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BACKGROUND: This study aimed to describe national peripheral vascular disease (PVD) risk and health burden, and vascular care capacity in Ghana. The gap between PVD burden and vascular care capacity in low- and middle-income countries was defined, and capacity improvement priorities were identified. METHODS: Data to estimate PVD risk factor burden were obtained from the World Health Organization Study on Global Ageing and Adult Health (SAGE), Ghana, and the Institute of Health Metrics and Evaluation Global Burden of Disease (IHME GBD) database. In addition, a novel nationwide assessment of vascular care capacity was performed, with 20 vascular care items assessed at 40 hospitals in Ghana. Factors contributing to specific item deficiency were described. RESULTS: From the SAGE database, there were 4305 respondents aged at least 50 years with data to estimate PVD risk. Of these, 57·4 per cent were at moderate to risk high of PVD with at least three risk factors; extrapolating nationally, the estimate was 1 654 557 people. Based on IHME GBD data, the estimated disability-adjusted life-years incurred from PVD increased fivefold from 1990 to 2010 (from 6·3 to 31·7 per 100 000 persons respectively). Vascular care capacity assessment demonstrated marked deficiencies in items for diagnosis, and in perioperative and vascular surgical care. Deficiencies were most often due to absence of equipment, lack of training and technology breakage. CONCLUSION: Risk factor reduction and management as well as optimization of current resources are paramount to avoid the large burden of PVD falling on healthcare systems in low- and middle-income countries. These countries are not well equipped to handle vascular surgical care, and rapid development of such capacity would be difficult and expensive.
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Creación de Capacidad , Países en Desarrollo , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Enfermedades Vasculares Periféricas/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Costo de Enfermedad , Femenino , Ghana/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Vasculares Periféricas/diagnóstico , Enfermedades Vasculares Periféricas/etiología , Enfermedades Vasculares Periféricas/terapia , Medición de Riesgo , Factores de RiesgoRESUMEN
BACKGROUND: There are few population-based studies on household child injury in African countries. OBJECTIVES: To determine the incidence, characteristics and risk factors of household and neighbourhood injury among children in semiurban communities in Kumasi, Ghana. METHODS: We conducted a cross-sectional population-weighted survey of 200 randomly selected caregivers of children under 18, representing 6801 households. Caregivers were interviewed about moderate to severe childhood injuries occurring within the past 6â months, for which the child staying home from school or activity, and/or required medical care. Multivariable logistic regression was used to identify factors associated with injury risk. RESULTS: Annual injury incidence was 593.5 injuries per 1000 children. Common causes of injury were falls (315.7 injuries per 1000 children), followed by cuts/lacerations and burns. Most injuries (93.8%) were of moderate severity. Children whose caregivers were hourly workers (AOR=1.97; 95% CI 1.06 to 3.68) had increased odds of sustaining an injury compared to those of unemployed caregivers. Girls had decreased odds of injury (AOR=0.59; 95% CI 0.39 to 0.91). Cooking outdoors (AOR=0.45; 95% CI 0.27 to 0.76) and presence of cabinet/cupboards (AOR=0.41; 95% CI 0.24 to 0.70) in the house were protective. Among children under 5â years of age, living in uncompleted accommodation was associated with higher odds of injury compared with living in a rented single room (AOR=3.67; 95% CI 1.17 to 11.48). CONCLUSIONS: The incidence of household and neighbourhood child injury is high in semiurban Kumasi. We identified several novel injury risk factors (hourly work, younger children) and protective factors (cooking outdoors, presence of cabinet/cupboards). These data may identify priorities for household injury prevention.
