bluuebunny/crossref_metadata_2025 huggingface dataset:
History of Anaesthesia in Ghana (3): Anaesthetic Techniques, Care of the Critically Ill, Extension of Anaesthetic Services and International Collaboration
Authors: Amponsah G.
Published: July 2023

This is the third instalment in the series on HISTORY OF ANAESTHESIA IN GHANA. The first instalment was on Human ResourceDevelopment in Anaesthesia.The second was on Developmentof Equipment, Consumables and Anaesthetic Drugs. The history of medicine in Ghana has been documented but there has not been any documentation of the history of anaesthesia in the country.Anaesthesia in Ghana has seen a number of changes in the last fifty to sixty years. These changes have been seen especially in the areas of anaesthetic drugs, anaesthetic techniques, the training of anaesthetic manpower and introduction of intensive care facilities.There has been an introduction of new and modern anaesthetic machines and monitors which were completely absent some decades ago. This article seeks to highlight some of the major changes that have taken place in the specialty. The challenges facing the specialty in terms of the supply of consumables, the lack of maintenance of equipment and the low numbers of enrolment into the specialty by physicians are discussed. The role of international collaborations and the setting up of new specialised units like the National Cardio-thoracic Centre are also mentioned in this article.
Yellow fever -1918/19
Authors: Editor-In-Chief
Published: July 2023

Yellow fever -1918/19
Malignant Skin Tumours in Kumasi: A Five Year Review
Authors: Adu E.J.K. , Koranteng A.
Published: July 2023

Introduction: Ultraviolet radiation is the primary aetiological agent in malignant melanoma (MM), squamous cell carcinoma (SCC) and basal cell carcinoma (BCC). Its effect on carcinogenesis can be influenced by endogenous and exogenous factors.Objective: To document the clinical and epidemiological features of patients presenting with malignant skin tumours at Komfo Anokye Teaching Hospital (KATH), from January 2009 to December 2013.Patients and Methods: Records of patients treated for malignant skin tumours at KATH were retrieved from the surgical out-patient department and theatre records and analysed.Results: 38 patients comprising 16 males and 22 females were treated for malignant skin disease from January 2009 to December 2013. Their ages ranged from 12 to 84 years (mean 48.4, SD=20.2). Predominant lesions were SCC (17 cases), MM (12 cases), and dermatofibrosarcoma protuberans (DFSP), (four cases). SCC were located on the scalp (eight cases), lower limbs (six cases), upper limb (two cases) and trunk (one). All MM lesions were located on the foot. DFSP lesions were found on the leg (one case), trunk (one case), and shoulders (two cases). Basosquamous carcinoma (BSC) was found on the trunk of an albino. All patients were treated surgically (48 procedures); three SCC patients had radiotherapy; one MM patient had chemotherapy.Conclusion: SCC, MM and DFSP were the main malignant skin tumours managed. Chronic wounds, scars and skin bleaching were the exogenous factors; whilst albinism and xeroderma pigmentosum were the endogenous factors identified. For prevention, earlycase detection, adequate treatment of wounds and sun avoidance are advocated.
Prostate Cancer Diagnostic Methods in Korle Bu Teaching Hospital, Accra, Ghana
Authors: Abrahams A.D. , Mensah J.E. , Tettey Y.
Published: July 2023

Objective: The diagnosis of prostate cancer is based on a combination of digital rectal examination (DRE), serum prostate specific antigen (SePSA) estimation and trans-rectal ultrasound guided biopsy (TRUS-B) of the prostate, the latter being the gold standard for prostate cancer diagnosis. This study compared the diagnostic rate of prostate cancer in patients attending the urology clinic at Korle-bu Teaching Hospital, Accra, Ghana, using these methods.Patients and Methods: One hundred and fifty male patients 45 years and older with abnormal DRE and raised or rising SePSA had TRUS biopsy done. The biopsies were processed routinely and all cancer positive slides were graded using the Gleason scoringsystem. DRE findings were comparatively analysed statistically against SePSA and histological findings.Results: Of the 150 subjects, 71(47.3%) were diagnosed as benign and 79(52.7%) had cancer on TRUS-B. Cancer diagnosis rate using a combination of DRE and SePSA was slightly higher (66.4%) than using DRE (64.5%) or SePSA (53.7%) in isolation.Conclusion: DRE was found to have a high positive predictive value, probably due to the late presentation of majority of the patients in this study. SePSA alone is not very reliable, and results must be interpreted with caution due to significant false positive rates. Combining DRE and SePSA improves cancer diagnosis rates.
Twenty-two Years of Repair of Atrial Septal Defects in Ghana
Authors: Tamatey M.N. , Sereboe L.A. , Tettey M.M. , Edwin F. , Entsua-Mensah K. , Gyan B. , Aniteye E.A. , Ofosu-Appiah E.A. , Okyere I. , Mohammed I. , Adzamli I.K. , Offei-Larbi G.
Published: July 2023

