Postgraduate Medical Journal of Ghana

A Novelty in Subspecialty Training in Gynaecology: The Case of Reproductive Endocrinology and Infertility Fellowship Program.

Ntumy YM — Thu, 28 Mar 2024 00:00:00 +0000

Imaging of Patients Suspected of Having Pulmonary Thrombo-Embolic Disease; The Value of Chest X-Ray Combined with Perfusion Scan

Teye S, Momodu J, Osayande E, Haberfeld J, Malan N, Vangu M — Thu, 28 Mar 2024 00:00:00 +0000

Objective: To determine the value of a recent chest x-ray (done within 24 hours of the perfusion scan) combined with perfusion in diagnosing acute pulmonary thromboembolism in clinical settings.

Methodology: Retrospective analysis of 155 consecutive patients clinically suspected with pulmonary thromboembolism between January 2017 and January 2019, who underwent a lung scintigraphy.

Results: Most of the study participants (75.5%) were black Africans. The overall population studied had a mean age of 50.09 years (SD 16.78). A recent chest x-ray was found in 40.1% of the projected sample size of 386 patients. The sensitivity and specificity of the PISAPED 1 reader were 96% and 97%, respectively, with a NPV and PPV of 99% and 89%. The sensitivity and specificity of the PISAPED 2 reader were both 96%, with a NPV and PPV of 86%and 99%, respectively. The PIOPED II and the PISAPED 1 had an agreement of 88.39% (Kappa value of 0.7348) while the PIOPED II and the PISAPED 2 had an agreement of 88.39% (Kappa value of 0.7444).

Conclusion: Chest x-ray in conjunction with perfusion scintigraphy is accurate and can be used where ventilation/perfusion scintigraphy cannot be done in the diagnosis of pulmonary embolism.

Knowledge, Practice and Perception of Triage By Staff of the Emergency Department of Ho Teaching Hospital

Kouro GM, Iroko D — Thu, 28 Mar 2024 00:00:00 +0000

Objective: This study sought to assess the knowledge, practice, and perception of triage by Emergency Department (ED) doctors and nurses of a new teaching hospital in Ghana.

Methodology: This was a cross-sectional study. Data was collected using a structured self-filled questionnaire which had sections on socio-demographic information of participants, knowledge, practice, and perception of triage. Descriptive statistics and bivariate analysis of the results was done using Microsoft Excel and Statistical Package for Social Sciences version 25, respectively.

Results: Eighty-three ED staff participated in this study; 56 nurses and 27 doctors. Sixty-four participants had at least moderate level of knowledge of South African Triage Scale (SATS). Their level of knowledge had statistically significant associations with their work experience (p = 0.032) and frequency of triaging (p = 0.000). Forty-nine participants had at least moderate level of triage practice skill. Their scores had statistically significant associations with their level of triage knowledge (p = 0.011) and frequency of triaging (p = 0.001). Majority of participants agreed that triaging is important in reducing waiting times (89%) and improving communication (92%).

Conclusion: The positive correlation between frequency of triaging and both knowledge and practice of triaging attests to the common notion that practice makes perfect. Regular on-the-job training may result in improvement in this skill. Participation by ED doctors should be encouraged.

Factors Influencing the Medical Student’s Interest and Career Choice in Neurosurgery

Thu, 28 Mar 2024 00:00:00 +0000

Objective: To determine the factors influencing interest and a career choice in neurosurgery among final year medical students.

Methodology: A mixed method study was conducted where primary data was collected from 120 final year medical students and three neurosurgery consultants in the University of Ghana Medical School, using quantitative cross-sectional study and qualitative Delphi panel study methods, respectively. The main study outcome was the choice of Neurosurgery as a specialty.

Results: About 90% of the students expressed interest in neurosurgery. Interest in neurosurgery (70%) and the will to make an impact in the specialty (75%) were the top factors for the 13.8% of students who said they would apply for neurosurgical residency, while the long duration of training deterred 63% of respondents. The students had poor exposure to the clinical aspects of the specialty. Practicing neurosurgeons placed a high premium on student interest in the field.

