Predictors of recurrence of chronic subdural haematoma in a cohort study of patients presenting in a sub-Saharan African teaching hospital.

BACKGROUND: Chronic subdural haematoma (CSDH) is a common neurological condition affecting the elderly with decreased quality of life. Recurrence leads to increase in number of hospital admissions and surgical interventions. Several factors contribute to recurrence of chronic subdural haematoma, and determination of these factors will help institute measures to reduce recurrence of CSDH, cost of care and improved quality of life. The aim of this study was to determine the predictors of recurrence of chronic subdural haematoma in a cohort of patients presenting in a Sub-Saharan African Teaching Hospital. METHODS: A prospective hospital-based cohort study of 62 participants who presented with CSDH and underwent burr-hole and drainage at the Neuroscience unit of the Korle-bu Teaching Hospital. The primary outcome of this study was the recurrence of CSDH within 3 months after the surgery. Data was entered into Microsoft Excel 2016 and exported to International Business Machine (IBM) Statistical Package for the Social Sciences (SPSS) version 21.0 for analysis. Predictors of recurrence of CSDH were determined using logistic regression with odds ratio calculated at the 95% confidence level and a p-value less than 0.05 accepted as statistically significant. RESULTS: There was a male preponderance of 45 (72.6%), over females of 17 (27.4%). The mean age was 63.1 ± 13.6 years. The recurrence rate of CSDH was 21.0% whilst the mortality rate was 4.8%. Facial palsy and dysphasia were associated with the recurrence of CSDH (p = 0.045, 0.029). Hypertension and bilaterality were associated with recurrence of CSDH from a univariate analysis (p = 0.039, OR = 4.865, CI = 0.975-24.285; p = 0.005, OR = 5.979, CI = 1.585-22.557). In a multivariate logistic regression analysis, bilaterality was the only independent predictor of recurrence of CSDH (p = 0.030, AOR = 5.47, CI = 1.18-25.34). CONCLUSIONS: Both hypertension and bilaterality showed statistically significant association with recurrence of CSDH. However, only bilaterality proved to be an independent predictor of recurrence of CSDH in patient who underwent burr-hole and drainage.

ADENOTONSILLECTOMY: CARE GIVERS' RECALL OF INFORMATION ON RISKS PROVIDED DURING INFORMED CONSENT PROCESS.

BACKGROUND: "Informed consent" for surgery has been widely researched; however, there is no local data on surgical risk recall by care givers' (usually a parent) of children undergoing adenotonsillectomy (Ts &A). AIM AND OBJECTIVE: This study evaluated care givers' recall of the surgical risks for Ts&A after verbal explanation compared to combined verbal and written explanation in the informed consent process. DESIGN OF THE STUDY: This was a prospective randomized comparative study of fifty parents/guardians of patients undergoing tonsillectomy and adenoidectomy for obstructive sleep disorders. SETTING: The E.N. T. Unit, Korle Bu Teaching Hospital, Accra, Ghana. MATERIALS AND METHODS: Parents/guardians of children were randomized to only verbal explanation or combined verbal and written explanations prior to signing informed consent a day before their wards' operation. Recall of surgical risks explained in the informed consent procedure was evaluated two days postoperatively. The rates of surgical risk recall for the two groups were analysed and compared. RESULTS: There were no significant differences in the demographic characteristics of the parents/guardians. The overall recall rate for surgical risks for the whole group was 46.0%. The surgical risk recall rate for the verbal explanation group, 44.4% was not significantly different from that for the combined verbal and written explanation group, 47.2% (p=0.624). There was a weak but significant positive correlation between risk recall scores and parental level of education (Spearman rs=0.306; p = 0.015). CONCLUSION: Among parents/guardians whose children were undergoing adenotonsillectomy, combining written explanation with verbal explanation in the informed consent process did not significantly improve postoperative surgical risks recall rate when compared with only verbal explanation. The overall risk recall rate was 46.0%. A study with larger sample sizes is recommended to confirm these findings.

Causes of low vision and their management at Korle Bu Teaching Hospital, Accra, GHANA.

BACKGROUND: Provision of low vision services to the visually impaired is vital in blindness intervention programs. Such services are avenues for low vision patients to utilize their residual vision in carrying out daily tasks. AIM: To review the causes of low vision and services provided to low vision patients at Korle Bu Teaching Hospital. STUDY DESIGN: A retrospective cross-sectional study. METHODOLOGY: Study subjects were low vision patients who had been referred by ophthalmologists and optometrists from all over Ghana for low vision services. At the Low Vision Centre, patients were re-examined to confirm that they had low vision and were suitable for low vision devices. The visual acuities of all patients was determined using a Snellen chart (with letters and tumbling E chart) followed by anterior and posterior segment examination using a Haagstreit slit lamp biomicroscope and direct and/or indirect ophthalmoscope (Keeler). All patients were refracted for near and distance and best corrected visual acuities were recorded. Patients with best corrected visual acuities of less than 6/18 but better than light 3/60 in the better were considered for low vision devices. Clinical records of low vision patients managed at the Korle Bu Teaching Hospital between March 2005 and December 2014 were examined to determine the main causes of low vision and interventions given. Their demographics, clinical features, services offered and annual trend in low vision uptake were analyzed. RESULTS: A total of 604 patients managed between March 2005 and December 2014 at the low vision centre of the Korle Bu Teaching Hospital were included in the study. The mean age was 40.55+6.95 years. There was statistically no significant difference between the mean age in either sex; p-value = 1.000. Glaucoma was the leading cause of low vision in 135 (22.35%) of cases, followed by non-glaucomatous optic atrophy 62(10.26 %), retinitis pigmentosa 54(8.94 %), maculopathy 52(8.61 %) and ARMD 48(7.95 %) respectively. Uptake of the low vision services was highest in the second year of commencing the services. Interventions were mainly magnifiers, telescopes, closed circuit television (CCTV), counselling and referral to the School for the Blind. CONCLUSION: Glaucoma and non-glaucomatous optic atrophy were the predominant causes of low vision, and magnifiers and telescopes were the most commonly prescribed devices.

