Living with chronic progressive external ophthalmoplegia alongside cataract, peptic ulcer disease, diabetes and hypertension in Ghana.

This is the case of a 51-year-old woman with chronic progressive external ophthalmoplegia (CPEO) alongside some comorbidities in a low-resource setting. This report seeks to sensitise clinicians about this rare condition in order to increase their index of suspicion and avoid misdiagnosis.

A gist on an obscure neoplasm in Ghana: gastrointestinal stromal tumours.

BACKGROUND: Gastrointestinal Stromal Tumour is a rare but potentially curable tumour of the gastrointestinal tract accounting for up to 1% of all gastrointestinal tumours. The discovery of Imatinib mesylate, a novel tyrosine kinase inhibitor has improved the chances even for unresectable, recurrent, or metastatic diseases. METHODS: This study sought to document the clinical and pathological characteristics of GISTs from two tertiary hospitals in Ghana that have undergone immunohistochemistry confirmation between 2014 and 2021. RESULTS: The median age of the subjects was 50 years with most of them (28.0%) being above 61 years. There were more females than males (64.0% vs. 36.0%). Abdominal mass and abdominal pain made up the majority of the clinical presentations. The majority of the subjects had partial gastrectomy (32.0%) which was followed by wedge resection (28.0%). Appendectomy and sleeve gastrectomy were the least performed procedures (8% each). Four of the 25 patients (16.0%) had resections of involved contiguous organs done with splenectomy being the most common procedure. The majority of GISTs were found in the stomach (68.0%) followed by the appendix (12.0%) and small bowel (12.0%). Gastrointestinal bleeding (55.8%) and abdominal pain (38.5%) were the most reported symptoms. Free resection margins were observed in 84.0% of the subjects and only 3/25 (12.0%) experienced tumour recurrence. CONCLUSION: GIST is a potentially curable tumour that once was obscure but currently gaining popularity. Surgical resection offers the hope of a cure for localized disease while targeted therapies is a viable option for recurrent, metastatic, or unresectable tumours.

Facile synthesis of water-soluble silver nanoclusters for the photocatalytic degradation of dyes by multivariate optimization approach.

In this study, silver nanoclusters protected by the natural tripeptide ligand (GSH@Ag NCs) were constructed for photocatalytic dye degradation. The ultrasmall GSH@Ag NCs were found to exhibit a remarkably high degradation capability. Aqueous solutions of the hazardous organic dye Erythrosine B (Ery. B) and Rhodamine B (Rh. B) were subjected to degradation in the presence of Ag NCs under solar light and white-light LED irradiation. The degradation efficiency of GSH@Ag NCs was evaluated using UV-vis spectroscopy, where Erythrosine B showed considerably high degradation of 94.6% compared to Rhodamine B, which was degraded by 85.1%, corresponding to a 20 mg L-1 degradation capacity in 30 min respectively under solar exposure. Moreover, the degradation efficacy for the above-mentioned dyes demonstrated a dwindling trend under white-light LED irradiation, attaining 78.57 and 67.923% degradation under the same experimental conditions. The astoundingly high degradation efficiency of GSH@Ag NCs under solar-light irradiation was due to the high I of 1370 W for solar light versus 0.07 W for LED light, along with the formation of hydroxyl radicals HO˙ on the catalyst surface initiating degradation due to oxidation.

Generalized tetanus in a farmer following treatment of an open ankle fracture by a traditional bone setter.

This is the case of a 31-year-old farmer diagnosed with an open right ankle fracture and tetanus sustained from an accident after opting for traditional bonesetter treatment. Open fractures increase the risk of tetanus infection therefore herbal treatment should be discouraged. Source control is important for holistic management of tetanus.

Late migration of an aspirated foreign body from the lung to the bowel: A plausible explanation or a medical mystery. A case report.

