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Foreign Body Inhalation: A Review of Patients at the Korle Bu Teaching Hospital, Accra, Ghana
E.D Kitcher
West African Journal of Medicine , 2009,
Abstract: BACKGROUND: Foreign body inhalation, a surgical emergency requiring prompt management to avoid morbidity and mortality , poses a diagnostic and management challenge to otolaryngologists. OBJECTIVE: To assess the pattern of foreign body inhalation at the ENT Unit Korle Bu Teaching Hospital Accra, Ghana. METHODS: The theatre records of patients managed for foreign body inhalation from Ist January 2003–31st December 2006 at the ENT Unit of the Korle Bu Teaching Hospital Accra, Ghana were studied with respect to age, sex, clinical presentation, types of foreign bodies removed, location of foreign bodies, and outcomes of the laryngoscopy or bronchoscopy procedures. RESULTS: There were forty patients with an age range of seven months to 15 years with a mean age of 4.78 years and a peak age incidence at zero–four year age group. The commonest inhaled foreign bodies included groundnuts in five (12.5%) patients, fish bones in six (15%) patients, plastic materials in five (12.5%) patients, metal material in five (12.5%) patients and seeds in five (12.5%) patients. The common clinical presentations included respiratory difficulty, irritating cough, choking, painful swallowing and whistling sound during breathing. Foreign bodies were localized in the right main bronchus in 27 (67.5 %) patients, and in the left main bronchus in ten (25%) patients and in the larynx in three (7.5%) patients. One patient died during bronchoscopy and another patient had bronchotomy for failed bronchoscopy. CONCLUSION: The peak age of occurrence of forein body inhalation is in the zero-four year age group. The commonest inhaled foreign bodies are groundnuts, fish bones, plastic materials, metal materials and seeds. Majority of inhaled foreign bodies tend to localise in the right main bronchus. WAJM 2009; 28(6): 368–370.
Trends in eclampsia at Korle Bu Teaching Hospatal, Accra Ghana
R Acquah-Arhin, EY Kwawukuwe
Nigerian Journal of Clinical Practice , 2003,
Abstract: Objectives: The aim of the study was to find out the current trend of eclampsia and the incidence in Korle Bu Teaching hospital Method: Case files of all patients who were managed as eclampsia from 1st January 1998 to 31st December 200 were reviewed Result: The incidence of eclampisa during the study period was 15.82 per 1000 deliveries and the fatality rate for eclampsia was 4.78%. About 36.25 of the patients did not receive any form of magnesium sulphate and about 47.5% of the patients arrived at the hospital in taxicabs Conclusion: The results suggested that the incidence of eclampsia had risen from 11.1to 15.82 per 1000 deliveries. It was concluded that magnesium sulphate should be made available in the district hospitals and the polyclinics. Protocol for its use should be circulated and enforced. In addition the ministry of Health could organize a pool of ambulance services for reasonable fees for the public. KEY WORDS: Eclampsia, Magnesium sulphate, maternal deaths. Nigerian Journal of Clinical Practice Vol.6(1) 2003: 1-4
Laparoscopic cholecystectomy at the Korle Bu Teaching Hospital, Accra, Ghana: An initial report
JNA Clegg-Lamptey, G Amponsah
West African Journal of Medicine , 2010,
Abstract: BACKGROUND: Laparoscopic cholecystectomy (LC) the preferred treatment for gallstones was not available in Ghana until 2005. OBJECTIVE: To report experience from Ghana of laparoscopic cholecystectomy in the treatment of galestones. METHODS: In a prospective study of patients with gallstones, information was obtained on demography, duration of various stages of the operation, analgesia and complication of patients with gallstones. All patients had general anaesthesia using endotracheal intubation, muscle relaxant and intermittent positive pressure ventilation. A standard four-trocar technique and maximum pneumoperitoneum pressure of 14mmHg were maintained during surgery. RESULTS: There were 50 women and two men aged 17-72 years (mean 44.2 years). All had symptomatic gallstones treated by interval LC. The main indications were biliary colic 23(44%) and previous cholecystitis 15(29%). There were scars from previous abdominal surgery in 22 (42%), mainly pfannenstiel. The Verres needle was used to obtain pneumoperitoneum in 40 (77%). Only one patient (1.9%) had the operation converted to open cholecystectomy. Most patients, 47/51 (92%), were discharged in 24 hours. The mean durations of various stages were: anaesthesia (110 minutes), pneumo-peritoneum (67.5 minutes) and reverse trendelenburg (47.8 minutes). The mean operating time reduced from 81 to 68 minutes in the last 20 patients. Complications were sore throat 11(21.6%), infection of the umbilical wound 3(5.9%), right shoulder tip pain (3; 5.9%) and bile leak 1(2%). There was no peri-operative mortality. CONCLUSION: Elective laparoscopic cholecystectomy can be performed with good results in patients with symptomatic gallstones in Accra.