Introduction: Atrial septal defects (ASDs) are one of the most common types of congenital heart disease. Repair is often necessary to forestall the various complications associated with the natural history. Surgical repair under cardiopulmonary bypass has beenone of the standard modes of treatment. Much of the data available is from the rest of the world. There is not much data from the West African sub region. The purpose of this study is therefore to provide data from this sub region, guide both referring and operating clinicians in their decisions, and also to serve as comparative data for future studies. We analysed our institutional data to determine the age and sex distribution, the types of ASD and the outcome of surgical repair.Subjects and Methods: A retrospective study was done for all patients who had surgical repair of ASD from January 1992 to December 2013 in the National Cardiothoracic Centre. The data was analysed using Microsoft excel 2010 software.Results: There were 129 patients, 2 in the first year and 9 in the last year of the study. There were 53 (41.0%) males and 76 (59.0%) females. The mean age was 17.6 ± 14.9 years (1 – 70), The commonest age group was 1 – 10 years; 53 (41.0%), followed by 11 – 20years; 36 (27.9%). Secundum ASDs were the commonest, 104 (80.6%), followed by primum ASDs 14 (10.9%), and sinus venosus ASDs 6 (4.7%). Large defects described as common atrium were 5 (3.9%). Autologous pericardium was used in repairing 125 (96.9%) and GORETEX® patch was used in the remaining 4 (3.1%). Thirty-three (25.7%) cases had associated cardiac anomalies that needed concomitant surgical intervention. The commonest was cleft in the anterior mitral leaflet causing severe mitral regurgitation 12 (9.3%), followed by pulmonary stenosis (PS) 11 (8.5%). There was an early mortality of 2 (1.6%). No other significant complication wasencountered.Conclusion: Surgical repair of ASDs in this sub region has been going on for over two decades now, with excellent outcomes. Patients with ASDs must be offered repair as soon as possible to forestall the serious complications that may follow unrepaired ASDs
Consent to Medical Treatment: What about the Adult Patient who is Incapable of Providing a Valid Consent?
Authors: Adwedaa E.O.
Published: July 2023

Consent to medical treatment is a principle that is increasingly gaining attention in health care systems across the world. For consent to be valid, five essential elements must exist. The patient must have the mental ‘capacity’ to provide consent, he or she must receiveadequate and accurate information, understand the information disclosed, make a decision voluntarily and without coercion, and then authorize the treatment. In an article on ‘consent to medical treatment’ in a previous edition of this journal, I outlined how the Ghanaian courts may resolve consent related information disclosure disputes. That article dealt with the provision of information to the adult patient who has the mental capacity to provide lawful consent to medical treatment. A likely question that an interested reader of that article may ask is; ‘what are the legal provisions in Ghana for treating patients who lack the capacity to provide lawful consent to medical treatment as a result of factors such as a young age, disease, severe brain or mental illness or incapacity such as occurs in severe dementia, severe learning disabilities, and being unconscious? The purpose of this article is to attempt to answer sucha question. The scope of the article is limited to the management of the adult patient without the mental capacity to consent to medical treatment, which for the purpose of this article, in Ghana, refers to any individual aged 18 years or older who lacks the mentalcapacity.
Gastric Diverticulum: a Rare Cause of Dyspepsia
Authors: Wu Lily P. , Asare O.K. , Clegg-Lamptey J.N.A.
Published: July 2023

Objective: Diverticular disease of the stomach is uncommon and rarely suspected in all cases of upper gastro-intestinal pathology. The aim of this report is to demonstrate gastric diverticulum as an uncommon cause of upper gastrointestinal symptoms. The literature in Ghana shows no documented record; and we therefore seek to highlight gastric diverticulum as a possible differential diagnosis when evaluating patients with dyspepsia.Case Report and Intervention: We present a case of a 26 year old man who presented to the outpatient clinic with a 2-year history of recurrent epigastric pain and dyspepsia. This patient had previous upper gastrointestinal endoscopies which were normal. The recurrence of his symptoms necessitated a referral to Korle-Bu Teaching Hospital, a tertiary hospital, where the diagnosis of gastric diverticulum was confirmed at endoscopy. He was managed with proton pump inhibitors. Treatment is largely conservative, except incomplicated cases such as bleeding and perforation where surgery is indicated.Conclusion: Gastric diverticulum is rare in Ghana. A high index of suspicion is required to make a diagnosis especially in symptomatic patients with apparently normal gastric mucosa at endoscopy.
Rural Health: From Disease Eradication to Medical Field Units
Authors: Editor-In-Chief
Published: July 2023

Rural health: from disease eradication to medical field units
Comparison of Hand and Ultrasonic Periodontal Parameters in Ghanaian Patients with Moderate Chronic Periodontitis
Authors: Vasco E. , Kwamin F. , Nyako E.A. , Tormeti D. , Ndanu T.A.
Published: July 2023