Eye Donation:Awareness and Willingness among Patients Attending a Tertiary Eye Center in Ghana.

BACKGROUND: Eye donation for corneal transplant holds the key for visual restoration from corneal diseases. Consequently, knowing the level of awareness of eye donation and willingness among potential donors to donate their eyes after death to ensure availability of donated cornea for transplantation is very crucial. This baseline information is essential for planning towards the establishment of an eye bank. AIM: To determine the level of awareness of eye donation and willingness to donate among patients attending the Eye Clinic at the Korle Bu Teaching Hospital. STUDY DESIGN: Cross-sectional study. MATERIALS AND METHODS: This cross-sectional study was done among 536 eye patients selected by convenient sampling and interviewed using a semi-structured administered questionnaire at the Eye Clinic at the Korle Bu Teaching Hospital. Univariate and multivariate logistic regression were performed at 5% level of significance. RESULTS: Awareness of eye donation and willingness to donate eyes after death were observed in 45 (8.40%) and 321(59.90%) of respondents respectively. Age group 60 and above [AOR = 2.62; CI (0.94-7.31); P=0.04] and education at the professional and tertiary levels [AOR = 4.00 (1.08-14.81); P= 0.03] were possible predictors of awareness of eye donation whilst education was the only predictor of willingness to donate an eye. The main source of awareness of eye donation was through healthcare personals and the media (46.70 %), while the optimal time for eye donation was known by 17.80 % of those who were aware of eye donation. CONCLUSION: Even though few respondents were aware of eye donation, majority of the respondents were ready to pledge their eyes for donation after death. There is the need for public education on the benefits of eye donation.

Breakfast eating habits among medical students.

BACKGROUND: Breakfast is often thought to be the most important meal of the day as it is known to provide energy for the brain and improve learning. It is also known to contribute significantly to the total daily energy and nutrient intake. Skipping breakfast may affect performance during the rest of the day. AIM: To determine the level of breakfast skipping among medical students and its effect on their attention span and level of fatigue during clinical sessions. DESIGN: A descriptive cross-sectional study of breakfast eating habits among medical students at the University of Ghana Medical School, Korle Bu-Accra. SETTING: The University of Ghana Medical School, Korle Bu-Accra. METHOD: Questionnaires were distributed to second year (pre-clinical) medical students studying the basic sciences and clinical students in ophthalmology to be self-administered. Interview data was captured and analyzed using SPSS version 17.0. RESULTS: The total number of pre-clinical students recruited was 154 and clinical students 163 bringing to a total of 317 students made up of 203 males and 114 females (M: F=1.8:1). The overall breakfast skipping among the students was 71.92%. The prevalence among the pre-clinical students was 76.62% and clinical students 67.48%. Generally, breakfast skipping was significantly related to fatigue and poor attention during clinical sessions. CONCLUSION: This study suggests that the medical students, both pre-clinical and clinical, skip breakfast and this may affect their studies adversely.

Quality of life outcomes of adenotonsillectomy for obstructive sleep disorders: our experience in a Tertiary Care Centre in Ghana.

BACKGROUND AND OBJECTIVES: Obstructive Sleep Disorders (OSDs) impacts negatively on the quality of life of children. However the long term outcomes of adenoton-sillectomy remain unknown. The aims and objectives of this study was to assess the long term quality of life of Ghanaian children with OSDs undergoing adenotonsillectomy. METHODS: The subjects for this study were cohort of children who were part of a study named Study1 carried out at E.N.T. Unit, Korle Bu Teaching Hospital, Accra. These children had adenotonsillectomy for OSDs and their quality of life were evaluated preoperatively and again four to six weeks post operatively using Obstructive Sleep Apnoea 18 (OSA 18 ) questionnaire; a quality of life assessment tool. Thirty five children who were at least nine months post adenotonsillectomy were invited to a follow up E.N.T.clinic for the current study named Study 2 and their quality of life were again evaluated using OSA 18 questionnaire. RESULTS: Thirty-one children with a mean age of 5.08 ± 0.95 years were seen. The mean OSA-18 preoperative score for Study1 was 4.27 ± 0.27; the mean OSA 18 post operative scores for Study1 and Study 2 were 1.93 ± 0.25 and 1.78 ±0.31 respectively. There was a significant reduction in the mean post operative OSA 18 score for both studies compared to the corresponding preoperative mean score (p-value = 0.001). The mean postoperative overall quality of life scoresfor Study 1 and Study2 were 8.52 ± 0.53 and 7.68 ± 1.06 respectively. CONCLUSION: There was significant improvement in long term quality of life outcomes following adenotonsillectomy for OSDs.