Ghana Medical Journal最新文献

Objective: To determine the Computed Tomography (CT) patterns of intracranial infarcts.

Design: A retrospective cross-sectional study.

Setting: The CT scan unit of the Radiology Department, Cape Coast Teaching Hospital (CCTH), from February 2017 to February 2021.

Participants: One thousand, one hundred and twenty-five patients with non-contrast head CT scan diagnosis of ischaemic strokes, consecutively selected over the study period without any exclusions.

Main outcome measures: Patterns of non-contrast head CT scan of ischaemic strokes.

Results: About 50.6% of the study participants were females with an average age of 62.59±13.91 years. Males were affected with ischaemic strokes earlier than females (p<0.001). The risk factors considered were, hyperlipidaemia (59.5%), hypertension (49.0%), Type 2 diabetes mellitus (DM-2) (39.6%) and smoking (3.0%). The three commonest ischaemic stroke CT scan features were wedge-shaped hypodensity extending to the edge of the brain (62.8%), sulcal flattening/effacement (57.6%) and loss of grey-white matter differentiation (51.0%), which were all significantly associated with hypertension. Small deep brain hypodensities, the rarest feature (2.2%), had no significant association with any of the risk factors considered in the study.

Conclusion: Apart from the loss of grey-white matter differentiation, there was no significant association between the other CT scan features and sex. Generally, most of the risk factors and the CT scan features were significantly associated with increasing age.

Funding: None declared.

Objective: To describe how seizure severity in children with epilepsy may be affected by certain socio-demographic and clinical variables.

Design: A cross-sectional study.

Setting: At the Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria.

Participants: Sixty children and adolescents who were being followed up for seizure disorder at the child neurology clinic.

Intervention: Information on socio-demographic characteristics was obtained with a questionnaire, details of neurological co-morbidities were extracted from the participants' records, and seizure severity was assessed with the National Hospital Seizure Severity Score 3 tool.

Main outcome measure: Chi-square test was used to establish the relationship between categorical variables, while the Independent t-test was used in describing the differences between means. Simple linear regression was calculated to assess the predictability of seizure severity.

Result: The median age was ten years (IQR = 6-13 years), with a male dominance (1.5:1). The Seizure Severity Score (SSS) ranged between 3 and 24 units, with a mean of 12.22 ± 4.29 units. The only characteristic that had a significant association with SSS on bivariate analysis was the "presence of co-morbidities" (p=0.019). A simple linear regression revealed that the presence of a neurological co-morbidity predicted an increase in the SSS by 2.67 units. [R2 = 0.091, F (1, 58)= 5.837, p = 0.019. β = 2.67, t= 2.42, p= 0.019.].

Conclusion: This study shows that neurological co-morbidities predict worsening seizure severity. This knowledge may influence prognostication and the charting of a treatment trajectory.

Funding: No external funding.

Objective: To document the epidemiological, clinical characteristics, believed triggers and associated behaviour in hair greying.

Design: A community based cross-sectional descriptive study was conducted in February 2020 following ethical approval and written informed consent from participants. All participants were clinically evaluated for hair greying, its pattern and location on the scalp. Socio-demographic data were documented. Data was entered and analyzed using the IBM statistics software version 22. Numerical and categorical variables are presented.

Setting: The study was conducted at an urban market in Lagos, Nigeria.

Participants: The study participants comprised 307 adult traders.

Results: The mean age of the 307 participants studied was 42.7±12.8 years. The prevalence of hair greying was 47.6% (51% in males and 45.9% in females). The median (IQR) age of those with grey hair was 52 (44, 59) years. The prevalence of hair greying was 14.8% in those aged 30-34 years and 97.2% in those aged 60 years and above. The prevalence of premature greying was 17.7% and greying before friends and family members was reported at 19.9% and 13%, respectively. Grey hair was diffuse in 81.5%; localized to the frontal area of the scalp in 55.5%. Use of hair dye was noted in 15.8%.

Conclusion: Hair greying is common in the study population. The age at onset is 30 years. Premature hair greying is uncommon in Nigeria. More epidemiological studies of hair greying especially of premature hair greying are needed.

Funding: Funding for this study was provided by the L'Oreal African Hair & Skin Research Grant.

Objectives: This study aimed to evaluate Health-related quality of life (HRQoL) among male patients with hypertension and its associated demographic, clinical and psychosocial factors.