Conclusion: To build interest among medical students to enter neurosurgical residency programs, students should be given more contact hours during their neurosurgery rotations, and neurosurgical mentorship programmes should be established in medical schools to give medical students insight into the typical life of practicing neurosurgeons.

Traumatic Rupture of Dermoid Cyst in Early Pregnancy: Diagnosis and Management in Peki Government Hospital Resulting in a Successful Delivery at Term

Thu, 28 Mar 2024 00:00:00 +0000

Introduction: Dermoid cyst is the commonest germ cell tumour, constituting about 20% of adult ovarian tumours. They are mostly asymptomatic, but complications such as torsion, rupture, and malignant transformation have been reported. Only a few cases of ruptured mature cystic teratoma in early pregnancy have been described and even fewer are those in early pregnancy with the pregnancy successfully carried to term with successful delivery.

Case Presentation: We present a case of a grand multiparous woman who presented to Peki Government Hospital at 11 weeks gestation with an acute abdomen following a fall. She had been diagnosed with a dermoid cyst a week with dimensions of 20cm x15 cm before the presentation. Ultrasound diagnosis of a possible rupture of the cyst was made on admission. Right oophorectomy was done at laparotomy. She had progesterone support for the succeeding 4 weeks and the pregnancy was successfully carried to term with good outcomes at delivery for both mother and baby. The APGAR score for the baby at 1minute and 5minute after birth were 7/10 and 8/10 respectively.

Conclusion: Traumatic rupture of dermoid cyst should be considered as a differential diagnosis in women presenting with acute abdomen in early pregnancy. Laparotomy with abdominal lavage is a viable management option in a low-resource setting.

Utilizing Point-Of-Care Ultrasound (POCUS) for Diagnosis in a Resource-Limited Setting: A Case Report of Pulmonary Embolism

Opare JN, Quao NSA, Addo TK, Bulley HK — Thu, 28 Mar 2024 00:00:00 +0000

Introduction: Acute pulmonary embolism (PE) is a common cause of cardiovascular-related deaths and poses diagnostic challenges due to its variable and non-specific symptoms. Computed tomography pulmonary angiography (CTPA) is the gold standard imaging method for PE diagnosis, but its availability is limited in resource-constrained settings. Point-of-care ultrasound (POCUS) has emerged as a valuable tool for emergency physicians, aiding accurate diagnoses, procedural guidance, and resuscitation efforts.

Case Presentation: This case report presents a 76-year-old woman with non-specific symptoms diagnosed with PE using POCUS in the Emergency Department of the Korle Bu Teaching Hospital. The POCUS findings included an enlarged right ventricle with a flattened septum (D sign), poor cardiac contractility, thrombi in the right ventricle and a plethoric Inferior Vena Cava (IVC). Prompt diagnosis facilitated timely management, leading to improved patient outcomes.

Conclusion: POCUS has proven to be indispensable in resource-constrained settings where confirmatory diagnostics are limited. Incorporating POCUS training into emergency medicine residency programs and establishing emergency ultrasound fellowships in under-resourced regions like Africa can enhance its utilization and empower clinicians in such environments. Equipping emergency room clinicians with POCUS skills enables timely diagnosis, early interventions, shorter Emergency Department stays, and improved patient outcomes. This approach can contribute to building an African faculty proficient in emergency ultrasound, facilitating the education and training of more clinicians in POCUS, and ultimately enhancing healthcare outcomes in resource-limited environments.

Noncirrhotic Portal Hypertension – A Case Report on a Sequela of Portal Vein Cavernoma

Ahorklo IMK, Arthur WE, Wordi D — Thu, 28 Mar 2024 00:00:00 +0000

Introduction: Increased pressures in the portal vein (portal hypertension) which occurs following portal vein thrombosis, results in cavernous transformation of the portal vein. Though portal vein thrombosis (PVT) is a frequent complication in cirrhotic patients, it may also exist as a basic vascular condition without any liver damage. Among the predisposing factors for portal vein cavernoma are deficiencies in protein C, S & antithrombin III, antiphospholipid syndrome and mutations in factor V Leiden and JAK2. Determination of the aetiology aids in the management plan to not only relieve symptoms of the patient but also to treat the underlying cause. Gastroesophageal variceal bleeding, splenomegaly, portosystemic collaterals, and ultimately hematologic abnormalities are among the prominent clinical features.

