Preoperative Intravenous Dexamethasone and Postoperative Analgesia Following Breast Surgery: A Prospective, Randomized Double-Blind Trial at a Tertiary Healthcare Facility in Ghana.

Introduction: Breast surgery may be associated with significant postoperative pain and if not adequately treated, may lead to the development of chronic post-surgical pain. This necessitates the use of effective management, involving the use a multimodal analgesia regimen for the management of post breast surgery pain. The analgesic effect of perioperative use of dexamethasone has been explored but findings have been inconsistent. Aim: The aim of this study was to determine the postoperative analgesic enhancing effect of a single preoperative dose of dexamethasone on patients undergoing breast surgery at a tertiary hospital in Ghana. Materials and Methods: This was a prospective, double-blind, placebo-controlled study involving 94 consecutively recruited patients. Patients were randomized into two groups: dexamethasone (n = 47) and placebo (n = 47). Patients in the dexamethasone group had 8mg (2 mL of 4 mg/mL) dexamethasone and those in the placebo group had 2 mL of saline administered intravenously just before induction of anaesthesia. All patients received a standard general anaesthesia with endotracheal intubation. The numerical rating score (NRS), time to first analgesic request and the total opioid consumed in the first 24 h were recorded. Results: Patients receiving dexamethasone had lower NRS scores at all measured time points but this was significant only at 8 h post-surgery (P = 0.037). The time to first rescue analgesia was significantly prolonged in the dexamethasone group (339.26 ± 312.90 min vs. 182.10 ± 166.72 min; P = 0.020). However, the mean total opioid (pethidine) consumed in the first 24 h postoperatively was not significantly different between the dexamethasone and control groups (113.75 ± 51.35 mg vs. 100.00 ± 60.93 mg; P = 0.358). Conclusion: A single preoperative dose of 8mg dexamethasone given intravenously, reduces postoperative pain compared to placebo, significantly reduces the time to first analgesia but not the total opioid consumed in the first 24 h post breast surgery.

Outcome of life-threatening arrhythmias among patients presenting in an emergency setting at a tertiary hospital in Accra-Ghana.

BACKGROUND: Management of life-threatening arrhythmia can be incredibly challenging in advanced health systems. In sub-Saharan Africa (SSA), this is likely more challenging because of weak pre-hospital and in-hospital critical care systems. Little is known about life-threatening arrhythmia and their outcomes in SSA. The aim of this study was to examine the types and outcomes of arrhythmias among haemodynamically unstable patients presenting at a tertiary hospital in Accra-Ghana. METHOD: This was a retrospective case series study conducted at the Korle-Bu Teaching Hospital (KBTH), Accra-Ghana. Medical records of patients who presented with or developed haemodynamically unstable arrhythmias within 24h of admission from January 2018 to December 2020 were reviewed. The demographic characteristics and clinical data including outcomes of patients were collected. Descriptive statistics were used and results presented in frequency tables. RESULTS: A total of 42 patients with life-threatening arrhythmias were included. Haemodynamically unstable tachyarrhythmias were the most common arrhythmias found among the patients (66.7%). Approximately 52% of patients had structural heart diseases whereas 26.2% had no apparent underlying cause or predisposing factor. Cardioversion (52.4%), commonly electrical (63.6%), and transvenous pacemaker implantation (23.8%) were the common initial interventions. The majority of the patients (88.1%) survived and were discharged home. CONCLUSION: Tachyarrhythmias are the most common haemodynamically unstable arrhythmias seen among patients presenting emergently in a leading tertiary hospital in Ghana. A high survival rate was observed and cannot be extrapolated to other healthcare settings in sub-Saharan Africa with limited resources to manage these clinical entities.

A Simplified Adult Expiratory Support Device: First Clinical Cases in a Low-Resource Setting.

PURPOSE: In low and middle-income countries, mechanical ventilators or commercially available devices used to offer continuous positive airway pressure are not readily affordable and available. In Ghana, nearly 10% of critically ill patients presenting to the emergency department require ventilator support. DESCRIPTION: We designed, built, and tested a simple expiratory positive airway pressure (EPAP) device to provide adult respiratory support in low resource environments with or without supplemental oxygen and without the need for electricity. EVALUATION: Laboratory tests demonstrated that the device is capable of delivering EPAP at levels expected to provide significant assistance to some patients. We present the first 2 cases where the use of this simple EPAP device provided critical respiratory support during weaning of patients from mechanical ventilation. CONCLUSIONS: A low-cost 3-dimensional printable adult respiratory support device could provide substantial benefit to patients suffering from respiratory distress through the delivery of appropriate levels of EPAP in a low-resource setting with limited infrastructure. Further clinical validation is needed for broader application in low-resource settings.