Background: The traditional method of treating chronic periodontitis initially is non surgical therapy which involves oral hygiene instructions and mechanical instrumentation using either hand or machine driven instruments. This reduces infection and then subsequent healing of the periodontal tissues with a resultant pocket elimination or reduction.General Aim: The aim of this study was to determine if hand and ultrasonic instrumentation produce comparable periodontal pocket reduction among Ghanaian patients with moderate chronic periodontitis.Methodology: The study was an interventional study, spanning a period of 5 months for each patient. Twenty patients with pocket depth 5 – 7 mm between the ages of 30 – 81 years were treated using hand and ultrasonic instrumentation at the University of GhanaDental School clinic. Periodontal parameters measured include plaque scores, bleeding on probing (BOP) scores, probing pocket depth (PPD), probing attachment level (PAL) and gingival recession. Significance level was set at 0.05.Results: The mean PPD at baseline for patients treated using hand instrumentation was 5.5mm and was reduced to 3.4mm at fifth session of instrumentation. Ultrasonic instrumentation recorded a reduction of baseline value of 5.5mm to 3.6mm at fifth session.Bothmethods of instrumentation recorded a significant reduction of the mean PPD without a significant difference in the mean reduction between the two methods of instrumentation.Conclusion: The use of hand or ultrasonic instrumentation produced similar results with respect to reduction in BOP, plaque scores, PPD and PAL
Surgical Oncological Mortalities: A Fifteen Year Analysis in Korle Bu Teaching Hospital, Ghana
Authors: Bediako-Bowan A.A.A. , Nsaful J. , Dakubo J.C.B.
Published: July 2023

Introduction: Cancer is the leading cause of death in economically developed countries and second leading cause of death in developing countries. Despite the high cancer mortality rates in developing countries the contribution of cancer to death in surgicalpractice has not been determined in our institution. An analysis of cancer deaths in the department of surgery at the Korle Bu Teaching Hospital is presented.Methods: All cases of cancer deaths from 1st January 1998 to 31st December 2013 were retrieved and retrospectively reviewed. The sex, age, primary tumour site, period of admission prior to death, cause of death and post-mortem findings formed the primary data for the analysis.Results: There were 113,960 admissions in the surgical department of KBTH over the fifteen year period, with 4,979 overall deaths, of which 1,637 were cancer mortalities, representing 32.85% of the total mortality and a cancer mortality rate of 1.44%. The commonest cancer deaths were from breast (14.48%), prostate (12.52%), colorectal (9.65%), gastric (8.74%) and pancreas (8.67%). Brain tumoursand Wilm’s tumours accounted for 37% and 21% respectively of cancer mortalities in the paediatric age group. Cancer mortalities in the adolescent age group showed many cases of nasopharyngeal cancers (15.85%). Lung cancers accounted for only 1.16% of cancer mortalities in the institution.Conclusion: Cancer accounted for a third of the deaths in the surgical department of KBTH with breast and prostate cancers being the leading overall causes of cancer deaths. Deaths due to lung cancer were low contrasting with the world trend.
Major Extremity Amputation: The Koforidua Experience
Authors: Baidoo R.O. , Debrah S.
Published: July 2023

Background: Major extremity amputation is a relatively common surgical procedure but there is a paucity of local data concerning such an important part of surgical practice. This study was undertaken to unearth the demographics, the common indications, levels, revision and mortality rates of major extremity amputation in a large orthopaedic facility in Ghana.Methods: A retrospective study of 94 consecutive patients with 95 major limb amputations between September 2010 to August 2013 was conducted and the results analysed.Results: Overall, the commonest indication for amputation was trauma which was responsible for 44(46.3%) cases. Of the 95 amputations, 81(85.3%) were lower limb amputations with below knee amputations accounting for 45(47.3%) cases. The age group 21 – 40years had the highest number of amputations with 38(40%) and the commonest cause in this age group was trauma. Average duration of hospitalization was 32 days with 8 patients (8.4%) requiring re-amputation. Six patients (6.4%) died.Conclusion: Major limb amputation is drastically life altering especially in third world countries where livelihoods may depend on the ability to perform manual tasks and opportunities for changes in career paths/gainful rehabilitation do not abound. If traumaticconditions are prevented and expeditiously dealt with and chronic diseases like diabetes are carefully managed, there will be a significant reduction in limb loss following trauma or diabetic foot syndrome.
Decision Support Tools in Medicine: Evidence-Based Medicine Approach in Tamale Teaching Hospital
Authors: Shamudeen A.M. , Tabiri S.
Published: July 2023

Objective: To determine whether laboratory results match the preliminary diagnosis, using a model of malaria diagnosis by clinical staff at Tamale Teaching Hospital (TTH), Ghana.Methods: Data of outpatients diagnosed with malaria in 2012 were collected retrospectively from clinical notes. Data of the clinicians who provided the preliminary diagnoses were collected by self-reporting questionnaire. Statistical analyses were performed with Epi-Info and SPSS software.Results: A total of 344 patients were diagnosed with malaria in 2012, consisting of 186 females and 158 males. The age ranges between one month and 80 years. Forty-four clinicians responded to the questionnaire, consisting of 12 females and 32 males with mean ± SD age of 40.2±10.0 years. Respondents included consultants, medical officers, house officers, physician assistants, physician specialists and senior nurses, with mean ± SD years since qualification of 11.6±9.8 (range: 1-40 years). Nearly one-half (49%) of the clinicians reported not normally requesting laboratory investigations for suspected cases of malaria, thus not following an evidence-based approach for preliminary diagnosis. Slightly over onehalf (51%) of the preliminary diagnoses of malaria in suspected cases were incorrect. However, statistical assessment of the clinician’s preliminary diagnosis and the results from laboratory tests for malaria parasites showed a correlation (p=0.6548 at 95% CI).Conclusion: Practice of evidence-based medicine and establishment of a technology-based healthcare system can lead to decrease incorrect diagnoses and inappropriate health care management
University of Ghana Medical School
Authors: Editor-In-Chief
Published: July 2023

