Postgraduate Medical Journal of Ghana

Microbial Dysbiosis and Immunopathogenesis of Oral Microbiome in the Development and Progression of Oral Squamous Cell Carcinoma: Systematic Review

Poonguzhalnalli Kumar — 2024-09-30

Objective: The purpose of this review is to evaluate the specific bacterial species and their association with oral cancer, particularly in oral squamous cell carcinoma (OSCC).

Methodology: A literature search was done through PubMed, Scopus, and Web of Science databases, and data were extracted according to inclusion criteria. Original studies of 20 articles were included in this review.

Results: A total of 20 articles and 961 samples were included in this review. The mean age was 60.12 ± 7.63, with a significantly higher male predilection (M: F – 2:1) ratio. 16S rRNA sequencing was found to be the most commonly used detection method. Alteration in the oral microbiome was seen with varying degrees of epithelial dysplasia, early & late stages of oral cancer. In OSCC patients, there was an increased abundance of specific microbiomes like Fusobacterium species, Porphyromonas gingivalis, and Prevotella compared to other species.

Conclusion: From this systematic review, it has been found that the changes in diversity of oral microbiome in cancerous patients than that of healthy patients. In OSCC there is an increased abundance of specific species such as Fusobacterium species, Porphyromonas gingivalis, and Prevotella species.

Exploring the Causes of Low Reporting of Medico-Legal Issues in Ghana: Perspectives of Key Informants in the Health Sector

Marian Opoku-Agyakwa — 2024-09-30

Objective: The study aimed at exploring factors leading to medico-legal issues and why they are under reported.

Methodology: This was a qualitative study in which 16 key informants were interviewed with a semi-structured questionnaire. Ethical approval was obtained from the Ghana Institute of Management and Public Administration (GIMPA) Ethical Review Board. Data was analysed thematically. A written informed consent was obtained from each participant.

Results: A medico-legal issue arose if the standard of care was perceived to have been breached or when a complaint was not managed according to the complainant’s expectations. Reasons for low reporting included the long emotionally exacting and expensive adjudication process. Additionally, procedures at the facilities to address complaints are considered non-transparent and prejudicial. Finally, interviewees were credulous believing in predetermined death. They have the attitude of ‘leave judgement to God.’ Even if the victim wants to take the matter up, others may impress upon them to stop it.

Conclusion: The study concludes that factors leading to medico-legal issues include a breach in the approved standard of care of the patient and whether the complainant is unhappy with the handling of the matter. The emotionally and financially exacting nature of dealing with these issues, and the perceived unfair processes account for the low reporting. Belief in fatalism is a contributory factor.

Disease Burden and Outcome of Neonatal Admissions at the Tamale Teaching Hospital, Ghana: A Prospective Study

Sylvia Phaphali Adzitey — 2024-09-30

Objective: To determine the pattern of diseases and factors affecting the outcome of neonates admitted at the Tamale Teaching Hospital Neonatal Intensive Care Unit (TTH NICU) over three months.

Methodology: A hospital-based prospective cohort design was used to collect data from participants. A sample size of 399 neonates (participants) admitted into the NICU from 1st March 2021 to 10th June 2021. Data was obtained using KoboCollect, exported into Excel for cleaning, coding and analysed using SPSS version 20.

Results: This study screened a total of 450 neonates under 28 days admitted in the NICU of Tamale Teaching Hospital, Ghana, over three months. Fifty-one of them were rejected, and 399 were included in the final analysis. The mean birth weight was 2600 g (±810g), with 33.1% of the neonates having low birth weight. Three hundred and forty-one (341) (85.5%) neonates survived, while 58 (14.5%) died during hospitalisation. The pattern of diseases showed that neonatal sepsis (37.3%, n=149/399), small for gestational age or low birth weight (SGA/LBW) (33.1%, n=132/399), neonatal jaundice (28.1%, n=112/399), prematurity (23.6%, n=94/399), birth asphyxia (13.5%, n=54/399) and congenital anomalies (7.8%, n=31/399) were the most common causes of admissions. All variables which had an association with neonatal mortality (p <0.05) were entered into a binomial logistic model, prematurity (AOR=6.974, 95% CI: 1.766-27.537; p=0.006) was the main predictor of mortality.

Conclusion: The common causes of admission and deaths in the TTH NICU during the study were neonatal sepsis, prematurity, birth asphyxia, LBW/SGA and neonatal jaundice. This highlights the need for interventions to address these conditions as we strive to reduce institutional neonatal mortality.

Predicting Factors of Length of Stay at a Neonatal Intensive Care Unit in a Tertiary Hospital in Ghana

Kojo Ahor-Essel — 2024-09-30

Objective: The aim of this research was to determine the factors that influence the length of stay in the NICU of the Korle Bu Teaching Hospital (KBTH), Accra.

Methodology: This was a retrospective study involving 249 preterm infants who were admitted and discharged from the NICU, KBTH from November 2021 to October 2022. The multivariable negative binomial regression model was used to assess the factors associated with the number of hospital days among the newborns.

Results: The median number of days stayed in the NICU was 12 days (IQR: 8-21).

