: 54.6/1000 births). The frequencies and birth prevalence (/10,000 births) of recorded defects were: Limb deformities 60(27.9), Neural tube defects (NTDs): 36(16.7), Urogenital system defects: 12(5.6), Gastrointestinal system defects 10(4.6) and Orofacial clefts 4(1.9). Birth defects occurrence showed a rising trend from 2009 to 2016. The mean (SD) age of mothers whose babies had Birth defects was 29.1(4.7) years. Only 62(46.6%) of 133 antenatal clinic folders of these women were traceable for further review. Eighteen (29.0%) had febrile illness in early pregnancy, 9(14.5%) had Malaria, 17(27.4%) had <4 antenatal clinic attendance, 7(11.3%) did not take folic acid and 6(9.7%) took herbal medications during pregnancy.

Conclusions: Birth defects occurrence showed a rising trend with limb deformities and NTDs having the highest prevalence. Record keeping was poor at the facilities. Birth defects preventive interventions like folic acid supplementation for women-of-childbearing age should be promoted in Enugu Metropolis.

Funding: This work was supported by the non-communicable disease Minigrant from the Task Force for Global Health, Decatur, Georgia, USA (TPN-FE-NCD-C2-IFO-9).