Idiopathic Scrotal Calcinosis: A Case Report and Review of Postoperative Outcomes.

Idiopathic scrotal calcinosis is a rare condition, characterized by the idiopathic deposition of calcium in the scrotal dermis leading to the formation of a single nodule or multiple nodules of different sizes. Surgical excision of the nodules reduces symptoms and improves cosmesis. We present a case of idiopathic scrotal calcinosis that had an en bloc excision of scrotal skin nodules and primary closure of the scrotal skin. Handling each hemiscrotum as a separate entity and preserving the median raphe with its uninvolved skin improved the cosmesis. Reported outcomes of surgery were satisfactory with no postoperative complications. At 30 months of follow-up, the residual scrotal skin had regained its laxity and the scrotum its normal configuration. There is the risk of recurrence of the calcific nodules post excision, but these may be smaller in size and with regained scrotal configuration that could be amenable to excision with further preservation of the native scrotal skin.

Safety and efficacy of single-dose preoperative intravenous dexamethasone on post-operative nausea and vomiting following breast surgery at Korle-Bu Teaching Hospital.

OBJECTIVES: Dexamethasone has beneficial effects on postoperative nausea and vomiting, however, many clinicians have raised legitimate concerns regarding its effect on blood glucose concentrations. This study determined the safety and efficacy of a single pre-operative dose of dexamethasone for PONV prophylaxis in patients undergoing breast surgery. DESIGN: Prospective, double-blind, placebo-controlled trial. SETTING: Surgical wards of the Korle-Bu Teaching Hospital, Accra, Ghana. PARTICIPANTS: The study was conducted among breast surgery patients. They were consecutively recruited and randomized into two groups: dexamethasone (n = 47) and placebo (n = 47). INTERVENTIONS: Patients in the dexamethasone group received 8mg (2mls of 4mg/ml) dexamethasone while those in the placebo group received 2mls of saline intravenously. PONV impact scores and blood glucose levels were recorded at 4, 8 and 24 hours postoperatively. MAIN OUTCOME MEASURES: Incidence of PONV and blood glucose levels. RESULTS: The incidence of postoperative nausea (PON) was lower in the dexamethasone group compared with the placebo group (12.8% vs. 29.8%; p-value= 0.044). There was no significant difference in the incidence of postoperative vomiting (POV) and PONV between the two groups. Blood glucose levels were higher in the dexamethasone group throughout the study period and significant at 8 and 24 hours postoperatively (p < 0.05). There was no difference in the incidence of clinically significant hyperglycemia between the groups (p-value = 0.169). CONCLUSION: A preoperative intravenous dexamethasone 8mg, reduces PON but not POV or PONV in breast surgery without clinically significant postoperative hyperglycemia. FUNDING: Non declared.

Serum Calcium and Magnesium Levels in Normal Ghanaian Pregnant Women: A Comparative Cross-Sectional Study.

BACKGROUND: Pregnancy is described as a normal physiologic state associated with various biochemical changes. Magnesium and calcium are essential macronutrients required for foetal growth. Complications associated with their deficiency during normal pregnancy include; low neonatal birth weight, pre-eclampsia, eclampsia and preterm labour. Changes in serum levels of magnesium and calcium in normal pregnancy have not been extensively studied among Ghanaian women. AIM: To determine the variation in serum magnesium and calcium levels with gestational age in normal pregnancy in Ghanaian women. METHODS: A hospital-based comparative cross-sectional study was conducted among 32 normal non-pregnant women (Group A) and 100 normal pregnant women (Group B) attending the clinic at the Korle-Bu Teaching hospital. The group B pregnant women were further divided into Group B1 (n = 33), Group B2 (n = 37) and Group B3 (n = 30) based on their pregnancy gestation as first, second and third trimester respectively. Blood samples were obtained from the antecubital vein of subjects and total serum calcium, magnesium, protein and albumin were estimated. Data obtained were analysed using SPSS for windows version 20. Analysis of variance (ANOVA) was employed to determine the statistical differences between the groups. A p-value of ≤ 0.05 was considered significant. RESULTS: Mean serum total calcium and magnesium in first, second and third trimester normal pregnant women were 2.14 ± 0.16, 2.13 ± 0.44, 2.13 ± 0.35 mmol/L and 0.77 ± 0.11, 0.77 ± 0.16 and 0.76 ± 0.14 mmol/L respectively. Mean serum total calcium and magnesium levels in non-pregnant women were 2.20 ± 0.16 and 0.80 ± 0.10 mmol/L respectively. There was a statistically non-significant difference in serum total calcium and magnesium between non-pregnant and normal pregnant women, with p-values of 0.779 and 0.566 respectively. Mean total serum protein and albumin in first, second and third-trimester normal pregnant women were 68.42 ± 10.37, 70.46 ± 6.84, 66.70 ± 7.83 g/L and 39.92 ± 3.22, 40.75 ± 8.06, 38.26 ± 3.02 g/L respectively. Mean total serum protein and albumin in non-pregnant women were 73.13 ± 7.02 and 42.94 ± 3.03 g/L respectively. Mean total serum protein and albumin levels were lower in pregnant women as compared to non-pregnant women with the difference being significant in the third trimester (p-values of 0.012 and 0.002). CONCLUSION: Total serum calcium and magnesium levels in normal pregnancy were non-significantly lower compared to non-pregnant women in Ghana. There was a reduction in total serum protein, and albumin levels during pregnancy with a significant reduction noticed during the third trimester compared to the non-pregnant state.

