Postgraduate Medical Journal of Ghana

Cardiovascular Diseases, Medication Non-Adherence, and the Potential Of Personalized Medicine: A Comprehensive Review

2024-06-20T16:24:51+00:00

Non-communicable diseases (NCDs) account for approximately 73% of global deaths, with cardiovascular diseases (CVDs) as the leading cause. It was responsible for 17.8 million deaths and significant disability-adjusted life years (DALYs) worldwide in 2017. In Africa, CVDs represent 38.3% of the NCD burden, and their incidence has surged by 50% over the past three decades, with sub-Saharan Africa experiencing the highest global burden of stroke. Medication adherence is a critical factor in managing CVDs, yet adherence rates remain alarmingly low, particularly among cardiovascular patients, where over 60% do not adhere to prescribed treatments. This review explores the importance of medication adherence in CVD management, the emerging role of personalized medicine, and genetic influences on adherence behaviours. Personalized medicine, which uses genetic, environmental, and lifestyle data for tailored healthcare, offers a transformative approach to CVD treatment, potentially improving outcomes and patient adherence. The review also examines recent advances in genomic research related to CVDs and medication adherence, highlighting the need for updated studies and innovative strategies to integrate genetic insights into clinical practice. Addressing these challenges and leveraging personalized medicine have the potential to enhance CVD management and patient outcomes significantly.

Assessment Of Antibiotic Resistance in Streptococcus Isolates Causing Infection of The Oral Cavity in Covid-19 Recovered Patients

2024-09-27T18:40:42+00:00

Objective: This study evaluates the load of Streptococcus species and assesses their antibiotic resistance in COVID-19-recovered patients (Group A) and healthy patients (who never suffered from COVID-19, Group B) attending the out-patient department in tertiary care dental hospital in Bhubaneswar, Odisha.

Methodology: Unstimulated saliva samples were collected from 25 patients of each group and were screened for Streptococcus species. Further species-level identification was done using routine microbiological, biochemical, antigen-detection kits, and PCR techniques. The antibiotic sensitivity test was carried out using the Kirby-Bauers disk diffusion test.

Results: Five different species of Streptococcus were isolated. In both groups, Streptococcus mutans isolates were more in number, followed by S. pyogenes. Our study also recorded that the Streptococcus strains isolated from COVID-19-recovered patients were resistant to more antibiotics than those isolated from non-COVID patients.

Conclusion: In conclusion, there has been a significant rise in the MDR strains of Streptococcus species in India and globally. In our study, COVID-19-recovered patients had more Streptococcus species isolated from their oral cavity than strains isolated from the healthy controls. Hence, dental hospitals and clinics can implement modified safety regulations and antibiotic policies to reduce infections and antibiotic resistance problems.

Ultrasound - Assisted Removal of Impalpable Contraceptive Implants at The Korle Bu Teaching Hospital

2024-09-27T13:56:49+00:00

Objective: To describe our experience of using ultrasonography to locate and remove impalpable implants in a low-resource environment.

Methodology: We report a series of non-palpable subdermal contraceptive implants with unsuccessful removal attempts at other facilities, who were referred to the Reproductive Health Unit, KorleBu Teaching Hospital, between 2015-2018. A high-resolution linear-array probe ultrasound was done to localize the implants. Removal was performed under local anaesthesia, involving a longitudinal incision within the ultrasound-guided skin markings and blunt dissection to locate and retrieve the implant.

Results: Fifteen patients with non-palpable subdermal contraceptive implants were referred after failed attempts by midwives or gynaecologists over the period. Implants included Implanon (9) and Jadelle (6), with durations of use ranging from 8 months to 5 years. Most implants were successfully located using high-resolution linear-array ultrasound probe, and removed under local anaesthesia. Implants were abnormally positioned in 5 cases, with depths ranging between 5 mm and 7 mm. In 14 cases, removal was successful through skin marker guidance or direct ultrasound guidance. One case required general anaesthesia and plastic surgeon’s assistance. No significant complications were reported.

Conclusion: In Ghana, the increasing incidence of impalpable contraceptive implants necessitates the use of interventional radiological methods for removal. Our case series demonstrates that ultrasound-guided removal of non-palpable implants is effective and can be performed with minimal complications in low-resource settings. We recommend training providers, including midwives, in ultrasound-guided implant removal techniques and advocating for early referral to specialized centers.

Determination of Salivary Lactoferrin Levels Before and After Non-Surgical Periodontal Treatment in Patients with Aggressive Periodontitis

2024-09-25T09:14:29+00:00

Objective: This study determined levels of Salivary lactoferrin (sLf) before and after non-surgical periodontal treatment (NSPT) in individuals with localized and generalized aggressive periodontitis compared to healthy controls.

Methodology: The study was an interventional and prospective design. Nineteen participants were clinically and radiographically diagnosed as having AP and 18 participants who did not show evidence of the disease or other diseases, served as controls. All participants received NSPT which included scaling and polishing for the controls and scaling and root planing (SRP) for the cases. Unstimulated whole saliva was collected from participants before and after NSPT. Salivary Lactoferrin levels were quantified using the Human Lactoferrin ELISA kit.