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Heridas y Lesiones/epidemiología , Accidentes por Caídas , Accidentes Domésticos/estadística & datos numéricos , Adolescente , Quemaduras/epidemiología , Niño , Preescolar , Estudios Transversales , Femenino , Ghana/epidemiología , Humanos , Incidencia , Lactante , Laceraciones/epidemiología , Modelos Logísticos , Masculino , Factores de Riesgo , Población Urbana/estadística & datos numéricos , Heridas y Lesiones/etiologíaRESUMEN
Background: Shortages in the right cadres of human resources to manage health emergencies remain an acute problem especially in low- and middle-income countries. Efforts to address this challenge are dependent on the knowledge and competency of emergency nurses. We sought to determine the knowledge level of nurses in emergency management in the Ashanti Region of Ghana. Methods: We used a cross-sectional, quantitative approach to evaluate knowledge about emergency care among 408 nurses working in wards and emergency units in 11 randomly selected district hospitals (6 public and 5 faith-based). Participants were purposively selected and examined on knowledge level using a structured questionnaire. The inclusion criteria were different cadres of nurses who had spent at least 6 months in the selected hospitals. Results: Four hundred and eight nurses participated. Most were general nurses (73.1 %) or mid-wives (14.4 %), with few specialised in emergency nursing (3.9 %) or critical care nursing (1.6 %). Mean percentage correct on an objective 20 question test on emergency care was 59.8 %. Few (35.6 %) nurses felt that they had adequate knowledge to manage emergencies. Around half (52.5 %) had received training in managing critically ill and injured patients through continuing professional development and 46.6 % felt prepared to work at emergency units. But few (34.7 %) reported having adequate logistics to manage emergencies and fewer (32.2 %) had time off to access training opportunities. Predictors of reporting adequate knowledge to manage emergencies included: having received training in managing critically ill and injured patients (p<.002), feeling prepared to work at emergency units (p<.001), and having adequate logistics to manage emergencies (p<.001). Conclusion: Most nurses did not feel that they had adequate knowledge to manage emergencies. This study has identified increased availability of continuing professional development on emergency care for nurses as a priority in Ghana.
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OBJECTIVE: To characterise the population that presents to the Accident and Emergency Centre (AEC) at Komfo Anokye Teaching Hospital (KATH) and to identify risk factors associated with bypassing proximal care facilities. METHODS: A structured questionnaire was verbally administered to patients presenting to the AEC over 2 weeks. The questionnaire focused on the use of health care resources and characteristics of current illness or injury. Measures recorded include demographics, socioeconomic status, chief complaint, transportation and mobility, reasons for choosing KATH and health care service utilisation and cost. RESULTS: The total rate of bypassing proximal care was 33.9%. On multivariate analysis, factors positively associated with bypassing included age older than 38 years (OR: 2.18, P 0.04) and prior visits to facility (OR 2.88, P 0.01). Bypassers were less likely to be insured (OR 0.31, P 0.01), to be seeking care due to injury (OR 0.42, P 0.03) and to have previously sought care for the problem (OR 0.10, P < 0.001). CONCLUSIONS: Patients who bypass facilities near them to seek care at an urban AEC in Ghana do so for a combination of reasons including familiarity with the facility, chief complaint and insurance status. Understanding bypassing behaviour is important for guiding health care utilisation policy decisions and streamlining cost-effective, appropriate access to care for all patients.
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Centros Comunitarios de Salud/estadística & datos numéricos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Vigilancia de la Población , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Estudios Transversales , Medicina de Emergencia/métodos , Medicina de Emergencia/estadística & datos numéricos , Femenino , Ghana , Humanos , Lactante , Cobertura del Seguro/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores Socioeconómicos , Encuestas y Cuestionarios , Población Urbana/estadística & datos numéricos , Adulto JovenRESUMEN
Many road traffic injuries in low- and middle-income countries (LMICs) are to bus passengers. We sought to determine the availability, functionality, and observed vs. self-reported use of seatbelts in large intercity buses in Ghana. We observed seatbelt use for 1,184 passengers in 35 large intercity buses. We interviewed a separate group of 633 bus passengers. All buses observed had seatbelts and most (92.6%) were functional. A little over a fifth (21.6%) of passengers were observed to wear seatbelts. However, 34.5% of passengers in the self-reported survey indicated always wearing seatbelts when riding in buses. Passengers on 5 buses out of the 35 observed where the driver verbally prompted them to wear seatbelts were more likely (57.8%) to wear seatbelts than on the other buses (15.3%, p = 0.001). Comparing the self-reported survey with observations, passengers tended to overinflate seatbelt use by a factor of 1.6. This study provides useful information for efforts to increase and monitor seatbelt use among large intercity bus passengers in LMICs.Supplemental data for this article is available online at.
