Non-invasive markers as predictors of oesophageal varices in cirrhotic patient in a teaching hospital in Ghana

Introduction: Oesophageal variceal (OV) bleeding is a potentially fatal consequence of portal hypertension in patients with liver cirrhosis. Upper GI endoscopy is recommended for screening for varices in cirrhotics for early detection and treatment, however, this is invasive. The purpose of this study was to assess the predictive values of the noninvasivetests in detecting the presence of OV.Methods: A cross-sectional hospital-based study involving 149 patients with liver cirrhosis was carried out at the Korle-Bu Teaching Hospital from 1st November 2015 to 25th November 2016. Relevant clinical parameters assessed included Child-Pugh class, ascites and splenomegaly. Full blood count and liver function tests, abdominal ultrasoundand gastroscopy were done for all the participants. Receiver operating characteristic curve was generated to determine the cut-off values for the best sensitivity, specificity, negative and positive predictive values of the variables (serum albumin, platelet count (PC), aspartate aminotransferase (AST)/alanine aminotransferase (ALT), PC/Spleen diameter(SD)) with regard to the presence of OV.Results: On gastroscopy, 135 (90.60%) had OV and 14 patients (9.40%) had no OV. One hundred and eleven of the varices (82.22%) were large varices and the rest (17.78%) small varices. The overall mean of serum albumin, PC and PC/SD were not significant predictors of the presence of OV. However, the overall mean of AST/ALT significantly predicted the presence of OV. A PC/SD cut off value of ≤833.3 had 72.62% diagnostic accuracy for diagnosing all OV.Conclusion: PC/SD cut-off could be used to screen cirrhotics for OV and treatment initiated in geographical areas lacking endoscopy facilitiesKeywords: oesophageal varices, non-invasive, predictors, platelet/spleenFunding: None declare

Spontaneous bacterial peritonitis among adult patients with ascites attending Korle-bu Teaching Hospital

Background: Spontaneous bacterial peritonitis (SBP) is one of the most common and life-threatening complications of ascites, mostly in patients with cirrhotic ascites and children with nephrotic syndrome. Recognition and prompt treatment of this condition is essential to prevent serious morbidity and mortality. It is therefore important to determine the prevalence of SBP among in-patients with ascites attending our facility and to determine the clinical characteristics associated with SBP among these patients. Methods: A cross-sectional study was conducted involving 140 patients with ascites irrespective of the underlying cause from 25th March 2016 to 25th November 2016. Demographic information and clinical data were collected using a standardized questionnaire. Ascitic fluid culture, the gold standard for SBP diagnosis and ascitic fluid cell count was done. Positive ascitic fluid culture and/ or ascitic polymorpho nuclear leukocyte ≥250cells/mm3 were diagnostic for SBP Results: Of the 140 patients with ascites the mean age was 44.7±13.2 years. There were seventy six (76) male and sixty four (64) female patients. The prevalence of SBP was 21.43% (30/140). Majority, (41.7%) of the bacteria isolated from ascitic fluid with SBP was Escherichia coli. History of jaundice, low arterial blood pressure on admission and encephalopathy were found to be independent predictors of SBP. Conclusion: SBP is common among patients with ascites admitted at the Korle-Bu Teaching Hospital. Jaundice, encephalopathy and low blood pressure are highly suggestive of SBP and diagnostic paracentesis should be done immediately on admission to confirm the diagnosis. Funding: None Keywords: Ascites, Spontaneous, Bacterial, Peritonitis, Ghana

Contamination and Health Risk Assessment of Exposure to Heavy Metals in Soils from Informal E-Waste Recycling Site in Ghana

The objective of this study is first, to investigate the level of heavy metals in soils from Agbogbloshie e-waste processing site (AEPS), the degree at which these heavy metals contaminate the area and finally, to assess the carcinogenic and non-carcinogenic health risk of heavy metals on workers and residents in around the AEPS. 132 soil samples were collected from the study area and the samples analyzed for Ba, Cd, Co, Cr, Cu, Hg, Ni, Pb and Zn heavy metals after appropriate preparations were made. Results of the analysis showed mean concentrations of Cd, Cr and Ni considered as carcinogenic were lower than permissible levels of Dutch and Canadian soil standards. Mean concentrations however of Cu, Pb and Zn were between 100% and 500% higher than the permissible levels. Assessment of the degree of Contamination indicated Ni<Ba<Co<Cr<Zn<Hg<Cu<Cd<Pb in an increasing order as contributing to the degree of contamination with according to the degree of contamination index the burning, dismantling, residential and commercial considered as very highly contaminated. The health risk analysis of individual heavy metals in soil indicated non-carcinogenic risk of Cr, Hg and Pb with hazard index above the safe level of 1 in the burning and dismantling areas and as such could trigger neurological and developmental disorders in children less than six (6) years

Health Risk Assessment of Organochlorine Pesticides Contaminations in Dairy Products from Selected Farms in Greater Accra Region-Ghana