A review of genitourinary cancers at the Korle-Bu Teaching Hospital Accra, Ghana
GO Klufio
West African Journal of Medicine , 2004,
Abstract: Objective: To determine the frequency and pattern of genitourinary malignancies seen at the Korle-Bu Teaching Hospital, Accra, Ghana Materials and methods: A retrospective review of genitourinary malignancies seen at the Korle-Bu Teaching Hospital from 1980 to 1990 was undertaken. Data was obtained from the operating theatre register, histopathology reports, and patient case notes. Information retrieved included age and sex of patients, organ involved and laterality where appropriate and tumour type. Results: 548 genitourinary malignancies were seen, of which 479 (87.4%) were in males and 69 (12.6%) in females. Adults comprised 93.4% and children 6.6%. The organ-specific distribution was as follows – prostate 349 (63.7%), bladder 117 (21.3%), kidney 57 (10.4%), testis 13 (2.4%), penis 10 (1.8%) and one each of the ureter and urethra. The kidney tumours comprised nephroblatoma (56.1%), adenocarcinoma (35.1%) with the rest being of urothelial origin. Of the bladder tumours, 50.4% and 44.8% were transitional cell and squamous cell carcinoma respectively. Virtually all the prostatic cancers (99%) were adenocarcinomas. Of the testicular tumours 8(61.5%) were of germ cell and 5 (38.5%) non-germ cell origin. The penile cancers were all squamous. The ureteric and urethral tumours were due to transitional cell and squamous cell carcinomas respectively. Conclusion: Prostatic carcinoma was the predominant genitourinary tumour, accounting for nearly two-thirds of cases, followed by the bladder and the kidney. Other tumours were relatively uncommon. Transitional cell carcinoma of the bladder was seen a little more commonly than the squamous type. Key Words: Prostate, Bladder, Kidney, Testis, Penis, Ureter, Urethra, Cancer, Site-specific, Histology. Résumé Objectif: Déterminer la fréquence et la tendance des génito-urinaires maligns vus au centre hospitalier universitaire du Korle-Bu à Accra au Ghana Matériels et Méthodes: Un bilan rétrospectif des génito-urinaires maligns vus au cntre hospitalier universitaire de 1980 au 1990 a été effectué. Des données ont été obtenues du registre de la salle d'operation, rapports histopathologies et dossier médical des patients. Des informations récupereés sont: age, et sexe des patients, organe impliqués et lateralité, si c'est nécessaire et le type de tumeur. Résultats: 548 cas des malignités génito-rinaire ont été vus, dont 479 soit 87, 4% étaient du sexe masculin et 69 soit 12,6% étaient du sexe féminin. Des adultes constituentt 93,4% et des enfants 6.6%. La repartition spécifique des organes sont representées par. prostate 349 (63,7%, la vessie 117 (21,3%), rein 57 (10,4%), testicule 13 (12,4%) penis 10 (1,8%) et chacun de uretere et uretre. Les tumeurs du rein sont representées par néphroblastome (56,1%) adenocarcinome (35,1%) et les autres etant d'origine d'urothélial. Parmi les tumeurs de vessei, 50,4% et 44,8% étaient des cellule transitionnelle et cellule carcinome du squame respectivement. Pratiquement, tous les
Outcome of Hospital Admissions in HIV-infected Children at the Korle Bu Teaching Hospital, Accra, Ghana
A Kwara, D Shah, LA Renner
West African Journal of Medicine , 2010,
Abstract: BACKGROUND: The burden of paediatric HIV infection remains high in resource-poor settings. Information on morbidity leading to hospitalisation as well as outcome is limited. OBJECTIVE: The objective of this study was to determine the reasons for hospital admissions of HIV-infected paediatric patients to a tertiary teaching hospital and the outcome of these admissions. METHODS: Retrospective chart review of inpatient records of all HIV-infected children aged 0 to 13 years admitted to the paediatric unit at Korle-Bu Teaching Hospital from 30 June 2007 to 30 June 2008 was performed. ed data included age, gender, weight, presenting conditions, diagnosis, duration of hospitalisation, antiretroviral treatment, and outcome. RESULTS: A total of 102 admissions occurred among 76 children. The mean age of the children was 4.5 ± 3.79 years and 42 (55%) were males. HIV diagnosis was made during hospitalisation in 23 (30%) of the 76 patients. Overall, 55 (64%) of the 76 patients had a weight for age of < 2nd percentile and 67% were not on antiretroviral therapy at time of admission. Of the 102 admissions, the predominant diagnosis included pneumonia (40%), gastroenteritis (24%), pulmonary tuberculosis (22%), and/or malaria (19%). Death occurred in 12 of the 102 admissions. Age, gender, and admitting diagnosis were not associated with death. CONCLUSIONS: Failure to thrive and common prevalent infections were the predominant reasons for hospitalisation for paediatric HIV/AIDS patients in Accra. Hospitalisations with these conditions should prompt early HIV testing. Efforts should be intensified to prevent maternal to child transmission of HIV infection.