Estimating the incidence of tuberculosis cases reported at a tertiary hospital in Ghana: a time series model approach.

BACKGROUND: The incidence of Tuberculosis (TB) differs among countries and contributes to morbidity and mortality especially in the developing countries. Trends and seasonal changes in the number of patients presenting with TB have been studied worldwide including sub-Saharan Africa. However, these changes are unknown at the Korle-Bu Teaching Hospital (KBTH). The aim of this study was to obtain a time series model to estimate the incidence of TB cases at the chest clinic of the Korle-Bu Teaching hospital. METHODS: A time series analysis using a Box-Jenkins approach propounded as an autoregressive moving average (ARIMA) was conducted on the monthly TB cases reported at the KBTH from 2008 to 2017. Various models were stated and compared and the best was found to be based on the Akaike Information Criterion and Bayesian Information Criterion. RESULTS: There was no evidence of obvious increasing or decreasing trend in the TB data. The log-transformed of the data achieved stationarity with fairly stable variations around the mean of the series. ARIMA (1, 0, 1) or ARMA (1,1) was obtained as the best model. The monthly forecasted values of the best model ranged from 53 to 55 for the year 2018; however, the best model does not always produce the best results with respect to the mean absolute and mean square errors. CONCLUSIONS: Irregular fluctuations were observed in the 10 -year data studied. The model equation to estimate the expected monthly TB cases at KBTH produced an AR coefficient of 0.971 plus an MA coefficient of - 0.826 with a constant value of 4.127. The result is important for developing a hypothesis to explain the dynamics of TB occurrence so as to outline prevention programmes, optimal use of resources and effective service delivery.

Nitric Oxide and Pre-Eclampsia: A Comparative Study in Ghana.

BACKGROUND: Preeclampsia is one of the commonest aetiologies of foetal and maternal mortality and morbidity. Though common, the aetiology of preeclampsia has remained unknown with several inconclusive theories surrounding the disease. Recent studies have implicated vascular endothelial dysfunction and possibly nitric oxide in preeclampsia. AIM: To compare plasma nitric oxide levels in pre-eclampsia and healthy pregnant women in a large tertiary hospital in Ghana. METHODS: This was a case-control study conducted among pre-eclampsia and healthy pregnant women in Korle-Bu Teaching Hospital over a four-month period. Thirty (30) pre-eclamptic and 30 healthy pregnant women aged 18-35 years with over 30 weeks' gestation were consecutively recruited into the study after obtaining informed consent. Plasma nitric oxide levels were determined using the Griess Reagent system. Data were analysed using Statistical Package for the Social Sciences (SPSS) software version 20.0 and results were compared using the independent t-test. A P-value of ≤ 0.05 was considered statistically significant. RESULTS: The parity and body mass index (BMI) of the participants were similar. There was a significant difference in the blood pressure of the pre-eclamptic compared to healthy pregnant women. There was no statistically significant difference (P-value = 0.160) in the plasma levels of nitric oxide in pre-eclamptic (Mean = 1178.78; SD = 89.70 nM) compared to healthy pregnant women (Mean = 1365.43; SD = 95.46 nM). CONCLUSION: Plasma nitric oxide levels may not play a significant role in the aetiology of pre-eclampsia.