Case Presentation: We present a case of a 16-year-old male with portal vein cavernoma complicated by bleeding oesophageal varices presenting with a second episode of hematemesis and melena within a 10-year period. He underwent endoscopic variceal band ligation and was put on oral warfarin and propranolol. The patient was followed up once at the outpatient clinic after discharge without the laboratory investigations we requested due to financial constraints. He has since been lost to follow up.

Conclusion: Bleeding oesophageal varices from noncirrhotic causes are common and a high index of suspicion is needed to make a diagnosis. Though investigations tailored towards identifying the underlying cause presents a challenge in a resource constrained setting like ours, management of complications and symptoms to reduce morbidity and mortality cannot be over-emphasized.

Propeller Flap: A Feasible Flap for Distal Third of Leg Defects – Two Cases Done at the Plastic Surgery Unit of the Greater Accra Regional Hospital

Asiedu CK1, Ngissah RK, Awere-Kyere L, Asamani D — Thu, 28 Mar 2024 00:00:00 +0000

Introduction: The traditional way of reconstructing soft tissue defects of the lower limb utilized muscle flaps as the ‘gold standard’ for Gustillo Anderson Grade III B fractures of the upper and middle thirds of the leg. Defects of the lower third of the leg are usually reconstructed with free flaps because of paucity and decreased reach of muscles. In resource constrained environments where free flaps are not routine with high failure rates, fasciocuataneous flaps are the only option left. We present our experience with the novel pedicled propeller perforator flaps for reconstruction of soft tissue defects in the lower limb.

Case Presentation: Between June and October 2020, 2 consecutive patients - a 34-year-old male and a 51-year-old female, were referred for cover for their distal leg defects from the Orthopedics and trauma Unit. All patients were operated on under spinal anaesthesia. Perforators from posterior tibial and peroneal arteries respectively, were identified pre-operatively with hand-held doppler and the propeller-pattern skin paddle was designed around the perforator closest to defect. After elevation of flaps and skeletonization of perforators, they were then rotated (180 degrees) and inset into defects. Case 1 had whole flap (104 cm²) surviving with only minor marginal epidemiolysis at tip whilst the second flap (58.5cm²) had necrosis of only the business end of the flap but subsequently healed by secondary intention after serial dressings. Both had secondary defects proximally after the rotation, which were skin grafted with 100% take.

Conclusion: Propeller flap in our experience, is a feasible versatile option for reconstruction of soft tissue defects in the distal third of the leg.

Clinical Approach to Adrenal Insufficiency

Atiase Y, Ampong C, Donkor-Baah C, Yorke E, Akpalu J — Thu, 28 Mar 2024 00:00:00 +0000

Adrenal insufficiency refers to inadequate production of glucocorticoids, mineralocorticoids, or both by the adrenal glands. This may result from dysfunction or complete destruction of the adrenal cortex (primary adrenal insufficiency), inadequate adrenocorticotropic hormone production by the pituitary (secondary adrenal insufficiency), or inadequate corticotropin-releasing hormone production by the hypothalamus (tertiary adrenal insufficiency). Diagnosis of adrenal insufficiency requires a high index of suspicion because of its nonspecific signs and symptoms. It is associated with a high morbidity and low quality of life even in patients on treatment. When it presents as adrenal crisis it has a high mortality. Glucocorticoid replacement is the mainstay of management, and this may be combined with mineralocorticoids in the case of primary adrenal insufficiency.

Health care personnel must be reminded of this condition, to improve rates of early diagnosis and improve outcomes in management. In this review, we also look at the management of adrenal insufficiency in special populations and the potential role of newer long-acting steroids in the management of adrenal insufficiency is briefly discussed.

In Memoriam - Professor Joseph Darkwa Seffah

Aryee K — Thu, 28 Mar 2024 00:00:00 +0000