The study was geared towards ascertaining the levels of synthetic pyrethroids and organochlorine pesticides residues in dairy products(milk, cheese and yoghurt) from selected farms in Greater Accra Region of Ghana. In all fifty (50) samples of dairy products (25 fresh cow milk, 9 cheese and 16 yoghurt) were analyzed. Detectable levels of organochlorine pesticides,OCPs(β-HCH, endrin, endosulfan, p’p’-DDT, heptachlor and methoxychlor) and Synthetic pyrethroids(permethrin, allethrin, cypermethrin, deltamethrin and cyfluthrin). Ultrasonic extraction was employed and extract clean-up was done using silica gel and analyzed using a gas chromatograph (Agilent Model 6890 Gas Chromatograph) equipped with Ni-63 electron capture detector (ECD). . Milk samples were found to be the most contaminated with respect to the OCPs and the levels ranged between 0.0001μg/ml and 0.0407μg/ml. β-HCH was the highest OCP with concentration of 0.0407μg/ml while Cyfluthrin was the highest synthetic pyrethroids recorded in yoghurt sample (0.0318μg/ml).The levels of organochlorine pesticide residues detected in all the tissues were below the accepted Maximum Residue Limits (MRL), as adopted by the WHO/FAO Codex Alimentarius Commission (2005). Keywords: dairy products, organochlorine pesticides, synthetic pyrethroid, health risk, Ghana, gas chromatograph

Applications of simulation within the healthcare context

This is a pre-print of an article published in Journal of the Operation Research Society. The definitive publisher-authenticated version Katsaliaki, K., Mustafee, N.,(2010). Applications of simulation within the healthcare context. Journal of the Operation Research Society. 62, 1431-1451 is available online at: http://www.palgrave-journals.com/jors/journal/v62/n8/full/jors201020a.htmlA large number of studies have applied simulation to a multitude of issues related to healthcare. These studies have been published over a number of unrelated publishing outlets, and this may hamper the widespread reference and use of such resources. In this paper we analyse existing research in healthcare simulation in order to categorise and synthesise it in a meaningful manner. Hence, the aim of this paper is to conduct a review of the literature pertaining to simulation research within healthcare in order to ascertain its current development. A review of approximately 250 high quality journal papers published between 1970 and 2007 on healthcare-related simulation research was conducted. The results present: a classification of the healthcare publications according to the simulation techniques they employ; the impact of published literature in healthcare simulation; a report on demonstration and implementation of the studies’ results; the sources of funding; and the software used. Healthcare planners and researchers will benefit from this study by having ready access to an indicative article collection of simulation techniques applied in healthcare problems that are clustered under meaningful headings. This study facilitates the understanding of the potential of different simulation techniques for solving diverse healthcare problems

Determination of the Concentration of Essential Elements in Pleurotus Ostreatus Cultivated on Valisneria Arthiopica as a Supplementary Substrate to Sawdust using Instrumental Neutron Activation Analyses

Abstract: Mushrooms are excellent nutritional and medicinal sources in the environment. This study has sought to conduct an analysis of the concentration of the essential elements in the mushroom sample that was cultivated on three supplementary substrate compositions (25% Vallisneria aethiopica and 75% Tripochton scleroxylon, 50% Vallisneria aethiopica and 50% Tripochton scleroxylon and 75% Vallisneria aethiopica and 25% Tripochton scleroxylon) using Instrumental Neutron Activation Analysis (INAA) at the Ghana Research Reactor-1 facility(GHARR-1). The concentrations of the elements were detected in Pleurotus ostreatus cultivated on three different percentage substrate compositions of a mixture of Vallisneria aethiopica and Triplochiton scleroxylon. The mixture of 50% Vallisneria aethiopica and 50% Tripochton scleroxylon was best for most of the cultivation of oyster mushrooms since most of the elements detected in the samples attained the highest concentration in this substrate. The validity of the INAA technique for determination essential elements was checked by analyses of SRM 1566b (Oyster tisue) and Peach leaves 1547, respectively. The mean concentrations of the nutritional elements (Al, Cs, Ca, Cu, Cr, Cl, Zn, Br, Hg, Th, Fe, K, Mg, Mn, Na and V) were determined in mushrooms cultivated on three different substrate mixtures

Determination of the Concentration of Essential Elements in Pleurotus Ostreatus Cultivated on Valisneria Arthiopica as a Supplementary Substrate to Sawdust using Instrumental Neutron Activation Analyses

Abstract: Mushrooms are excellent nutritional and medicinal sources in the environment. This study has sought to conduct an analysis of the concentration of the essential elements in the mushroom sample that was cultivated on three supplementary substrate compositions (25% Vallisneria aethiopica and 75% Tripochton scleroxylon, 50% Vallisneria aethiopica and 50% Tripochton scleroxylon and 75% Vallisneria aethiopica and 25% Tripochton scleroxylon) using Instrumental Neutron Activation Analysis (INAA) at the Ghana Research Reactor-1 facility(GHARR-1). The concentrations of the elements were detected in Pleurotus ostreatus cultivated on three different percentage substrate compositions of a mixture of Vallisneria aethiopica and Triplochiton scleroxylon. The mixture of 50% Vallisneria aethiopica and 50% Tripochton scleroxylon was best for most of the cultivation of oyster mushrooms since most of the elements detected in the samples attained the highest concentration in this substrate. The validity of the INAA technique for determination essential elements was checked by analyses of SRM 1566b (Oyster tisue) and Peach leaves 1547, respectively. The mean concentrations of the nutritional elements (Al, Cs, Ca, Cu, Cr, Cl, Zn, Br, Hg, Th, Fe, K, Mg, Mn, Na and V) were determined in mushrooms cultivated on three different substrate mixtures