Results: The mean ages were: GAP=33.80±8.93, LAP=32.11±8.07 and Controls = 31.39±8.98 years. Concentration of sLf before NSPT among the cases was 70.92±26.84 (-μg/ml-) and the controls had 48.39±28.56 (-μg/ml-). After treatment, concentration of sLf was 68.57±25.34 (-μg/ml-) for cases and 43.42±21.54(-μg/ml-) for controls. A significant difference was observed at baseline between cases and controls (p= 0.018) and after treatment (p=0.003) which indicated sLf levels were higher in the diseased than non-diseased individuals.

Conclusion: Elevated sLf levels serve as an indication for increased degree of inflammation and this biomarker can be used to determine the severity of AP.

A Comparative Scanning Electron Microscopic Study of The Efficacy of Three Gutta-Percha Solvents Used During Endodontic Retreatment

2024-09-27T11:52:57+00:00

Objective: This study sought to compare the number of unfilled dentinal tubules in the root canals using a Scanning Electron Microscope (SEM) after the use of K-files and the respective solvents (Chloroform, Eucalyptol, D-limonene).

Methodology: The study was a prospective comparative study. Single-rooted teeth extracted because of various dental conditions were root-treated using the rotary ProTaper system and stored in normal saline. After three months, the teeth were randomly assigned to the three solvent groups (Chloroform, Eucalyptol, and D-limonene). Gutta-percha was removed using the solvent and K-files. The teeth were then divided longitudinally and the root canal surfaces (apical third, middle third, and coronal third) were examined using a scanning electron microscope to determine the number of unfilled dentinal tubule orifices per unit area.

Results: D-limonene had the greatest number of unfilled dentinal tubules across the three segments of the divided teeth while Chloroform had the least number of unfilled dentinal tubules

Conclusion: D-limonene had superior gutta-percha removal abilities as compared to Eucalyptol and Chloroform.

Exploring Knowledge, Beliefs, And Misconceptions on Breast Cancer in an Urban Fishing Community in Ghana - A Qualitative Study

2024-09-26T16:18:23+00:00

Objective: This study set out to understand the beliefs of an indigenous population and explore the reasons behind this delayed presentation.

Methodology: This qualitative study adopted a cross-sectional design and was carried out in Jamestown, Ghana. The participants included opinion leaders and ordinary community members. Four focused group discussions (FGDs) and six key-informant interviews (KIIs) were conducted. A general inductive approach was used to analyze the data. Transcripts of interviews were coded in line with the developed codebook.

Results: A total of 46 participants aged 18-70 years were enrolled in this study comprising six key informants and 40 FGD participants. The median age of the key informants was 47.4 years and that of the FGD participants was 39.1 years. Females constituted 45.7% of all participants. The main themes that emerged for causes of breast cancer were; sexual fore play, exposures (risky practices), infections and “at risk groups”. “Breast changes” was the main theme for presentation of breast cancer while stigma, fear, support systems, religion and attitude of healthcare workers were the dominant themes that influenced care seeking behaviour of participants.

Conclusion: The people of Jamestown had some misconceptions regarding the causes of breast cancer. They also had some knowledge about the signs and symptoms of breast cancer. They believed that early diagnosis and prompt treatment could improve the outcome of breast cancer but fear and stigma associated with the condition prevented affected individuals from seeking care early.

Stress and Bruxism: A Study Among Dental and Medical Students at The University Of Ghana

2024-09-27T13:45:21+00:00

Objective: This study aimed to determine the association between stress and bruxism.

Methodology: A cross-sectional study was done among dental and medical students of the University of Ghana. Anonymized online questionnaires were distributed to the target population. Participants were asked if they, or anyone had noticed them repeatedly grind or clench their teeth while sleep or awake. The questionnaire also included the Perceived Stress scale (PSS) to determine the levels of self-perceived stress among the participants. The presence or absence of bruxism was cross-tabulated with the levels of PSS scores.

Results: A total of 129 students participated in this study. These consisted of 70 females. The prevalence of self-reported bruxism in general was 8.5% in the study population. That of sleep bruxism was 5.4%, while awake bruxism was self-reported in an equal number of students. The distribution of self-reported bruxism varied significantly among the different academic levels of the study participants (P=0.008). Students with bruxism reported higher stress scores (P=0.041).

Conclusion: Dental and medical students with self-reported bruxism indicated higher stress scores.

Rare Internal Herniation of The Terminal Ileum into a Retroperitoneal Fossa: A Case Report

2024-07-11T16:30:04+00:00

Introduction: The causes of acute abdomen can riddle many surgeons and clinicians as a whole, amongst which internal hernias are can be illusive puzzles. While clinical history and examination are helpful, they are often nonspecific for internal hernias. The role of imaging can’t be overstated in diagnosing the cause of acute abdomen, but we are sometimes welcomed with a completely different picture in theatre than what was diagnosed preoperatively.