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Vehículos a Motor , Cinturones de Seguridad , Accidentes de Tránsito , Ghana , Humanos , Autoinforme , Encuestas y CuestionariosRESUMEN
Risk loci identified through genome-wide association studies have explained about 25% of the phenotypic variations in nonsyndromic orofacial clefts (nsOFCs) on the liability scale. Despite the notable sex differences in the incidences of the different cleft types, investigation of loci for sex-specific effects has been understudied. To explore the sex-specific effects in genetic etiology of nsOFCs, we conducted a genome-wide gene × sex (GxSex) interaction study in a sub-Saharan African orofacial cleft cohort. The sample included 1,019 nonsyndromic orofacial cleft cases (814 cleft lip with or without cleft palate and 205 cleft palate only) and 2,159 controls recruited from 3 sites (Ethiopia, Ghana, and Nigeria). An additive logistic model was used to examine the joint effects of the genotype and GxSex interaction. Furthermore, we examined loci with suggestive significance (P < 1E-5) in the additive model for the effect of the GxSex interaction only. We identified a novel risk locus on chromosome 8p22 with genome-wide significant joint and GxSex interaction effects (rs2720555, p2df = 1.16E-08, pGxSex = 1.49E-09, odds ratio [OR] = 0.44, 95% CI = 0.34 to 0.57). For males, the risk of cleft lip with or without cleft palate at this locus decreases with additional copies of the minor allele (p < 0.0001, OR = 0.60, 95% CI = 0.48 to 0.74), but the effect is reversed for females (p = 0.0004, OR = 1.36, 95% CI = 1.15 to 1.60). We replicated the female-specific effect of this locus in an independent cohort (p = 0.037, OR = 1.30, 95% CI = 1.02 to 1.65), but no significant effect was found for the males (p = 0.29, OR = 0.86, 95% CI = 0.65 to 1.14). This locus is in topologically associating domain with craniofacially expressed and enriched genes during embryonic development. Rare coding mutations of some of these genes were identified in nsOFC cohorts through whole exome sequencing analysis. Our study is additional proof that genome-wide GxSex interaction analysis provides an opportunity for novel findings of loci and genes that contribute to the risk of nsOFCs.
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Labio Leporino , Fisura del Paladar , Labio Leporino/genética , Fisura del Paladar/genética , Femenino , Predisposición Genética a la Enfermedad/genética , Estudio de Asociación del Genoma Completo , Humanos , Masculino , Polimorfismo de Nucleótido Simple/genéticaRESUMEN
PURPOSE: To estimate the population-based annual rate of hernia surgery in Ghana, so as to better define the met and unmet need and to identify opportunities to decrease the unmet need. METHODS: Data on operations performed from June 2014 to May 2015 were obtained from representative samples of 48 of 124 district (first-level) hospitals, 9 of 11 regional (referral) hospitals, and 3 of 5 tertiary hospitals, and scaled-up to nationwide estimates. Rates of hernia surgery were compared to previously published annual incidence of symptomatic hernia in Ghana (210/100,000 population) and to published annual rates of hernia surgery in high-income countries (120-275/100,000). RESULTS: Estimated 17,418 [95% uncertainty interval (UI) 8154-26,683] hernia operations were performed nationally. The annual rate of hernia operations was 65 operations/100,000 population (95% UI 30.2-99.0). The rate was considerably less than the annual incidence of new symptomatic hernia or rates of hernia surgery in high-income countries. Hernia operations represented 7.5% of all operations. Most hernia operations (74%) were performed at district hospitals. Most district hospitals (54%) did not have fully trained surgeons, but nonetheless performed 38% of district-level hernia operations. CONCLUSIONS: The rate of hernia operations fell short of estimated need. Most hernia repairs were performed at district hospitals, many without fully trained surgeons. Future global surgery benchmarking needs to address both overall surgical rates as well as rates for specific highly important operations. Countries can strengthen their planning for surgical care by defining their total, met, and unmet need for hernia surgery.