INTRODUCTION AND IMPORTANCE: Foreign body (FB) aspiration is a common preventable cause of death among children between ages 1-3 years. A rare case of an aspirated sharp metallic object in a 4-year-old boy that migrated from the left lung to the GIT after a year is presented after bronchoscopy and thoracotomy failed to retrieve it. PRESENTATION OF CASE: A 4-year-old boy presented with cough a year after aspirating a sewing machine needle. He was stable with normal chest findings. Previous bronchoscopy attempts failed to retrieve the needle. A thoracotomy was done after a chest CT revealed the foreign body in the left lower lobe. FB could not be palpated nor visualized intraoperatively. Flexible bronchoscopy could also not visualize the needle in the airway. A postoperative x-ray done revealed the needle was no longer in the chest but in the bowel. CLINICAL DISCUSSION: Bronchoscopy is the standard treatment for FB aspiration but in our case, it failed on two occasions to retrieve the sharp object. Our literature search revealed only reported cases of migrating FB from one bronchus to the other, and from the bronchus to the gastrointestinal tract (GIT) but not from the lung into the GIT. CONCLUSION: FB migration from the lung to the GIT after a year without signs of perforation is possible. While we brainstorm the plausible explanations for this migration, one may wonder if this is just a medical mystery.

Decline in Uptake of Childhood Vaccinations in a Tertiary Hospital in Northern Ghana during the COVID-19 Pandemic.

At the beginning of the COVID-19 pandemic, early modelling studies estimated a reduction in childhood vaccinations in low- and middle-income countries. Regular provision of both curative and preventive services such as antenatal care and childhood immunizations has been negatively affected since the onset of the pandemic. Our study was aimed at examining the impact that the pandemic had on childhood vaccination services at the Tamale Teaching Hospital (TTH). A mixed methods study design was employed for the study, which was conducted at the Child Welfare Clinic (CWC) of the TTH. With quantitative approach, we retrospectively looked at the uptake of the various vaccines during the pandemic era, defined as the period between 1st March 2020 and 28th February, 2021, and the prepandemic era defined as the period 1st March 2019 to 29th February, 2020. The qualitative approach was used to understand the perspective of five healthcare providers at the CWC and the four caregivers of children who have missed a vaccine or delayed in coming, on the factors accounting for any observed change. Data analysis was done using Microsoft Excel 2016 and thematic content analysis. Quantitative data were presented in frequencies, percentages, and line graphs. With the exception of the Measles Rubella (MR) 2 vaccine, we observed a decline ranging from 47% (2298) to 10.5% (116), with the greatest decline seen in the BCG and the least decline seen in the MR1 vaccine. The month of May 2020 saw the greatest decline, that is, 70.6% (813). A decline of 38.3% (4473) was noted when comparison was made between the designated prepandemic and pandemic eras, for all the vaccines in our study. Fear of COVID-19 infection and misinformation were commonly given as reasons for the decline. Catch-up immunization schedule should be instituted to curtail possible future outbreaks of vaccine-preventable diseases.

Giant primary scrotal lipoma in a low-resource setting: challenges with diagnosis and review of literature.

Lipoma is the commonest benign mesenchymal tumor composed of matured adipocytes. A literature search revealed few reported cases of giant scrotal lipoma. This article aims to report a giant scrotal lipoma weighing 1100 g and illustrate our challenges with the diagnostic process in a low-resource setting. A 28-year-old male presented with a huge right scrotal mass. Examination revealed the mass had no cough impulse. It was firm, non-tender and lobulated, with definite edges. Scrotal sonography was suspicious of lipoma. Intraoperatively, there was an encapsulated scrotal wall mass and an incidental inguinoscrotal hernia, content being the omentum. The scrotal mass was excised, hernia sac was ligated, and excised and the posterior wall was repaired. Histology confirmed the scrotal mass as a lipoma. Primary scrotal lipomas are rare but should be considered in the differential diagnosis of unusual scrotal masses. Ultrasonography is a useful diagnostic tool in resource-limited settings.

Rising Trend of "Veil Entanglement Injuries" in Northern Ghana: A Case Series.