Case Presentation: We report a case of a 22year old man, with about a week’s history of abdominal pains. Laparotomy revealed a loop of terminal ileum and omentum strangulated in an inferior ileocaecal, retroperitoneal pouch.

Conclusion: The causes of acute abdomen remain to be a mysterious medical phenomenon with a vast array of possibilities. Diagnosing this sometimes comes with difficulty, especially with limited resources. Complete understanding of the aetiology sometimes occurs only at the point of surgical intervention.

The Lazarus Phenomenon: Auto- Cardioversion After Termination of Resuscitation -A Case Report

2025-02-07T08:26:29+00:00

Introduction: Lazarus phenomenon is rare, and a dramatic occurrence characterised by a delayed return of spontaneous circulation after cardiopulmonary resuscitation is terminated. We report a case of this rare phenomenon.

Case Presentation: A 45-year-old unemployed man with haemorrhagic pericardial effusion developed iatrogenic perforation of the right ventricle and cardiac tamponade during attempted catheter pericardiocentesis. He became hemodynamically unstable for which he was referred to the cardiothoracic centre and an emergency sternotomy was carried out. He arrested as he was being wheeled to theatre. The sternum was opened, the perforations were repaired, direct cardiac massage was carried out, he was defibrillated 14 times each with 20 joules but there was no response. He was declared dead after 40 minutes of resuscitation. After an additional 20 minutes of no cardiac activity while he was being closed, he regained spontaneous cardiac activity and eventually recovered. Three years of follow up did not reveal any neurological sequelae.

Conclusion: Though the Lazarus phenomenon is rare, it is observable and therefore clinicians should be aware of this phenomenon, and to observe any patient for at least 10-15 minutes (watchful waiting period) using non-invasive monitoring after the termination of cardiopulmonary resuscitation before confirming death.

Spontaneous Bilateral Rupture of The Extensor Tendons of The Knee in Patients with Chronic Kidney Disease. Case Reports

2024-06-21T12:59:37+00:00

Introduction: Bilateral rupture of the extensor tendons of the knee (quadriceps and patella tendons) are uncommon and usually occur as a result of trauma. Spontaneous bilateral tendon ruptures are a rarer injury and has been reported to occur in patients with chronic renal disease and secondary hyperparathyroidism. Patients usually present with sudden inability to actively extend their knee and walk. Over 50% of these injuries are usually missed so a high index of suspicion is required for early diagnosis. These case reports aim to create awareness among physicians and primary care givers about the condition and ensure early diagnosis and management

Case Presentation: We report two cases of spontaneous bilateral knee extensor tendon rupture involving the quadriceps tendon and patella tendon in a 30 year and 50-year-old males respectively. Both patients had chronic renal failure and were on chronic dialysis for a minimum 8 years and were being managed for secondary hyperparathyroidism. One patient had surgical repair and is doing well functionally but the other declined surgery.

Conclusion: Spontaneous knee extensor tendon rupture though rare, occurs in patients on chronic dialysis with secondary hyperparathyroidism. Physicians and primary care givers managing these patients must be aware and maintain a high index of suspicion in order to pick this condition since as seen in our first patient, early treatment is associated with good functional outcomes.

Intrauterine Treatment of Fetal Supraventricular Tachycardia Complicated By Fetal Hydrops: Livebirth At Term

2025-01-22T08:23:34+00:00

Introduction: Fetal tachycardia is a rare complication during pregnancy, with supraventricular tachycardia (SVT) being a common cause of a primary sustained fetal tachyarrhythmia. If developed early in pregnancy, it can lead to non-immune fetal hydrops (FH). Multidisciplinary approach is mandatory between pediatric cardiologists (both paediatric and adult), neonatologist, and maternal-fetal medicine specialist.

Case Presentation: We present a case of fetal SVT, complicated with FH at 24 weeks’ gestation, which was successfully treated with transplacental flecainide to emphasize the need for prenatal evaluation of pregnancies complicated by FH and provision of appropriate treatment to optimize outcome. 35-year-old MPLK; with a gravidity of 1 and parity 0, was referred to our Fetal Medicine Clinic due to an increased fetal heart rate (FHR) of 243 beats per minute during a routine fetal anatomical survey scan at 22 weeks gestational age (GA). The pregnant woman and the fetus had no clinical symptoms, and clinical examinations and investigations revealed no organic lesions. The fetus developed congestive heart failure evidenced by cardiomegaly, pericardial effusion, ascites, and skin edema at 24 weeks’ gestation. The couple made an informed decision for transplacental antiarrhythmic therapy which resulted in successful fetal cardioversion, with minimal maternal side effects. Delivery was conducted at 37W GA, and baby is currently 4 months old and well.

Conclusion: Prenatal evaluation of pregnancies complicated by fetal hydrops is necessary to determine the underlying etiology and provide appropriate treatment to optimize outcome.

Residency training: Bridging the Gap Between Medicine and Dentistry

2025-03-27T19:33:37+00:00