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Hernia/epidemiología , Herniorrafia/estadística & datos numéricos , Adolescente , Adulto , Anciano , Niño , Preescolar , Países en Desarrollo/estadística & datos numéricos , Femenino , Ghana/epidemiología , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Hernia/complicaciones , Hernia Abdominal/complicaciones , Hernia Abdominal/epidemiología , Hernia Abdominal/cirugía , Herniorrafia/normas , Hospitales Públicos/estadística & datos numéricos , Humanos , Hernia Incisional/complicaciones , Hernia Incisional/epidemiología , Hernia Incisional/cirugía , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
In contrast to the progress that has been made toward understanding the genetic etiology of cleft lip with or without cleft palate, relatively little is known about the genetic etiology for cleft palate only (CPO). A common coding variant of grainyhead like transcription factor 3 ( GRHL3) was recently shown to be associated with risk for CPO in Europeans. Mutations in this gene were also reported in families with Van der Woude syndrome. To identify rare mutations in GRHL3 that might explain the missing heritability for CPO, we sequenced GRHL3 in cases of CPO from Africa. We recruited participants from Ghana, Ethiopia, and Nigeria. This cohort included case-parent trios, cases and other family members, as well as controls. We sequenced exons of this gene in DNA from a total of 134 nonsyndromic cases. When possible, we sequenced them in parents to identify de novo mutations. Five novel mutations were identified: 2 missense (c.497C>A; p.Pro166His and c.1229A>G; p.Asp410Gly), 1 splice site (c.1282A>C p.Ser428Arg), 1 frameshift (c.470delC; p.Gly158Alafster55), and 1 nonsense (c.1677C>A; p.Tyr559Ter). These mutations were absent from 270 sequenced controls and from all public exome and whole genome databases, including the 1000 Genomes database (which includes data from Africa). However, 4 of the 5 mutations were present in unaffected mothers, indicating that their penetrance is incomplete. Interestingly, 1 mutation damaged a predicted sumoylation site, and another disrupted a predicted CK1 phosphorylation site. Overexpression assays in zebrafish and reporter assays in vitro indicated that 4 variants were functionally null or hypomorphic, while 1 was dominant negative. This study provides evidence that, as in Caucasian populations, mutations in GRHL3 contribute to the risk of nonsyndromic CPO in the African population.
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Población Negra/genética , Fisura del Paladar/genética , Proteínas de Unión al ADN/genética , Mutación con Pérdida de Función/genética , Factores de Transcripción/genética , Animales , Codón sin Sentido/genética , Mutación del Sistema de Lectura/genética , Estudio de Asociación del Genoma Completo , Humanos , Mutagénesis Sitio-Dirigida , Mutación Missense/genética , Sitios de Empalme de ARN/genética , Pez Cebra/embriología , Pez Cebra/genéticaRESUMEN
BACKGROUND: There has been a steady increase in the number of patients with cleft lip and palate being treated at our hospital. OBJECTIVE: The aim of the study was to determine the socio-demographic characteristics of patients with cleft lip and palate as seen in a hospital setting. METHODS: New and consecutive patients with cleft lip and palate attending the maxillofacial clinic during the period between February 2003 and January 2004 were prospectively surveyed. Data including age of child, gender, address, type of cleft, associated birth anomalies, family history of cleft, mother's age at birth of child, mother's occupation, and mother's smoking and drinking habits were collected and analyzed using a SPSS package. RESULTS: Seventy-four new cases of cleft lip and palate were seen comprising 33 males and 41 females. Their ages ranged from one day old to 21 years with an overall mean age of 10 months. Cleft lip alone (57%) was the most common presentation. Seventy percent of the mothers were less than 30 years of age. Majority (76%) lived in the Ashanti Region, i.e. within less than 80 kilometres from the clinic. No patient had a family history of facial cleft. Ninety-three percent of the mothers were either unemployed or worked in jobs considered as low earning which included dressmaking, hairdressing, peasant farming, and petty trading. None of the mothers smoked or drank alcohol either before o r duringthe pregnancy. CONCLUSION: Cleft lip and palate was more commonly seen in low income families. The mothers were found to be relatively young. None of the patients and mothers had a family history of cleft. A larger population-based study is warranted to further clarify these findings.