INTRODUCTION: Veils are thin garments that are worn over the head, wrapped round the neck, and left hanging loosely over the torso up to the thighs. They are also known as scarf or "dupatta." Veils can get entangled in spokes of motorbikes or in belt-driven machinery resulting in a variety of life-threating injuries. CASE REPORTS: We report nine major cases of veil entanglement injuries (VEI) that presented to the Orthopedic Unit of Tamale Teaching Hospital from July 10, 2017 to June 12, 2020. All the patients were females with ages ranging from 5-months to 44-year. All the accidents involved either a motorbike or auto rickshaw. Head, neck, and extremity injuries were the most common. Eight out of nine patients had circumferential neck bruise referred to as "veil sign" in this report. One patient died. CONCLUSION: The rising trend of VEI is alarming among women in Northern Ghana. We recommend widespread public education and awareness creation. We also recommend modification of traffic regulations by policy makers to avert this avoidable injury.

Performance of COVID-19 associated symptoms and temperature checking as a screening tool for SARS-CoV-2 infection.

INTRODUCTION: Coronavirus disease-19 (COVID-19), which started in late December, 2019, has spread to affect 216 countries and territories around the world. Globally, the number of cases of SARS-CoV-2 infection has been growing exponentially. There is pressure on countries to flatten the curves and break transmission. Most countries are practicing partial or total lockdown, vaccination, massive education on hygiene, social distancing, isolation of cases, quarantine of exposed and various screening approaches such as temperature and symptom-based screening to break the transmission. Some studies outside Africa have found the screening for fever using non-contact thermometers to lack good sensitivity for detecting SARS-CoV-2 infection. The aim of this study was to determine the usefulness of clinical symptoms in accurately predicting a final diagnosis of COVID-19 disease in the Ghanaian setting. METHOD: The study analysed screening and test data of COVID-19 suspected, probable and contacts for the months of March to August 2020. A total of 1,986 participants presenting to Tamale Teaching hospital were included in the study. Logistic regression and receiver operator characteristics (ROC) analysis were carried out. RESULTS: Overall SARS-CoV-2 positivity rate was 16.8%. Those with symptoms had significantly higher positivity rate (21.6%) compared with asymptomatic (17.0%) [chi-squared 15.5, p-value, <0.001]. Patients that were positive for SARS-CoV-2 were 5.9 [3.9-8.8] times more likely to have loss of sense of smell and 5.9 [3.8-9.3] times more likely to having loss of sense of taste. Using history of fever as a screening tool correctly picked up only 14.8% of all true positives of SARS-CoV-2 infection and failed to pick up 86.2% of positive cases. Using cough alone would detect 22.4% and miss 87.6%. Non-contact thermometer used alone, as a screening tool for COVID-19 at a cut-off of 37.8 would only pick 4.8% of positive SARS-CoV-2 infected patients. CONCLUSION: The use of fever alone or other symptoms individually [or in combination] as a screening tool for SARS-CoV-2 infection is not worthwhile based on ROC analysis. Use of temperature check as a COVID-19 screening tool to allow people into public space irrespective of the temperature cut-off is of little benefit in diagnosing infected persons. We recommend the use of facemask, hand hygiene, social distancing as effective means of preventing infection.

Female Genital Mutilation/Cutting Resulting in Genital Tract Obstruction and Sexual Dysfunction: A Case Report and Literature Review.

Female Genital Mutilation/Cutting (FGM/C) is the practice of cutting parts of the female external genitalia in fulfillment of sociocultural obligations and in some cases for nonmedical reasons. It is classified into 4 main types depending on the extent of cutting. Some forms of FGM/C are common in at least 29 countries globally, mainly in Africa. The overall prevalence of FGM/C in Ghana is approximately 4%. The motivation for this practice varies from community to community but includes the fulfillment of cultural values, uplifting the girl child, and, according to some reports, reducing sexual desire and promiscuity. The objective of this article is to illustrate how FGM/C resulted in sexual dysfunction in a young woman married for 2 years. We present a 19-year-old female who was subjected to female genital cutting in her formative years who presented with apareunia for 2 years in her marriage. We illustrated how FGM/C led to a genital tract obstruction with resultant sexual dysfunction. Examination revealed a Type 3 FGM/C (infibulation) with almost complete occlusion of the genital tract. She underwent a successful defibulation and resumed sexual activity with her husband within 6 weeks of the procedure.