Serum nitric oxide levels in healthy pregnant women: a case- control study in a tertiary facility in Ghana.

BACKGROUND: Pregnancy is associated with significant changes in maternal cardiovascular system which regulates oxygen and nutrient supply to the growing foetus. Nitric oxide, a physiologic vascular smooth muscle relaxant regulates blood flow and therefore may play a role in the cardiovascular changes in pregnancy. The study aimed to determine the levels and changes in maternal serum nitric oxide levels during healthy pregnancy. METHODS: A case-control study was conducted among 32 healthy non-pregnant women as controls and 100 healthy pregnant women (consisting of 33 first trimester, 37 s trimester, and 30 third trimester) as cases. Subjects were consecutively recruited into the study after obtaining an informed consent and meeting the inclusion criteria. Griess Reagent method was used to determine serum nitric oxide levels. RESULTS: There were no statistically significant difference in the ages and parity of recruited cases and controls. Mean arterial blood pressures were significantly lower (p = 0.009) and serum nitric oxide levels were significantly higher (p < 0.001) in healthy pregnant women compared to healthy non-pregnant women. There was a non-significant progressive increase in serum nitric oxide levels during healthy normal pregnancy. CONCLUSIONS: The finding of a significantly reduced blood pressures and a significant increase in serum nitric oxide levels in healthy pregnancy may suggest a role of nitric oxide in vascular adaptation in pregnancy.

Serum magnesium and calcium in preeclampsia: a comparative study at the Korle-Bu Teaching Hospital, Ghana.

BACKGROUND: A large percentage (16% of maternal mortality in developed countries, compared to 9% in developing countries), is due to hypertensive disorders in pregnancy. The etiology of preeclampsia remains unknown, with poorly understood pathophysiology. Magnesium and calcium play an important role in vascular smooth muscle function and therefore a possible role in the development of preeclampsia. AIM: We aimed to compare serum magnesium and total calcium levels of preeclamptic and normal pregnant women at the Korle-Bu Teaching Hospital in Ghana. PATIENTS AND METHODS: A comparative cross-sectional study involving 30 normal pregnant and 30 preeclamptic women with >30 weeks gestation and aged 18-35 years, was conducted at the Korle-Bu Teaching Hospital. Magnesium and calcium were determined using a flame atomic absorption spectrometer. RESULTS: Mean serum magnesium and total calcium levels in preeclamptic women were 0.70±0.15 and 2.13±0.30 mmol/L, respectively. Mean serum magnesium and total calcium levels in normal pregnant women were 0.76±0.14 and 2.13±0.35 mmol/L, respectively. There was a statistically nonsignificant difference in serum magnesium and total calcium in preeclamptic women compared to normal pregnant women, with p-values of 0.092 and 0.972, respectively. CONCLUSION: Serum magnesium and total calcium, therefore, seem not to differ in preeclamptic women compared to normal pregnant women in Ghana.

Relationship between serum total magnesium and serum potassium in emergency surgical patients in a tertiary hospital in Ghana.

INTRODUCTION: Potassium and magnesium are the two most abundant intra-cellular cations. They play pivotal roles in many essential biological processes. Deficiencies of these electrolytes are of clinical importance in hospitalised patients. AIM: To determine the relationship between serum total magnesium and potassium levels in adult patients requiring an emergency intra-abdominal surgery and the clinical utility of this relationship in the care of patients. METHODS: A cross sectional study was conducted over a five month period at the Korle-Bu Teaching Hospital. All 101 adult patients admitted for emergency intra-abdominal surgery, who met the inclusion criteria and gave informed consent, were consecutively recruited and enrolled into the study. Patients' characteristics preoperative total serum magnesium, serum potassium and albumin levels were determined. Regression analysis and correlation coefficients were used to determine the relation between serum magnesium and potassium. Analysis was done using SPSS version 20. RESULTS: Mean serum total magnesium and serum potassium were 0.66±0.20mmol/L and 3.79±0.65mmol/L respectively. There was a significant but weak positive correlation between serum hypokalaemia and serum magnesium levels. Pearson's correlation coefficient (2 tailed) was 0.21, R(2)= 0.04, p = value 0.038. Analysis generated a regression model: [Mg] = 0.06[K] + 0.42mmol/L, with a p-value = 0.038. CONCLUSION: A mathematical relationship was found between serum total magnesium and serum potassium among adult patients who require emergency intra-abdominal surgery. However, it had limited clinical utility. FUNDING: None declared.