Factors affecting the survival of the “at risk” newborn at Korle Bu Teaching Hospital, Accra, Ghana
J Welbeck, RB Biritwum, G Mensah
West African Journal of Medicine , 2003,
Abstract: High risk pregnancies continue to be associated with high perinatal mortality and morbidity in developing countries. Korle Bu Teaching Hospital is no exception with a perinatal mortality rate of 98.7/1000 births. Multiple factors resulting in this include the high risk nature of the pregnancies resulting in increased incidence of premature deliveries and asphyxiated babies, the delay in transfer of the sick neonate as well as the inadequate mode of transfer. The type of delivery other than the spontaneous vaginal route also affects the outcome, though the relationship was not statistically significant. Logistic regression analysis showed that maturity, birthweight and time from birth to admission to NICU were the most significant factors associated with the survival of the neonate. Proper foetal surveillance both in the antenatal period and during labour cannot be over emphasized and the mere presence of a paediatrician at these high risk deliveries may make a difference. Also, increased vigilance in the special care offered will help reduce mortality.
Singleton preterm births in Korle bu teaching hospital, Accra, Ghana – origins and outcomes
K Nkyekyer, C Laryea, T Boafor
Ghana Medical Journal , 2006,
Abstract: Objective: To determine the singleton preterm birth rate, the relative proportions of the clinical categories of preterm births and to compare the outcomes in these categories. Setting: Department of Obstetrics & Gynaecol-ogy, Korle Bu Teaching Hospital. Participants: Preterm births from 1st July to 31st December 2003. Results: Out of a total of 4731 singleton births 440 were preterm, giving a preterm birth rate of 9.3%. One hundred and eighty-five (42%, [95% Confidence Interval (CI) 37.4%, 46.8%]) preterm births followed spontaneous onset of preterm la-bour (group A), 82 (18.6%, [95% CI 15.2%, 22.7%]) followed preterm premature rupture of membranes, PPROM (group B) and 173 (39.3%, [95% CI 34.8%, 44.1%]) were medically indicated (group C). The commonest indication for delivery in group C was severe pre-eclampsia/eclampsia. Although there was no significant difference in the mean gestational ages at delivery between the groups, babies in group C had significantly lower birth weights. No differences in sex ratios, still-birth rates, or incidence of low Apgar scores were found. Babies in group C were significantly more likely to be admitted to the neonatal intensive care unit (NICU) and had a significantly higher perina-tal death rate. Survivors of NICU admission among group C babies spent significantly longer periods in hospital before discharge. Conclusion: Outcomes of preterm births in Korle Bu Teaching Hospital are less favourable among indicated preterm births than among spontaneous or PPROM-related preterm births. A detailed study of the causes of neonatal morbidity and mortality is suggested to determine any differences between the three groups.