Regulatory focus and junk food avoidance: The influence of health consciousness, perceived risk and message framing.

The purpose of this research is to examine: (1) the health-related factors namely perceived health consciousness and perceived risk that motivate a person's intention to avoid junk food consumption, and (2) the influence of regulatory focus (promotion vs prevention foci) on a person's intention to avoid junk food consumption under the conditions of gain-framing vs loss-framing health communication and messages. A set of hypotheses are tested across three studies. Study 1 (n = 148) shows that regulatory focus influences the consumers' intention to avoid junk food. Also, health consciousness mediates the relationship between regulatory focus and junk food avoidance intention. Study 2 (n = 132) finds that perceived risk amplifies the relationship between regulatory focus and health consciousness. Study 3 (n = 168) demonstrates that message framing combined with the appropriate regulatory focus positively influences the consumers' intention to avoid junk food. The findings validate and extend the current theoretical framework in relation to unhealthy eating behaviours (e.g., junk food consumption). Based on the findings of this research, the practitioners can utilise the correct type of health information or claims for the appropriate consumer segment (whether prevention or promotion foci) to effectively implement campaigns and programs.

Fluorine-containing graphene quantum dots with a high singlet oxygen generation applied for photodynamic therapy.

Recently, graphene quantum dots (GQDs) have been extensively studied in biomedical areas such as bio-imaging, bio-sensing and photothermal therapy due to their superior optical and physiochemical properties compared to traditional organic biomarkers. Application of GQDs in photodynamic therapy (PDT) has been explored since 2014, but currently the main challenges are inadequate singlet oxygen (1O2) quantum yield (QY), poor solubility and biocompatibility. Herein, we report on the synthesis of a new class of fluorine-containing GQDs (F-GQDs) by an oxidative cutting method using fluorinated graphite as the raw material. The as-synthesized F-GQD sample demonstrates an average particle size of 2.1 nm with a fluorine doping content of 1.43%. The F-GQDs have a better water solubility and biocompatibility than the GQDs, and emit strong green fluorescence at 365 nm excitation with a relative fluorescence QY of 13.72%. Moreover, the fluorescence imaging effect as well as photodynamic activity was successfully tested in both an in vitro HepG2 cell line model and a 3D multicellular spheroid model, the latter of which mimics the tumour microenvironment. Further studies using UV-visible spectroscopy to monitor the degradation of water-soluble 9,10-anthracenediyl-bis(methylene)dimalonic acid (ABDA) demonstrate that the F-GQD sample generates 1O2 efficiently (QY = 0.49) under visible light irradiation. Compared to non-fluorinated GQDs, the as-reported F-GQDs appear to be a more promising photosensitizer for image-guided PDT.

Recent Advances in Synthesis, Optical Properties, and Biomedical Applications of Carbon Dots.

Carbon dots (CDs) are relatively new and one of the most propitious nanomaterials ever known to humanity, primarily consisting of a carbonized carbon core with heteroatoms in organic functional groups attached. CDs show various fascinating properties, such as tunable excitation/emission, chemical inertness, photostability, low toxicity, good biocompatibility, ease of handling, and eco-friendliness. Due to the anomalous optical and chemical properties of the CDs, they have a wide range of applications in the fields of bioimaging, biosensing, photocatalysis, optoelectronics, etc. In this Review, we intend to cover the many strides in CDs chemistry, which is an emerging paradigm, in conjunction with the most recent discoveries of CDs with near-infrared fluorescence, phosphorescence, electroluminescence, chirality, and antibacterial activity. Our main emphasis will be on the contemporary evolution in synthetic strategies, optical properties, and biomedical applications of CDs in nanomedicine and nanotheranostics.