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.

Adverse events reported after first dose of SARS-CoV-2 vaccine in the Northern Region of Ghana.

AIM: The study examined the associated adverse events following SARS-CoV-2 vaccination among healthcare workers during the first dose of the vaccine in the Northern Region of Ghana. DESIGN: The study was a cross-sectional survey involving 463 healthcare workers. METHOD: The data were collected using a structured questionnaire. The data were analysed descriptively, and binary logistics was performed using SPSS version 25. RESULTS: The mean age was 33.4 ± 9.7 years, the majority (43.6%) being ≤30 years and males (57.2%). The self-reported prevalence of SARS-CoV-2 vaccine adverse events was 75.5%. Common systemic adverse events comprised headache (47.5%), dizziness (18.4%) and local adverse events included generalized body pains (44.0%) and abscess around the injection sites (11.2%). The study found a high prevalence of self-reported SARS-CoV-2 vaccine adverse events involving both systemic and local adverse events. Our study gives useful information that can be used for public health-targeted interventions to boost public confidence in SARS-CoV-2 vaccines.

Review of rigid esophagoscopy in a Tertiary Hospital in Ghana.

Rigid esophagoscopy is a common endoscopic procedure worldwide for both diagnostic and therapeutic purposes. Even though this procedure is performed commonly in our center no published reports exist. We reviewed our experience with rigid esophagoscopy. This was a 9-year review of rigid esophagoscopy, done under general anaesthesia, at ENT and Cardiothoracic Units of Tamale Teaching Hospital. Parameters evaluated were patients´ demographics, indication for rigid esophagoscopy and outcome of the procedure. One hundred and fifteen cases of rigid esophagoscopies were evaluated. The ages ranged from 10 months to 87 years with a peak incidence 69.6% (n = 80) occurring within the first decade of life and a male preponderance of 54.8% (n = 63). Majority of the cases were emergencies 87.8% (n =101) and for therapeutic reasons 87% (n =100). The most common findings during esophagoscopy were: coins 60.9% (n = 70), fish bone 11.3% (n = 13), esophageal tumours 7.8% (n = 9) and dentures 5.2% (n = 6). All the cases were successfully treated with no mortality recorded. Rigid esophagoscopy was more commonly performed in males with peak age incidence occurring during the first decade of life. Emergency patients and esophagoscopy with therapeutic intent constituted the largest two groups in this study. Coins, fish bone, esophageal tumours and dentures were the most common findings. There was no mortality recorded.

Flexible bronchoscopy in Ghana: initial experience in a tertiary hospital.

INTRODUCTION: the use of flexible bronchoscopy in developing countries is limited. We report our initial experience and outcome with the use of flexible bronchoscopy at the Tamale Teaching Hospital in Ghana. This is the first reported case series of flexible bronchoscopy in Ghana. METHODS: a retrospective review of patients who had flexible bronchoscopy from 2017-2019 was analyzed. Patient demographics and outcomes were summarized using frequency distribution and percentages. RESULTS: we performed flexible bronchoscopies in 33 patients with mean age of 43 years. All patients were symptomatic at the time of presentation with the most common symptoms being chest pain (63.6%), dyspnea (57.6%) and cough (48.5%). The indication for bronchoscopy in most of the cases were suspected malignancy in 16 (48.5%) followed by infection 9 (27.3%), trauma 4 (12.1%) and others 4 (12.1%). We observed abnormal bronchoscopic findings in 25 (75.8%) of the cases with most of the pathologies in the right main bronchus. Twelve patients had toilet bronchoscopy, 6 had biopsy, 5 had no intervention and 4 patients had bronchoalveolar lavage (BAL). Culture and sensitivity results were available for 11 patients, of which 7 patients had negative results. Thirteen (13) malignancies and 11 inflammatory/infectious diseases were diagnosed in this case series. The mean procedure time was 32 minutes with mean hospital stay of 7 days. There was no complication or mortality in our series. Conclusion: flexible bronchoscopy is a safe procedure and indispensable in Ghana where there is an increasing incidence of lung diseases.

Foreign Body Aspiration in Northern Ghana: A Review of Pediatric Patients.

BACKGROUND: Foreign body (FB) aspiration requires a high index of suspicion for diagnosis and prompt management to avoid morbidity and mortality. This retrospective study was conducted to review pediatric foreign body aspiration at the Ear, Nose and Throat (ENT) Unit of the Tamale Teaching Hospital (TTH). MATERIALS AND METHODS: The theater records of children managed for foreign body aspiration from January 2010 to December 2016 at the ENT Unit of TTH were retrieved and data summarized with respect to age, gender, indications for bronchoscopy, nature of foreign body, location of foreign body, and outcome of the bronchoscopy procedure. RESULTS: A total of 33 children were managed within the five-year study period and comprised 16 (48.5%) males and 17 (51.5%) females. The commonly aspirated FBs were groundnuts (13, 39.4%) and metallic objects (7, 21.1%). The peak incidence occurred in children aged ≤ 3 years. The foreign bodies (FBs) were commonly localized to the right (24.2%) and left (24.2%) main bronchi, respectively. One patient had emergency tracheostomy for failed bronchoscopy. CONCLUSION: Groundnuts were the most commonly aspirated foreign body with most of the FBs localized in the bronchi.