Blood pressure response to out-patient drug treatment of hypertension in 1973 – 1993 at Korle-Bu Teaching Hospital, Accra, Ghana
IF Adukwei Hesse
West African Journal of Medicine , 2003,
Abstract: A retrospective audit of the first twelve months of out patient drug treatment of hypertension at the Korle--Bu Teaching Hospital during the period 1973 – 1993 is reported. A previous study had shown that at least 7 drug regimes were used to treat hypertension at Korle-Bu during the period. The aim of the present study was to compare the effect and efficacy of these antihypertensive drug treatment regimes on blood pressure during the first 12 months of treatment. Result of 155 (47%) case notes, which met the inclusion criteria, are presented. One month of drug treatment of hypertension significantly reduced systolic and diastolic blood pressure by 21.4 ± 30.5 (p<0.001) and 13.8 ± 16.5 (p<0.001)mmHg, respectively. This reduction in blood pressure was maintained to the 12th month. At 12 months, systolic and diastolic blood pressures were unchanged in 19% and 28% of patients, respectively, indicating no response to drug treatment. Recommended target blood pressure of < 140/90mm Hg was achieved in only 25.6% of all patients. All drug treatment regimes significantly reduced blood pressure to a similar extent so that any differences were not statistically significant. However, the efficacy of the drug regimes differed significantly (p=0.02). It was greatest in patients treated with monotherapy with either diuretic or reserpine, intermediate with two drug combinations and least with 3 or 4 drugs. The data showed that diuretics were marginally better than reserpine as first line monotherapy. Furthermore, any diuretic based 2-drug regime was equally efficacious although a beta--blocker or methyldopa as second drug seemed favoured by the data. The addition of a third or fourth drug was counter productive as the increased number of drugs did not decrease blood pressure significantly.
Mycobacterial species causing pulmonary tuberculosis At the korle bu teaching hospital, Accra,
K.K Addo, K Owusu-darko, D Yeboah-manu, P Caulley, M Minamikawa, F Bonsu, C Leinhardt, P Akpedonu, D Ofori-adjei
Ghana Medical Journal , 2007,
Abstract: Objective: Characterize mycobacterial species causing pulmonary tuberculosis (PTB) at the Korle-Bu Teaching Hospital in Ghana. Design: Sputum smear positive samples, two (2) from 70 patients diagnosed as having tuberculosis, after they had consented, were collected from the Korle-Bu Teaching Hospital Chest Clinic between January and July 2003. Setting: Korle-Bu Teaching Hospital Chest Clinic, Accra. Results: Sixty-four mycobacterial isolates were obtained and confirmed as members of Mycobacterium tuberculosis complex by colonial morphology and conventional biochemical assays. Fortyseven (73%) were M. tuberculosis, the human strain, 2 (3%) M. bovis, the bovine strain, 13 (20%) M. africanum I (West Africa type), and 2 (3%) M. africanum II (East Africa type). Conclusion: The results indicate that, there are various strains causing PTB at the Korle-Bu Teaching Hospital and of great concern is M. bovis, which mostly causes extra-PTB in humans but found to cause PTB in this study. This calls for the need to conduct a nationwide survey using both conventional and molecular techniques to characterize various mycobacterial species causing TB in Ghana. This will result in better understanding of the various strains circulating in the country and inform individual TB treatment regimen especially the inclusion or exclusion of pyrazinamide.
Nosocomial and Community Acquired Infections in Korle Bu Teaching Hospital, Accra
M.J Newman
West African Journal of Medicine , 2009,
Abstract: BACKGROUND: Nosocomial or hospital acquired infection has been recognized as a serious public health problem in the last twenty years. In most hospitals in Africa-South of the Sahara, although the types of community acquired infections are known, neither the magnitude, nor the common types of nosocomial infections has been documented. OBJECTIVE: This study was carried out to find the prevalence of hospital and community acquired infections in hospitals, and to estimate the overall prevalence of HAI and CAI in Korle Bu Teaching Hospital. METHODS: A one-day prevalence survey of nosocomial and community acquired infection in a tertiary-care hospital in Accra was performed using the 1980 British national protocol and the result was analyzed using computerized gargets. RESULTS: Of the 907 patients on admission (on the day of the study), 61 (6.7%) had hospital-acquired infection and 287 (31.6%) had community acquired infection. The commonest hospital acquired infection was wound infection followed by skin and lower respiratory infections. Of the community infections, the most common cases were lower respiratory and skin infections. Fifty-three percent of all patients were on antimicrobial treatment. Patients on metronidazole were 212 (44%), ampicillin/amoxicillin 199 (41.6%), cloxacillin 163 (34%) and gentamicin 135 (28%). Approximately 20% of patients were on three or more drugs. CONCLUSION: This study has shown that the prevalence of community acquired infections in our hospital is much higher than that from nosocomial infections and that the British national survey protocol can be used in countries with limited resources. WAJM 2009; 28(5): 300–303.
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