University of Ghana Medical School
First Ghanaian Surgeon— Dr. C.O. Easmon
Authors: Editor-In-Chief
Published: July 2023

First Ghanaian Surgeon— Dr. C.O. Easmon
Indirect Obstetrics Causes of Maternal Death: A-20 Year Retrospective Autopsy Study at the Korle-Bu Teaching Hospital
Authors: Der E.M. , Adu-Bonsaffoh K. , Kwame-Aryee R.A. , Akosa B.A.
Published: July 2023

Background: The pattern and contributions of indirect causes of maternal deaths in Ghana from autopsy data have not been studied. The aim of this study was to estimate the proportions, the spectrum and demographic characteristics of maternal deaths that resulted from indirect obstetrics causes, and to offer recommendations.Material and methods: This was a retrospective study of the above stated parameters from autopsy records in the department of pathology of Korle-Bu Teaching Hospital (KBTH).Results: Approximately 15.2%, of all maternal deaths during the period of study were indirect obstetric causes with a mean age of 28.0 years. About 32.5% of the deaths were recorded in women within 25 – 29 year age group. A little more than a third (35.9%) of the deaths occurred in a health facility. The common underlying indirect causes of death were: infections 99 (39.4%), SCD 73 (29.1%), anaemia in pregnancy 32 (12.7%), chronic liver disease (CLD) 15 (6.0%), cardiovascular disorders (CVS) 10 (4.0%), pulmonarythromboembolism (PE) 8 (3.2%) and neoplastic lesions 5 (2.0%). The common infections were: HIV/AIDS 24 (24.2%), pneumonia 19 (19.1%), purulent bacterial meningitis 17 (17.2%), malaria 9 (9.1%) and tuberculosis 8 (8.1%). The common complications of SCD leading to death were: anaemia 40 (54.8%), haemolytic crisis 10 (13.7%) and acute chest syndrome 9 (12.3%). The major complications of anaemia and CLD in pregnancy leading to death were congestive cardiac failure 28 (87.7%) and septicaemia 7 (46.7%). Deaths due to CLD 3 (37.5%) CVS 6(40.0%) and neoplastic lesions 3 (60.0%) were commoner within the age group of 30 – 34 years. Deaths due to CVS disorders 6 (60.0%) and neoplastic lesions 3 (60.0%) occurred commonly in health facilities.Conclusion: The study found that 15.2% of all maternal deaths were due to indirect causes. These commonly occurred in the community and in the 25 -29 year age group. Infections were the commonest cause of death. The authors conclude that indirect causes of maternal deaths cannot be ignored and that efforts should be focused on their reduction. Research is needed in thisarea of maternal death including the mechanisms by which these cause death and what programme could reduce it.
Disclosing Medical Errors to Patients: Overcoming the Challenge in Clinical Communication
Authors: Awindaogo F.R.
Published: July 2023

Summary: Ethical and professional guidelines obligate doctors to disclose medical errors to patients when they occur. But very few doctors are divulging their own errors, especially in a very paternalistic doctor-patient relationship witnessed in sub-Saharan Africa where the prevalence of medical errors is unknown due to absence of error reporting and disclosing mechanisms. Doctors are not disclosing their errors because of perceived consequences when they do and the lack of disclosure skills that is not taught at all stages of the educational system including the postgraduate level. However, patients want to know and be told when things go wrong.This article looks at the barriers to disclosure of medical errors, the benefits of disclosure for both the doctor and patient, and how doctors can begin disclosing errors based on current literature.
Factors Associated with Antenatal Steroid Uptake in Mothers at Risk of Preterm Birth at a Teaching Hospital In Ghana
Authors: Sackey A.H. , Tagoe L.G. , Oppong S.A.
Published: July 2023

Background: This study was performed to determine the factors associated with antenatal corticosteroid (ACS) use in pregnant women at risk of preterm birth at the Korle-Bu Teaching hospital (KBTH) in Accra.Method: A descriptive cross-sectional study. Subjects and outcome measures - Mothers who should have received antenatal steroids were identified by the admission of their preterm infants to the neonatal unit at KBTH. Maternal ACS status was determined, and the characteristics of women who received ACS were compared with those who did not.Results: There were 284 eligible admissions during the study period of 6 months, of which 43% (121 mothers) were studied due to administrative and logistical constraints. Out of these 121 mothers, 92 (76%) had received antenatal corticosteroids. Mothers withprimary and secondary education were less likely to receive antenatal corticosteroid (OR 0.240, 95% CI 0.058-0.984), (OR 0.211, 95% CI 0.050-0.897) respectively, compared to those with tertiary level education. Mothers who delivered at other hospitals outside KBTH were also less likely to receive ACS (OR 0.195, 95% CI 0.070-0.545). Women who had caesarean delivery were more likely to receiveantenatal corticosteroid compared to those with vaginal delivery (OR 4.378 95% CI 1.690-11.346). In this cohort, there was no association between antenatal corticosteroid use and maternal age, maternal medical condition, fetal gender or previous preterm delivery.Conclusion: ACS use in KBTH is low but similar to other low-income countries. Low educational attainment and delivery outside the tertiary facility are factors associated with low use of ACS.
Non-Communicable Disease In Children In Ghana: Health And Social Burden Of Care On Households
Authors: Yawson A. , Badasu D.M. , Atobra D. , Anarfi J. , Abuosi A.A. , Adzei F.A.
Published: July 2023