Predictor of shorter length of stay in the NICU was preterm infants with birthweight between 1500-2499g (aβ: -0.39, 95% CI: [-0.54, -0.24], p<0.001). Predictors of prolonged length of stay in the NICU were late initiation of breastmilk feeding (aβ: 0.31, 95% CI: [0.01, 0.60], p=0.040), preterm infants with neonatal jaundice (aβ: 0.15, 95% CI: [0.02, 0.28], p=0.023), neonatal sepsis (aβ: 0.44, 95% CI: [0.30, 0.57], p<0.001), and necrotising enterocolitis (aβ: 0.37, 95% CI: [0.16, 0.58], p<0.001).

Conclusion: Preterm infants who initiated breastmilk feeding late, developed neonatal sepsis, necrotising enterocolitis and neonatal jaundice were more likely to stay longer at the NICU. While those with birth weight between 1500-2499grams

Religious Mandatory Premarital HIV Testing; Assessment of Perceptions on Ethical Concerns Among Healthcare Workers in Kwaebibirem

Brainard Asare — 2024-09-30

Objective: This cross-sectional survey describes healthcare workers’ (HCWs’) perceptions on religious mandatory premarital HIV testing- (RMPmHT) associated ethical concerns.

Methodology: An online survey was completed with an e-questionnaire, circulated via WhatsApp, (a freeware, centralized instant messaging cross-platform). This involved 530 participants and data were descriptively analyzed using Epi info 3.5.1.

Results: The findings illustrate that HCWs, mostly aged 30 or younger with a mean age of 30.4 (±7.2), were largely familiar with RMPmHT, (58.5%). Despite general acceptance, disclosing positive results to RO leadership was widely discouraged. HCWs considered RMPmHT non-intrusive, yet paradoxically believed it increased the risk of stigmatization. Despite an unclear ethical paradigm and state silence on RMPmHT, HCWs didn't see knowledge of a positive result as a 'right' for RO leadership. Policy frameworks for 'medico-legal' permission and result disclosure were seen as ambiguous. Concerns about fragile confidentiality structures persist, and the prohibition of marriages for HIV-positive or RMPmHT-dissenting couples was widely deprecated.

Conclusion: RMPmHT, tenably, infringes upon the right to marry and found a family, bodily integrity, privacy, and information as negative results may subtly be a precondition for marriage. Advocacy for the need to situate RMPmHT in a clear ethical paradigm remains imperative. Policy frameworks guiding documentation of consent processes, HIV couple discordancy, counselling, information, disclosure, data management and linking RMPmHT services to public health institutions should be engendered.

Prevalence and Predictors of Complementary and Alternative Medicine Use Among Children Attending an Asthma Clinic in a Tertiary Hospital in Ghana

Kojo Ahor-Essel — 2024-09-30

Objective: The objectives of this study were to determine the prevalence and type of CAMs, and predictive factors among Ghanaian children with asthma.

Methodology: A cross-sectional study involving 110 children with physician-diagnosed asthma attending the Asthma Clinic of the Department of Child Health (DCH), Korle Bu Teaching Hospital (KBTH), Accra were consecutively recruited between February 2018 to May 2019. Data were collected with a semi-structured, pre-tested, investigator-administered questionnaire.

Results: Out of the 110 participants, forty-nine (44.5%) had used CAM within the last 12 months. The three most frequently used remedies as stand-alone or in combination were honey (80.0%), garlic (34.2%) and lemon/lime (26.3%%). In the multivariable logistic regression analysis, CAM use among children aged 10--13 years was over 4 times the use among those aged 5--9 years (AOR=4.45, 95% CI: 1.32-14.98, p=0.016), 71% less among female children (AOR: 0.29, 95% CI: 0.10-0.80, p=0.017) and 85% less among mothers in middle occupation class relative to the low occupation class (AOR: 0.15, 95% CI: 0.15, 95% CI: 0.03-0.77, p=0.023).

Conclusion: There was high prevalence of CAM use among the children attending the asthma clinic, KBTH. Adolescents and children from low occupational class are more likely to use CAM, while the female child was less likely.

Training and Developing Physician-Scientist Careers to Enhance Medical Research in Ghana

Edem M.A. Tette — 2024-09-30

Summary

A physician-scientist is a medical doctor who combines clinical practice with research. They often work in academic medical centers, research institutions, or hospitals, where they split their time between treating patients and conducting research to advance medical knowledge, develop new treatments, and improve public health. Their work is well recognized as they are reported to constitute 37% of Nobel Prize winners in Physiology or Medicine, and several prize winners in Chemistry. However, regardless of how inherently fulfilling this may be, in Ghana and many other regions of the world, increasingly fewer doctors aspire to become physician-scientists. Currently, there is a lack of clarity regarding the path to becoming a physician-scientist in Ghana and other African nations. So, for the young doctor of today who wishes to embark on a research career, there are more questions than answers. The authors emphasize the need for structured programs, early commitment, and resource allocation to nurture the next generation of physician-scientists. They also examine the potential of integrating research-focused training into existing medical programs and the role of various stakeholders, such as universities and the Ministry of Health, in supporting these initiatives. The authors call for innovative approaches and strategic planning to enhance the capacity of Ghanaian doctors to pursue careers in medical research, ultimately contributing to global scientific advancement and improving healthcare in low and middle-income countries. They conclude that more needs to be done to develop more physician scientists.