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Labio Leporino/epidemiología , Fisura del Paladar/epidemiología , Adolescente , Adulto , Niño , Preescolar , Demografía , Femenino , Ghana/epidemiología , Encuestas Epidemiológicas , Humanos , Lactante , Recién Nacido , Masculino , Estudios Prospectivos , Factores de Riesgo , Factores SocioeconómicosRESUMEN
Orofacial clefts (OFCs) are congenital dysmorphologies of the human face and oral cavity, with a global incidence of 1 per 700 live births. These anomalies exhibit a multifactorial pattern of inheritance, with genetic and environmental factors both playing crucial roles. Many loci have been implicated in the etiology of nonsyndromic cleft lip with or without cleft palate (NSCL/P) in populations of Asian and European ancestries, through genome-wide association studies and candidate gene studies. However, few populations of African descent have been studied to date. Here, the authors show evidence of an association of some loci with NSCL/P and nonsyndromic cleft palate only (NSCPO) in cohorts from Africa (Ghana, Ethiopia, and Nigeria). The authors genotyped 48 single-nucleotide polymorphisms that were selected from previous genome-wide association studies and candidate gene studies. These markers were successfully genotyped on 701 NSCL/P and 163 NSCPO cases, 1,070 unaffected relatives, and 1,078 unrelated controls. The authors also directly sequenced 7 genes in 184 nonsyndromic OFC (NSOFC) cases and 96 controls from Ghana. Population-specific associations were observed in the case-control analyses of the subpopulations, with West African subpopulations (Ghana and Nigeria) showing a similar pattern of associations. In meta-analyses of the case-control cohort, PAX7 (rs742071, P = 5.10 × 10(-3)), 8q24 (rs987525, P = 1.22 × 10(-3)), and VAX1 (rs7078160, P = 0.04) were nominally associated with NSCL/P, and MSX1 (rs115200552, P = 0.01), TULP4 (rs651333, P = 0.04), CRISPLD2 (rs4783099, P = 0.02), and NOG1 (rs17760296, P = 0.04) were nominally associated with NSCPO. Moreover, 7 loci exhibited evidence of threshold overtransmission in NSOFC cases through the transmission disequilibrium test and through analyses of the family-based association for disease traits. Through DNA sequencing, the authors also identified 2 novel, rare, potentially pathogenic variants (p.Asn323Asp and p.Lys426IlefsTer6) in ARHGAP29 In conclusion, the authors have shown evidence for the association of many loci with NSCL/P and NSCPO. To the best of this knowledge, this study is the first to demonstrate any of these association signals in any African population.
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Labio Leporino/genética , Fisura del Paladar/genética , Predisposición Genética a la Enfermedad/genética , Etiopía/epidemiología , Femenino , Sitios Genéticos/genética , Marcadores Genéticos/genética , Estudio de Asociación del Genoma Completo , Ghana/epidemiología , Humanos , Masculino , Nigeria/epidemiología , Polimorfismo de Nucleótido Simple/genética , Análisis de Secuencia de ADNRESUMEN
BACKGROUND: We aimed to assess the structure, function and performance of Ashanti Region's emergency medical services system in the context of the regional need for prehospital emergency care. DESIGN: A mixed-methods approach was employed, using retrospective collection of quantitative data and prospectively gathered qualitative data. Setting - pertinent data were collected from Ghanaian and international sources; interviews and technical assessments were performed primarily in the Ashanti Region of Ghana. PARTICIPANTS: All stakeholders relevant to emergency medical services in the Ashanti Region of Ghana were assessed; there was a special focus on National Ambulance Service (NAS) and Ashanti Region healthcare personnel. INTERVENTION: This was an observational study using qualitative and quantitative assessment techniques. MAIN OUTCOME MEASURES: The structure, function and performance of the Ashanti emergency medical services system, guided by a relevant technical assessment framework. RESULTS: NAS is the premier and only true prehospital agency in the Ashanti Region. NAS has developed almost every essential aspect of an EMS system necessary to achieve its mission within a low-resource setting. NAS continues to increase its number of response units to address the overwhelming Ashanti region demand, especially primary calls. Deficient areas in need of development are governance, reliable revenue, public access, community integration, clinical care guidelines, research and quality assurance processes. CONCLUSIONS: The Ashanti Region has a growing and thriving emergency medical services system. Although many essential areas for development were identified, NAS is well poised to meet the regional demand for prehospital emergency care and transport.
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Ambulancias/normas , Servicios Médicos de Urgencia/normas , Personal de Salud , Ghana , Humanos , Entrevistas como AsuntoRESUMEN
BACKGROUND: The aims of this study were to characterize the patients seeking acute care for injury and non-injury complaints in an urban Emergency Department in Ghana in order to 1) inform the curriculum of the newly developed Emergency Medicine resident training program 2) improve treatment processes, and 3) direct future community-wide injury prevention policies. STUDY DESIGN: A prospective cross-sectional survey of patients 18 years or older seeking care in an urban Accident and Emergency Center (AEC) was conducted between 7/13/2009 and 7/30/2009. Questionnaires were administered by trained research staff and each survey took 10-15 minutes to complete. Patients were asked questions regarding demographics, overall health and chief complaint. RESULTS: 254 patients were included in the sample. Participants' chief complaints were classified as either medical or injury-related. Approximately one third (38%) of patients presented with injuries and 62% presented for medical complaints. The most common injury at presentation was due to a road traffic injury, followed by falls and assault/fight. The most common medical presentation was abdominal pain followed by difficulty breathing and fainting/ blackout. Only 13% arrived to AEC by ambulance and 51% were unable to ambulate at the time of presentation. CONCLUSION: Approximately one-third of non-fatal adult visits were for acute injury. Future research should focus on developing surveillance systems for both medical and trauma patients. Physicians that are specifically trained to manage both the acutely injured patient and the medical patient will serve this population well given the variety of patients that seek care at the AEC.