Background: Non-communicable diseases (NCDs) are on the increase among children. This paper determines the health and social burden of care imposed on households by NCDs among children in Ghana.Methods: This was a cross-sectional study in three hospitals in Ghana, Ashanti, Greater Accra and Volta Regions. Interviewer administered structured questionnaire was used for data collection. Data was analyzed by proportions, ratios and chi square forassociation between categorical outcome measures (at 95% confidence level) using SPSS version 21.Discusion: Burden of caregiving for children with NCDs rested heavily on women (169; 75.1%) and immediate family (176; 78.3%). Managing child’s condition was expensive and created financial difficulties for households. In all 87.4% of households depended on the national health insurance scheme (NHIS) and 45.8% indicated NCDs in children was a burden. In addition, 47% of the caregivers said life was much better before they found out about child’s ailment. Families had no financial support from extended families or communities/employers. Despite enormous challenges faced by households, there was no indication families suffered isolation ordiscrimination.
Conclusion: National Health Insurance coverage of NCDs especially childhood cancers will reduce the burden of care on households. Improving access to care at regional/district levels for children with NCDs is imperative.
The School of Public Health
Authors: Editor-In-Chief
Published: July 2023

The School of Public Health
Ghana College of Physicians and Surgeons
Authors: Editor-In-Chief
Published: July 2023

Ghana College of Physicians and Surgeons
Sodium Hypochlorite And Its Use As Root Canal Irrigant: A Survey Among Ghanaian Dental Practitioners
Authors: Konadu A.B. , Ampofo P.C. , Hewlett S. , Nyako E.A. , Ndanu T.A.
Published: July 2023

Background: The majority of endodontic treatment in Ghana is provided by general dental practitioners due to the absence of specialists in endodontics. Sodium hypochlorite has been described as one of the commonly used irrigation solutions during endodontic treatment. However, there are no published reports on its use in Ghana.Aim: The study was to determine the proportion of Ghanaian dental practitioners who have used sodium hypochlorite for irrigation and the concentrations they usually use. Materials and methods: Self-administered questionnaires were mailed to dental practitioners in private clinics, government hospitals and clinics, teaching hospitals and training institutions across the country between December 2015 and March 2016. The collated data was analyzed using Microsoft Excel 2010 and SPSS 20.0.Results: The most commonly used root canal irrigant was 2.5% Sodium Hypochlorite (Milton®). This was routinely used by 31 (73.7%) of the respondents as root canal irrigant while normal saline solution was used regularly by only 6(15.8%) respondents. The variousconcentrations of sodium hypochlorite used were 0.5%, 2.5%,1% and 5.0%; with the following percentage-use respectively, 42.9%, 32.1%,21.4% and 6.1%. Three (10.7%) respondents had reported experiencing some complications with the use of sodium hypochlorite.Conclusion: Sodium hypochlorite is the most commonly used root canal irrigant by dental practitioners in Ghana. The concentrations usually used ranges between 0.5% and 5.0%.
A Survey Of Dental Surgeons In Ghana On Their Utilization Of Supplemental Local Anaesthetic Methods During Root Canal Therapy
Authors: Ampofo P.C. , Osei-Tutu K. , Nyako E.A. , Hewlett S. , Quartey-Papafio N.
Published: July 2023

Background: Teeth with irreversibly inflamed pulps can be preserved with endodontic or root canal treatment (RCT). The primary methods used to manage pain during RCT are local infiltration injections and nerve blocks. When infiltrations are used, it is reasonable that the acidic nature of inflamed tissues, can reduce the availability of the active form of the local anaesthetic agent. In the case of nerve blocks, the acidity of the inflamed tissue is unlikely to play a significant role in the failure to achieve anaesthesia. Supplementalanaesthesia methods including periodontal ligament injection (intraligamentary), intraosseous injection, and intra-pulpal injection have been suggested as adjuncts to obtaining complete anaesthesia of the symptomatic irreversibly inflamed dental pulp.Aim: This study was to ascertain the types of supplemental anaesthesia techniques, and their levels of utilization during lower molar RCT in Ghana.Materials and methods: An online survey was done by e-mailing questionnaires to practicing dental surgeons registered on the Ghana Dental Association(GDA), google’s group platform. Data obtained was analyzed using SPSS version 21.Results: Eighty-five percent (34) of respondents indicated that they employ supplemental injections during RCT. Pulpal and intraligamentary techniques were the most commonly used, with 70.6% and 47.1% of dentists reporting utilization respectively.Conclusion: There is the need for update courses in the utilization of intraosseous supplemental local anaesthesia. Other supplemental injection techniques like the inferior alveolar nerve block (IANB) plus nitrous oxide inhalation have to be introduced to dentistscarrying out RCT, so they can add such techniques to their pain management portfolio.
Kwashiorkor and Dr. Cicely Delphine Williams
Authors: Editor-In-Chief
Published: July 2023