Design: This was a facility-based cross-sectional study.

Setting: This study was carried out at the outpatient department in Korle-Bu Teaching Hospital.

Participants: Three hundred and fifty-eight hypertensive patients were recruited for this study.

Data collection: Information on socio-demographic characteristics, clinical features, insomnia, medication adherence, psychological distress, sexual dysfunction and HRQoL were obtained through patient-reported measures using structured questionnaires and standardised instruments.

Statistical analysis/main outcome measure: The study assessed HRQoL among male hypertensive patients. One-way ANOVA was used to compare the average scores of the various domains of HRQL across the independent variables. Multivariate linear regression models with robust standard errors were used to determine factors associated with quality of life.

Results: Participants with poor perceived overall HRQoL was 14.0%. Comparatively, HRQoL (mean ± SD) was the least in the physical health domain (56.77±14.33) but the highest in the psychological domain (58.7 ± 16.0). Multivariate linear regression showed that income level, educational level, insomnia, overall satisfaction, sexual desire and medication adherence were significant predictors of HRQoL. Average scores of HRQoL domains reduced with a higher level of sexual desire dysfunction.

Conclusion: HRQoL among male hypertensive patients was negatively affected by insomnia, sexual desire dysfunction, educational level and adherence to antihypertensive medications but positively affected by income level. Clinical practice and policy processes should be directed at these factors to improve HRQoL.

Funding: No external funding.

Objectives: To describe the importance of Health clubs in Asthma management in Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi state.

Design: a cross-sectional qualitative study using focus group discussions (FGD) and Key informant interviews (KII).

Setting: the study was conducted from June to July 2019 at the Pulmonology Unit, Department of Pediatrics, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, a tertiary health facility in Ebonyi State, Nigeria.

Participants: 15 out of 25 caregivers of our pediatric asthma clients who attend the Asthma club and nine key informants drawn from club members and some care givers.

Data collection/intervention: With informed consent, data were collected from participants using recorded interviews.

Statistical analysis/main outcome measure: This was done using the descriptive phenomenological psychological by sorting out each description's explanation and separating them into inferred meaning units for analyses and discussion for easier analysis.

Results: Out of 25 caregivers invited, 15 participated in the FGD, all were females aged 32-57 years. For the KII, two out of nine participants were males, three were parents (adults), whereas six were children, 9 to 16 years. Generally, most respondents expressed that the Asthma club improved their sense of well-being y providing a better understanding of the illness, and skills for its management.

Conclusion: The asthma club provides informational and affirmational supportive value to clients. We encourage as many centres as possible to raise an asthma club for more effective health communication and asthma care.

Funding: none declared.

Bacground: Microbial Identification was done by phenotypic methods. VITEK-2 and Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) are now being increasingly used in laboratories.

Objectives: To compare and evaluate the usefulness of MALDI-TOF MS and VITEK-2 in routine microbial identification.

Methods: The performances of MALDI-TOF MS and VITEK 2 were compared for identifying microorganisms.

Results: MALDI- TOF MS and VITEK-2 correctly identified 96 % (96/100) and 97% (97/100) of the isolates upto the genus level.

Conclusion: MALDI TOF MS and VITEK -2 gave comparable identification and error rates. The rapid reduction in turnaround time with MALDI TOF is a significant game-changer in the field of clinical microbiology.

Funding: State Board of Medical Research (SBMR).

Introduction: Total Knee replacement (TKR) is performed to relieve pain and restore both the mechanical axis and joint line whenever indicated. Most of prostheses being used for TKR were manufactured using dimensions from Caucasians' measurements. This study documented the dimensions of distal femora of Nigerians and correlated the dimensions with different TKR prostheses.

Materials and methods: Fifty-six matured femora were measured. Dimensions of distal femora from other regions were retrieved from published articles. The dimensions of TKR prosthesis were extracted from product monographs. Analyses were done with Microsoft excel 2010 (Microsoft Corporation, Redmond, Washington, United States) and STATA version 13 (StataCorp, Texas. USA). Statistical significance was set at p ≤ 0.05.

Results: The average Mediolateral dimension was 79.3 ± 4.4 mm. The anterioposterior dimensions of the medial and lateral condyles were 63.7 ± 3.6 mm and 64.9 ± 3.3 mm respectively. There were no significant differences between the left and right distal femur. The average aspect ratio calculated was1.23 ± 0.05. There was a mismatch of aspect ratio of the distal femora and those of the prostheses. Equations that can be useful both clinically and in forensic medicine were generated.