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Servicio de Urgencia en Hospital/estadística & datos numéricos , Hospitales Urbanos/estadística & datos numéricos , Dolor Abdominal/epidemiología , Accidentes de Tránsito/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Ghana , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Encuestas y Cuestionarios , Heridas y Lesiones/epidemiología , Adulto JovenRESUMEN
The case of a simple bone cyst occurring in the ramus of the mandible of a 19-year-old woman is reported. The fluid aspirated from the cyst cavity was biochemically analysed. The electrolyte and protein concentrations were similar to those of serum. It is suggested that the fluid was extravasated from blood.
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Quistes Maxilomandibulares/química , Enfermedades Mandibulares/patología , Adulto , Cloruros/análisis , Colesterol/análisis , Exudados y Transudados/química , Femenino , Humanos , Quistes Maxilomandibulares/patología , Potasio/análisis , Proteínas/análisis , Sodio/análisisRESUMEN
This randomised double-blind study compared the efficacy of the closed-mouth and the conventional mandibular block injection techniques in 200 patients requiring anaesthesia for tooth extractions. Results showed the success rate of inferior alveolar nerve anaesthesia with a single injection to be 97% in the conventional group, and 79% in the closed-mouth group. Within 5 min after the injection, 87% of the conventional group as compared with 55% of the closed-mouth group had lip numbness. The conventional and closed-mouth techniques, respectively, yielded 22% and 2% positive aspirations. Long buccal nerve anaesthesia during the closed-mouth injection was achieved in 71% of cases. Both techniques produced similar pain responses, as well as changes in blood pressure and pulse rate. The closed-mouth injection technique produced a greater variety of unexpected symptoms than the conventional. It was concluded that the conventional technique was more effective in blocking the inferior alveolar nerve, and was also faster in producing anaesthesia, but yielded more positive aspirations than the closed-mouth technique.
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Anestesia Dental/métodos , Nervio Mandibular , Bloqueo Nervioso/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Método Doble Ciego , Femenino , Humanos , Lidocaína , Labio/inervación , Masculino , Persona de Mediana Edad , Succión , Extracción DentalRESUMEN
Three patients with severe gagging problems requiring mandibular molar extractions and who could not tolerate conventional block injections were successfully given closed-mouth mandibular block injections without provoking any retching. This technique permits patients to concentrate on clenching their teeth during the injection. This displacement activity, combined with the reduction in tactile sensation following anaesthesia, helps to prevent gagging.
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Anestesia Dental/métodos , Atragantamiento , Nervio Mandibular , Bloqueo Nervioso/métodos , Adulto , Femenino , Humanos , Inyecciones , Masculino , Persona de Mediana Edad , Diente Molar , Extracción DentalRESUMEN
A range of oral manifestations in a patient who was subsequently confirmed as infected with the human immune deficiency virus are presented. Most of these lesions have been previously reported in the literature, and represent opportunistic infection changes resulting from immune deficiency. The rare occurrence of a malignant large cell lymphoma intra-orally in this patient is also reported. The need for clinicians to treat all oral lesions as potentially infective and to wear gloves routinely is stressed.
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Síndrome de Inmunodeficiencia Adquirida/complicaciones , Linfoma de Células B Grandes Difuso/etiología , Neoplasias de la Boca/etiología , Adulto , Herpes Zóster/complicaciones , Humanos , Linfoma de Células B Grandes Difuso/patología , Masculino , Neoplasias de la Boca/patologíaRESUMEN
This paper documents the type, frequency and duration of complications associated with regional anaesthesia of the maxillary nerve via the greater palatine canal in a series of 101 patients treated in the Oral Surgery Department, United Dental Hospital of Sydney.