Kwashiorkor and Dr. Cicely Delphine Williams
Health Research and MFM Subspecialty
Authors: Seffah J.D.
Published: July 2023

Editorial
Aggressive Plasma Cell Myeloma as an Underlying Cause of Paraparesis In an Unusually Young Male Patient
Authors: Lovi N.K. , Koffie D. , Antiri E.K. , Abole E. , Tawiah J.E. , Amihere F. , Ekem I.
Published: July 2023

Plasma Cell Myeloma, also called multiple Myeloma, is a haematological malignancy characterised by the proliferation of malignant plasma cells with an associated monoclonal paraproteinemia. The disease is described to have a median age of diagnosis in the 7thdecade of life and rare below the 4th decade. We report a case in which the patient was first diagnosed as having Multiple Myeloma at the age of 29 years. The patient had been having symptoms for at least 5 months prior to the diagnosis being arrived at. His earliest symptoms were non-specific: malaise, low grade fever, easy fatigability. These were followed by palpitations, recurring bipedal swelling, polyuria and two months later gnawing lower back pain. Shortly after, he experienced sudden inability to walk without support. The patient reported to us that he had visited a number of primary care facilities where he had full blood counts done as well as x-rays of the lumbosacral spine but was apparently told that apart from having moderate anaemia, his lumbo-sacral X-ray findings were not significant. At the last facility he visited before presenting to our hospital, he was told that he had severe anaemia due tochronic kidney disease. At presentation, a careful review of his history together with his laboratory investigations which included a FBC, blood film comment, BUE/Cr, and X- ray of the thoracolumbosacral spine was suggestive of Multiple Myeloma. Hence with his first blood film comment which showed mild rouleaux formation a bone marrow aspirate was requested. An ESR had not been done. Themarrow showed plasma cell infiltration of 65%. Serum protein electrophoresis showed an M component of 8g/L while a serum free light chain assay revealed an increase of the lambda component of 8480 mg/L (normal: 5.71- 26.30). A repeat x ray showed lytic lesions in the pelvic girdle, spine, shoulders and sternum. Patient was started on oral and intravenous hydration, renal dialysis, Zoledronic acid, chemotherapy with Vincristine, Adriamycin, Dexamethasone and Thalidomide, physiotherapy and thoracolumbar bracing. Patientresponded well to treatment.
Menstrual Hygiene Management and Resources for Adolescent Girls in an Urban Setting in Accra, Ghana
Authors: Emmanuel B. , Yawson A.E.
Published: July 2023

Background: Menstruation is the recurring peeling of the inner part of the uterus or the shedding of the uterine lining on a regular basis in the reproductive-aged females during the monthly menstrual cycles. Menstrual hygiene management (MHM) is an everyday challenge to the adolescent girl child globally, and in developing countries like Ghana. Positive menstrual hygiene management is important because it helps in preventing several health challenges which may be associated with poor menstrual hygiene management. The aim of this study was to determine the state of MHM among adolescent girls in Accra.Method: Quantitative cross-sectional study was conducted using self-administered questionnaires to collect data which was analysed to evaluate the sanitary provisions in the school. Two Basic Schools in Legon, Accra were identified and random sampling procedurewas used to select research participants.Results: Findings revealed that the mean age at menarche of adolescent girls in Basic Schools in Legon was 11.9 ±1.2 years; and that MHM was promoted at home and in schools. In all, 68% and 21% of the adolescent girls routinely bathed two and three times daily respectively during menstruation; 50% of the respondents changed sanitary products three times daily when menstruating, this was followed by 47% who changed twice daily. More than half of them disposed of their used sanitary products by wrapping and putting inthe dustbins. Sanitary facilities were seen to be available and in use during the time of survey.Conclusion: Menstrual hygiene practices among the Basic School girls were good, with socio-economic factors contributing to the use of good disposable menstrual products during menstruation. Sanitary facilities were seen to be available and in use although resources such as running water, soap for hand washing, and sanitary products in the event of an emergency were unavailable.
Psychiatrists’ Disclosure of the Side Effects of Medications to Patients with Schizophrenia in A Major Hospital in Nigeria
Authors: Okpataku C.I.
Published: July 2023