A Disturbing Emerging Trend of Alcohol-Based Hand Sanitizer Burns in Northern Ghana: A Case Series

Anwar Sadat Seidu — 2024-09-30

Introduction: During the COVID-19 pandemic and in the aftermath of it, there was a surge in the use of alcohol-based hand sanitizer (ABHS). This was because the Center for Disease Control and Prevention and the World Health Organization recommended it as an essential commodity for hand hygiene and the reduction of infection transmission. However, alcohol is flammable and has the potential to cause burns if ignited. There are few reports of ABHS-related burns in literature. We aim to report 8 cases of ABHS burns in Northern Ghana and sound a clarion call to stakeholders on a disturbing emerging trend.

Case Presentation: About 62.5% of the victims were children and 75% were female with a male-to-female ratio of 1:3. The mean age of victims was 13.25 years while the mean total burn surface area was 29.8%. All victims in this study sustained their injuries because of an attempt by either them or their collaborators to use ABHS as fuel to light a fire for domestic purposes. Most of the burns sustained were second-degree (75%). The case fatality rate of ABHS burns was 25%.

Conclusion: Alcohol-based hand sanitizer, though effective for hand hygiene, is flammable and can cause burns when used injudiciously. ABHS burn is an emerging public health problem. There is a need for public education to curb this emerging trend and forestall future incidents. The Food and Drugs Authority (FDA) should consider the addition of warning labels for flammability on the containers and instruction manuals of sanitizers.

Complete Pentalogy Of Cantrell: Case Report And Review Of Literature

Beatrice Nkolika Ezenwa — 2024-09-30

Introduction: Pentalogy of Cantrell (POC) is a rare congenital anomaly with two sub-categories: complete or partial. Complete has all five defects (anterior diaphragmatic defect, ventral abdominal wall defect, pericardial defect, intracardiac anomalies, and lower sternal defect). The first documented case was described by Cantrell et al. in 1958. Both sporadic and genetic causes have been proposed for POC, with a reported incidence of 5 - 10 cases per one million live births and various clinical presentations. The prognosis of POC depends on the severity of the defects and the associated cardiac anomalies. This case report seeks to increase awareness of this condition, emphasize the need for appropriate counselling in our environment, and review the literature on previous reported cases’ outcomes.

Case Presentation: A 5-hour-old term female neonate was referred to our Children Emergency Center with multiple defects (ectopia cordis, sternal cleft, omphalocele, and limb abnormalities) with dysmorphic facies. A diagnosis of POC was made, and multidisciplinary management was instituted. The eviscerated heart and epigastric omphalocele were dressed and evaluated for palliative surgical care. However, she developed complications with sepsis and electrolyte derangements and died from multi-organ failure before any surgical intervention could be carried out.

Conclusion: Though rare, the Pentalogy of Cantrell in its classical form does occur in our environment. The presence of extracardiac and limb deformities worsens the outcome. Based on poor outcomes, there is a need to emphasize appropriate antenatal and postnatal assessments to provide effective counselling on termination, neonatal palliative care, and surgical repairs as appropriate.

Ulnar Artery Pseudo-Aneurysm in a Young Adult Male Due to Penetrating Trauma

Ighohwo Etuh — 2024-09-30

Introduction: We present a young adult male who developed a proximal left ulnar artery pseudo-aneurysm that resulted from a penetrating stab wound after a period of 10years.

Case Presentation: A 28years old male was referred to our facility with a history of an expanding left forearm swelling. He was initially diagnosed as a case of haematoma. A clinical diagnosis of pseudoaneurysm was confirmed by computed tomography angiography and resection done with ligation of the proximal ulnar artery and the distal branches.

Conclusion: Proximal ulnar artery pseudo-aneurysm is very rare and may be associated with dire consequences in cases of delayed or missed diagnosis. Operative intervention remains the mainstay of treatment.

Two Stage Flexor Tendon Reconstruction After Over Five Decades of Disability Using Silicone Foley

Saani Osman — 2024-09-30

Introduction: Surgical reconstruction of flexor tendon injuries, particularly old injuries, in the digital flexor sheath area (Zone II) are very difficult to perform, presenting significant challenges to both patients and treating surgeons. The healing tendons tend to adhere to the fibro-osseous canal, the proximal and distal ends of tendons are mostly retracted, and in worst cases, the fibro-osseous canal is already collapsed.

Case Presentation: We report in detail how we employed the silicone foley catheter SFC instead of Hunter’s rod, to achieve a magnificent functional outcome in a two-staged reconstruction of a five-decade old flexor tendon injury in Zone II of the right ring finger (RRF).

Conclusion: Surgical correction is still an option for flexor tendon injury even decades after injury. The utility of one’s hand can still be restored regardless of the age of the patient and the period of injury.

Medical Genetics and Education

Ebenezer Badoe — 2024-09-30