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Anestesia Dental/efectos adversos , Nervio Maxilar , Bloqueo Nervioso/efectos adversos , Anestesia de Conducción/efectos adversos , Blefaroptosis/etiología , Sangre , Diplopía/etiología , Humanos , Incidencia , Lidocaína/administración & dosificación , Hueso Paladar/inervación , Estrabismo/etiología , Factores de TiempoRESUMEN
BACKGROUND: The Millard method of unilateral cleft lip repair has been associated with a short lip and a flattened nose on the cleft side. The aim of this study was to determine the need for revision surgery following repair of unilateral cleft lip repair at the Komfo Anokye Teaching Hospital. METHOD: Satisfaction with facial appearance (upper lip, nose and general facial appearance) was assessed quantitatively by means of a Visual Analogue Scale (VAS), where 0 cm indicates totally unsatisfied or "highly unattractive" and 10 cm indicates totally satisfied or "highly attractive". Three assessors--parents, surgeon and lay-person--were purposively selected to score their level of satisfaction with repair of complete and incomplete unilateral cleft lip. The assessors also indicated the need for any revision. RESULTS: The total sample size was 120, of which 40.0% were male and 60.0% were female. There were 79 cases of repaired complete unilateral cleft lip and 41 incomplete unilateral cleft lip. Average scores of satisfaction of parents were 6.6, 6.8 and 7.2 for nose, lip and general facial appearance (GFA) respectively. Satisfaction scores for surgeon were 6.1(nose), 6.0 (lip) and 6.5 (GFA), while those of the lay-assessor were 5.2(nose), 5.4 (lip) and 6.0(GFA). Concerning the need for revision, parents indicated 30.2% as needing revision, surgeon 33%; and lay-assessor 40%. Of the cases that needed revision, 33.3% were complete cleft lip and 0.1% were incomplete cleft lip. CONCLUSION: Parents were more satisfied with unilateral cleft lip repair using the Millard procedure than either the surgeon or lay assessor. Those who needed revision were mostly children who presented with complete unilateral cleft lip.
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Labio Leporino/cirugía , Procedimientos de Cirugía Plástica , Actitud del Personal de Salud , Actitud Frente a la Salud , Niño , Estudios Transversales , Estética , Femenino , Ghana , Hospitales de Enseñanza , Humanos , Masculino , Madres/psicología , Evaluación de Necesidades , Nariz/cirugía , Satisfacción del Paciente , Estudios Prospectivos , Procedimientos de Cirugía Plástica/psicología , Reoperación/psicologíaRESUMEN
The Viva Voce is a form of assessment dating back to antiquity. It is widely used by the English-speaking West African Postgraduate Medical Colleges for intermediate and exit level examinations. Although it is still popular till the present day, there is a growing awareness of its limitation as an examination method. This paper explores the origin, format, advantages and limitations of oral examinations in postgraduate surgical assessment and proffers practical guidelines on its usage.
RESUMEN
The present study determined the anti-inflammatory activity of Wissadula amplissima var rostrata (Schum. & Thonn.), and calculated the total phenolic content and total antioxidant capacity of the plant in an attempt to justify the traditional uses of the plant in the Ashanti region of Ghana for the management of spider,wasps and bee stings. Powdered dried leaves of Wissadula amplissima were Soxhlet extracted with Petroleum Ether (PWA, yield: 1.46% (w)/(w)); Chloroform (CWA, yield: 1.18% (w)/(w)) and Methanol (MWA, yield: 3.39% (w)/(w)). These fractions were tested for anti-inflammatory activity using carrageenan-induced foot edema in 7 day old chicks. The effect before the induction of inflammation (pre-emptive protocol) paradigm was used for the assessment. Oral administration of PWA, CWA and MWA (30 - 300 mg/kg) dose dependently reduced edema with maximal effects of 68.25±2.03%, 77.83±0.81% and 62.21±2.61% respectively. Similarly the NSAID, Diclofenac (10 - 100 mg/Kg, i.p) and the steroidal anti-inflammatory drug dexamethasone (0.3 - 3 mg/Kg, i.p) used as positive controls, dose-dependently inhibited the edema with maximal effect of 87.96±1.11% and 67.47±3.51% respectively. The potencies exhibited by all three extracts were comparable to that shown by Diclofenac but higher than that of Dexamethasone. Phenols were detected in all three extracts with the highest concentration in the MWA. The extracts also scavenged DPPH with EC(50) values of 0.9784, 0.9096 and 0.2767 for PWA, CWA, MWA respectively. The results of this study give scientific credence to the local use of Wissadula amplissima to modulate inflammation induced by stings of animals.