Background: Crucial factors to consider in the management of psychotic disorders are the side effects of medications administered in these conditions. They commonly occur with all known classes of antipsychotics used in the treatment of schizophrenia, and this influences adherence.Objectives: This study determines the extent to which doctors disclose the potential side effects of antipsychotics to patients and its association with drug adherence behavior.Method: Adult patients with schizophrenia who were receiving medications at a psychiatric facility were sampled over a 2-year period. Consenting patients who met the inclusion criteria completed a questionnaire requesting information on the knowledge about sideeffects of their medications, sources of this knowledge and the side effects they were experiencing while using these pills. They also responded to the Medication Adherence Rating Scale-10. The data generated was analyzed by means of frequencies, means and Chisquare test.Results: 175 respondents were interviewed. Their mean age was 36.01+/-9.71 years, with a male preponderance. 96% of the respondents were not informed about the likely side effects of their drugs before commencing treatment. No statistically significant relationship between having knowledge about side effects and drug adherence p=0.137. All the patients were on conventional antipsychotics with some actively experiencing side effects, most of which were fatigue and somnolence.Conclusion: The non-disclosure of information about side effects of medications to patients were enormous. There is a need for psychiatrists to give facts and details about treatment to their patients to enhance standard of care.
My Experience in Clinical Practice as A Medical Registrar in The United Kingdom (UK)
Authors: Norman Dartel
Published: July 2023

My experience working in the UK National Health Service (NHS) has been largely positive. Reflecting on my previous experiences makes me aware of the need for a standardised structure of practice to be put in place to guide the care of patients in Ghana as well as to ensure patient safety. There is still a lot that needs to be done in terms of the legal framework that guides medical  practice in Ghana. Civil society groups and other medical groups should champion the enactment of laws on emergency care, patient safety, patient communication and patient involvement in their own care. Most of what I’ve discussed in this essay can be implemented with little to no resources.
Storage Facilities for the Dead In Ghana
Authors: Anim J.T.
Published: July 2023

The distinction between a mortuary and a funeral home appears blurred to the average Ghanaian who readily considers any storage facility for human corpses in Ghana as a mortuary. Added to this is the fact that virtually all such storage facilities are to be found inhospitals in Ghana. Only a few funeral homes are found in this country and even some of these are beginning to take on the role of a mortuary. This paper defines and addresses the differences between the two facilities and also discusses the need to encourage the construction of community/public mortuaries with the view to shifting the responsibility of administering such community mortuaries from the hospitals, in line with best practices elsewhere. This would enable the hospital pathology service to play its traditional role of diagnosis of diseases in living patients, while also ensuring adequate manpower development by other relevant agencies to fulfill the mandate of the Coroner’s Act, 1960 (Act 18).
Prevenient Grace: An Investigation into Arminianism
Authors: Rutherford J. Alexander
Published: July 2023

If a plant grows with shallow roots, the storms of a season will wither away and uproot it; like a house built on sand, a poor foundation will doom its fate. But this isn’t a book on botany, nor on architecture; foundations, good roots, are essential to thought structures as well as material structures. In theology, a bad foundation will produce results as catastrophic as bad roots or shifting sand. How we think about God and His work in the world will profoundly affect how we live and work out our Christian faith. This book evolved from the conviction that a prominent theological system rests on a fragile foundation. It is written as a small contribution towards refounding our understanding of God’s relationship with the world and our salvation on His Word. The theology in question is Arminianism; the foundation is prevenient grace. Deep within Evangelical Arminianism lies the essential doctrine that God has acted in the life of all human beings, giving them enabling grace enough to respond or reject His offer of salvation. The contention of this book is that this doctrine has no biblical grounds and is rationally unfounded and that Arminianism itself stands or falls on this doctrine. In order to establish the necessary groundwork for analyzing prevenient grace, I present in the first chapter a biblical theology and then systematic synthesis of the doctrine of total depravity. Then, after defining the doctrine of prevenient grace in Chapter 2, I consider every available argument in favour of prevenient grace, beginning with the biblical texts used to defend it in Chapter 3 and then the philosophical and theological arguments in Chapters 4 and 5. With the arguments for the doctrine considered, I then present theological, philosophical, and biblical arguments against the doctrine in Chapters 6-8. The weight of this offensive critique lies in the presentation of the case for the doctrines of unconditional election and the effectual call in Chapters 7 & 8. The intended audience for the book is undergraduate students, lay theologians, and pastors, but the argument and analysis within will make it useful to the graduate student and scholar. To make it accessible to those just entering the debate over God’s sovereignty in salvation, frequent use is made of in-text and footnote definitions for technical terms, with a glossary of all obscure terms in the appendices.
Détours archaïques du cinéma
Authors: Nardin Patrick
Published: July 2023

Dans le champ des images composites, la représentation se sépare des dispositifs optiques pour devenir une réalité simulée conçue à partir d’un principe d’assemblage. Si l’on considère l’image en mouvement, cette définition fait l’impasse sur les schémas de médiation, qui développent des mondes composites où l’image n’est jamais une donnée stable ; en problématisant les systèmes de diffusion, en exploitant des procédés empiriques, en s’affranchissant de tout préalable littéraire, le cinéma dit expérimental révèle des espaces essentiellement composites ; les pratiques qui s’y déploient, où le rapport au matériel est déterminant, peuvent ainsi agglomérer les situations les plus hétérogènes. Le recours à des techniques obsolètes ou à des méthodes parfois archaïques, n’est pas une niche ; ces procédures atypiques font retour dans la culture informatique, où se réhabilite paradoxalement le traitement manuel des images. De fait, l’image numérique n’est pas dépourvue de matérialité et ne se situe pas nécessairement en rupture avec les systèmes analogiques. Il reste que la démarche artistique n’est en rien une entreprise de communication et qu’elle s’ajuste mal aux prescriptions esthétiques ; la question de l’image composite est ici problématisée au lieu d’être définie. Ce ne sont pas les processus d’homogénéisation de sources disparates qui sont considérés, mais au contraire le « démontage » des procédés et la révélation de la structure discontinue des images.
Virtual reconstruction of the Church of St. Nicholas the Wonderworker (Lori region of Armenia): a study of the cultural heritage of the Russian presence in Armenia in the XIX - XX centuries
Authors: Mamonova Svetlana Alekseevna
Published: July 2023