Conclusion: This study has provided measurements that can be considered when the designing of a suitable femoral component of total knee prosthesis for Nigerians. This study also provided equations that can be used to estimate the dimensions of the medial and the lateral condyles and femoral length from parts of distal femur in forensic medicine.

Funding: Self-funded.

Objective: The main aim of this study was to investigate levels of total aflatoxin and aflatoxin M₁ in bokina, a home-made non-alcoholic beverage prepared from dairy milk, millet and sugar.

Methods: Bokina, dairy milk and millet were purchased monthly over a period of 7 months from bokina producers at Ashaiman and Nima, in Ghana. Total aflatoxin and aflatoxin M₁ levels in these samples were measured using a fluorometric procedure and High-Performance Liquid Chromatography.

Results: Aflatoxin levels in bokina samples ranged from 1.0 to 21.0 ppb for Ashaiman samples and 1.0 to 23.0 ppb for Nima samples. Out of 21 samples from each site 1 from Ashiaman and 2 from Nima had levels total aflatoxin above the acceptable limit of 20 ppb. Similarly, total aflatoxin levels millet samples ranged from 1.0 to 55.0 ppb for Ashaiman and 5.0 to 53.0 ppb for Nima samples, with 2 samples from Ashiaman and 6 from Nima having levels above 20ppb. The levels of Aflatoxin M₁ in milk ranged from 0.09 to 6.20 ppb for Ashaiman samples and 0.13 to 12.55 ppb for Nima samples. Out of the samples, 12 from Ashiaman and 10 from Nima (n=21) had levels of Aflatoxin M₁ above the acceptable limit of 0.5 ppb.

Conclusion: Bokina samples tested were contaminated with aflatoxin. All doses of aflatoxin have a cumulative effect on the risk of cancer. Therefore, farmers and bokina producers must be educated on good storage practices and monitored to protect the public from aflatoxin exposure and toxicity.

Funding: The study was self-funded.

Objective: To determine causes of visual impairment (VI) among staff of the Eye Centre at the Korle Bu Teaching Hospital.

Design: This was a cross-sectional study.

Setting: The Eye Centre, Korle Bu Teaching Hospital (KBTH), from October 2016 to March 2017 on all consenting members of staff.

Participants: Eighty-four (79.3%) of 106 consenting staff members participated in this study.

Data collection/intervention: A detailed history (demographic, ocular, medical co-morbid conditions), ocular examination and relevant diagnostic investigations were conducted. Interventions initiated included treatment for glaucoma, dry eye and allergic conjunctivitis and spectacles prescription for refractive errors.

Main outcomes: Prevalence of avoidable causes of VI (glaucoma, cataract, refractive errors). Secondary outcomes included prevalence of unavoidable causes of VI.

Results: Eighty-four (79.3%) members of staff participated in this study. Most of the participants were females, 54(64.3 %). Age ranged from 23 to 60 years with an average of 35.8±9.9 years (mean ± SD).Prevalence of VI was 9.5 % (8/84), all due to uncorrected refractive error. Other known causes of VI included open angle glaucoma in 12(14.3 %), macular scar of unknown cause, 1(1.2 %) and sutural cataract, 1(1.2 %) but were all visually insignificant.

Conclusions: The prevalence of VI among the staff of the Eye Centre of the KBTH was 9.5 %, all due to refractive errors. Other known causes of avoidable visual impairment and blindness encountered were glaucoma (14.3 %), macular scar (1.2 %) and cataract (1.2 %), all asymptomatic. Routine eye screening should be part of periodic medical examination for employees.

Funding: None declared.

Abdominal aortic aneurysm (AAA) is a fatal disease with high perioperative morbidity and mortality. Endovascular AAA repair (EVAR) is associated with remarkable improvement in the morbidity, mortality and length of hospital stay relative to open operative repair. We report a 79-year-old man with epigastric pain, which was diagnosed to be due to AAA on a computerised tomography angiogram (CTA). His only risk factor was hypertension. He had endovascular repair in 2018, the first-ever in Ghana and West Africa. 2021 is the 3rd year of surveillance post- EVAR with no disease progression or complication. This seminal case is a beacon of hope in Ghana's resource-constrained healthcare system.

Funding: None declared.