Visual Outcome of Patients with Pituitary Adenomas Following Surgery and Its Contributory Factors at a Tertiary Hospital in Ghana

BACKGROUND: Craniotomy and transphenoidal microsurgery are surgical options for treatment of pituitary adenoma at Korle Bu Teaching Hospital(KBTH). Despite major advances and reported success rates of transphenoidal resection globally, paucity of local data regarding visual outcome of either procedure exists. We evaluated the visual outcome of patient with pituitary adenoma following surgery in a tertiary hospital in Ghana.METHODS: This is a prospective study of 18 of 45 consecutive new patients with pituitary adenoma seen from November 2010 to July 2013 at Korle-Bu Teaching Hospital(KBTH), Accra, Ghana. Sixteen (88.9%) of the 18 had surgery by transphenoidal route and 2(11.1%) by craniotomy. All patients had macroadenoma (tumour size >1cm) and histological confirmation of diagnosis. Pre-operative and post-operative visual acuity and its relationship to tumour size and duration of symptoms before diagnosis were evaluated.RESULTS: Data on 18 patients aged 33-60 years, mean (SD) 45.9±8.5, was analysed. Eleven (61.1%) were females.Visual blur, 15(83.3%), and headache,13(72.2%), were predominant presenting complaints.Common neuro-ophthalmic signs included unilateral or bilateral optic atrophy, 17(94.4%), Relative Afferent Pupillary Defect (RAPD) in 8(44.4%) and impaired colour vision in 32 of 36(88.9%) eyes. Preoperatively, 8(22.2%) and 13(36.1%) of 36 eyes were visually impaired or blind respectively. Postoperatively, 6(16.7%) eyes were visually impaired and 17(47.2%) eyes blind. Blindness was associated with late presentation (p<0.005) and larger tumour width (p<0.036).CONCLUSIONS: More than a third of eyes of patients with pituitary adenoma were blind before and after surgery. Blindness was associated with late presentation and larger tumours. Transphenoidal surgery may be beneficial following early diagnosis to avoid irreversible blindness/visual impairment

Microbial profile of root canals of pulpally infected teeth in Ghanaians

Introduction: Pulpal and periapical infections are initiated by microorganisms when they gain access to the dental pulp. The success of root canal treatment principally depends on the eradication of the micro-organisms in the root canal system. The aim of this study was to evaluate the viable microbial profile of root canals with various stages of infection in Ghanaians. Material and Methods: Forty-four consecutive patients with sixty teeth referred to the Restorative Dentistry Clinic requiring root canal treatment were recruited. Root canal samples were collected from the teeth with sterile paper points. The samples were processed and subjected to microbial analysis and identification using Matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) mass spectrometry (MS). Results: A total of 259 isolates were recovered from the 60 infected root canals, belonging to twenty different microbial genera. Out of the 259 microbial species isolated, only two were Candida albicans, a fungi; 257 (99.2%) were bacterial isolates belonging to 19 genera. The 19 genera encompassed 53 bacterial species, out of which 26 (49.1%) were identified as facultative anaerobes, 15 (28.3 %.) as obligate anaerobes and 12 (22.6%) were aerobes. Streptococcus species (Streptococcus oralis, Streptococcus mitis, Streptococcus mutans and Streptococcus constellatus) were the most predominant isolates, followed by Prevotella sp, Actinomyces sp, Enterococcus faecalis and Rothia sp respectively. Conclusion: The findings of this study show that infected root canals are polymicrobial in nature. The determination of the microbial profile aids in understanding the pathogenesis of pulpal and periradicular infections and helps in choosing effective antimicrobial irrigation and medicament for root canal treatment