In studies on the history of the Russian presence in Armenia, an important place is occupied by the question of the role of the Orthodox Church. Currently, there are several Orthodox churches in Armenia. One of the most interesting, the Church of St. Nicholas the Wonderworker in Amrakits (Lori region of Armenia) is unique in its architecture, has a century-old history, but suffered significant destruction during the large-scale Spitak earthquake in 1988. Since that time, it has actually lost its significance as a functioning temple. In 2022, survey work began in Armenia to determine the possibility of restoring the partially destroyed church building or (if such restoration is impossible) recreating this temple in an authentic form. In this regard, the task of creating a virtual reconstruction of the Church of St. Nicholas the Wonderworker, using three-dimensional modeling methods, is relevant. An important condition for such work is the availability of a set of sources that allow the implementation of such a project. In this study, a source base has been formed, including drawings, plans, measurements of the church building, as well as photographs of the object before and after the 1988 earthquake. The author studied the history of the settlement Nikolaevka, founded at the beginning of the 19th century (now Amrakits), as well as the history of the construction of the temple of St. Nicholas the Wonderworker in the early twentieth century. The main purpose of the study is to reconstruct the appearance of the church at the beginning of the 20th century. The article contains a study of the history and architectural features of the Church of St. Nicholas the Wonderworker, as well as a description of the process of creating a virtual reconstruction and the problems associated with it. The author used SketchUp 2022, Vision, Lumion 10 as software.
Advancements in diabetes Care in Poland
Authors: SCHUBERT AGATA , CZECH MARCIN
Published: July 2023

Background: The aging population and increasing prevalence of diabetes are placing significant strain on healthcare systems globally, including in Poland. In recent years, notable progress has been made in establishing patient care systems and improving access to treatment, with significant changes in the reimbursement of innovative therapies. However, as the impact of diabetes on the healthcare system continues to grow and advancements are introduced in patient care, there is a pressing need, to continually search for the most optimal solutions to further enhance diabetes care. Objectives: This paper summarize developments of diabetes care in Poland with a special focus on reimbursement of novel therapies introduced in recent 5 years. Methods: We conducted a review of published sources and publications on the management of diabetes care in Poland. This included an analysis of the latest advancements in coordinated care, the collaborative efforts between general practice physicians and specialists, as well as changes in reimbursement policies and other notable progressions in patient-centric care. Furthermore, we analyzed published reports from the National Fund and assessed reimbursement expenditures. Conclusion: The landscape of diabetes treatment in Poland has undergone significant changes in recent years driven by advancements in pharmacological therapies, technological innovations, and healthcare policies. While challenges remain, these changes offer opportunities for further progress in diabetes care in Poland. Continuous efforts to improve patient centered care along with embracing emerging technologies, will contribute to more effective diabetes management and improved quality of life for individuals with diabetes in the country.
Movilidades y reproducción patrimonial e identitaria en celebraciones festivas rurales del Pirineo navarro, España
Authors: Martínez Lorea Ion , Sanz Tolosana Elvira , Iso Tinoco Andoni
Published: July 2023

The social and economic sustainability of rural territories largely depends on the possibilities offered by the mobility of the actors involved: daily commuting, bi-residential strategies, commercial supplies, and tourist flows. In this respect, the interconnection between rural and urban spheres is particularly significant and gives rise to hybrid socio-spatial realities, whose articulation is key in processes of social change. The purpose of this article is to analyze the relationship between different forms of mobility and the celebration of a set of festive events in depopulated territories, within the framework of mountain rurality, specifically in the Pyrenean valleys of Aezkoa, Salazar, and Roncal, in the region of Navarre (Spain). These events have not only multiplied in recent years but also hold considerable relevance as elements of vindication, identity cohesion, and tourist promotion. Thus, we study the interplay between mobility, festive events, and territorial sustainability, considering how both organization and celebration involve permanent residents, non-permanent residents, visitors, and economic actors who may or may not belong to the respective territories. The methodological strategy involves a qualitative approach, using techniques such as documentary collection and analysis, observation, and twenty-two semi-structured interviews with key informants and experts from the region. This approach offers a novel perspective by incorporating mobility processes into the analysis of rural territorial transformation. It acknowledges the importance of redefining places, spatialities, and identities, moving away from static perspectives. This becomes particularly evident through the organization and celebration of festive events in which social actors with different types of mobility and connection to the territory contribute to the production and reproduction of local identities and heritage.