Outcome of barium enema in patients with colorectal symptoms

Background: For many years, double contrast barium enema has been an effective way to evaluate the large bowel. With the development of the colonoscope, the role of barium enema has been questioned. However itis still useful in investigating patients with colorectal symptoms especially in the developing world where colonoscopy is widely unavailable and fraught with challenges in completely evaluating the colon.Objective: This study aimed at reviewing double contrast barium enema investigations in our centre.Methods: This was a retrospective study on patients who underwent double contrast barium enema at the Korle Bu Teaching Hospital from May 2003 to April 2007 on account of symptoms referable to the large bowel.Results: A total of 362 investigation reports were studied, of which 205 were for males and 154 for females, the mean age of the patients was 55.3 years (S.D 15.3years). Majority of the investigations, 228 (61.96%), were normal. Diverticular disease diagnosed in 88 (23.91%) cases was the commonest finding, followed by neoplasm 27 (7.34%) cases and Ulcerative colitis 6 (1.63%) cases, non-specific narrowing of the bowel in 4 (1.09%) and in 5 (1.36%) cases their investigations were inconclusive due to poor bowel preparation. Rectal bleeding was the most frequent symptom prompting barium enema studies.Conclusion: Double contrast barium enema study of the large bowel is an important evaluation of patients with colorectal symptoms

Participatory action research as a tool for community development : experiences from Northwestern Ghana

This study reports on a community development project conducted in Charia, a small village in northwestern Ghana. The primary intent of the study was to field-test the participatory action research approach of actively involving local people in their own development efforts. Traditional approaches to helping rural communities have seldom provided the opportunity for people in problem situations to influence the solutions to those problems. In this study, a participatory action research approach was used to actively involve local people and other stakeholders in the design, execution, evaluation and implementation of activities influencing the lives of the people of Charia. Through strategic planning processes, community members envisioned the desired conditions for their village, the obstacles preventing them from achieving those conditions, the strategic directions to overcoming those obstacles, and the necessary actions required to fulfill those strategic directions. Results from this West African village seem to verify the predictions of intervention theory that was developed within a North American business and professional context. Specifically, I found that when people are helped to develop valid information about their situation and to make free and informed choices about the remedies to their own problems, then feelings of emancipation, empowerment, and psychological success are enhanced. The end result is internal commitment to implement the necessary actions leading to their own development

Psychosocial aspects of breast cancer treatement in Accra, Ghana

Objectives: To evaluate psychosocial influences and effects of breast cancer treatment.Design: Cohort questionnaire survey.Setting: Surgical Outpatient Department, Korle Bu Teaching Hospital (KBTH), Accra, Ghana.Subjects: Women previously treated for breast cancer, including those still on hormonal therapy.Main outcome measures: Perception of quality of treatment and psychosocial support; and patients’ felt needs for alternative treatment.Results: Eighty nine women treated one to 22 years previously were interviewed. The majority (86%) had mastectomy. Chemotherapy was the most unpleasant aspect of treatment in 58(65.2%), and 27 (30.3%) were not warned about complications of treatment. Thirty eight (42.7%) reported being afraid (frightened or terrified) at the diagnosis; other reactions were shock, devastation, weeping and depression. Twenty two (24.7%) received no counselling and 15 (18.5%) did not have opportunity to express their fears of death 55 (61.8%), mastectomy/deformity 27 (30.3%) and financial incapability 23 (25.8%). Forty four (49.4%) used alternate ‘treatment’, mainly prayer camps (25 cases) and herbs (22 cases), before and during hospital treatment. Use of alternate treatment led to delays in treatment in 23 women. They had complaints about the care they received: lack of sympathy and emotional support (16 cases), lack of information and communication (13 cases), lack of counselling (9 cases) and slow processes (8 cases).Conclusions: Many patients utilise prayer camps and herbs leading to delays in treatment. Breast cancer patients in Ghana (West Africa) are not receiving satisfactory emotional support, communication and counseling. Adequate psychosocial interventions need to be implemented

During treatment in Ghana? A pilot study

Objectives: To determine the causes of delayed presentation in breast cancer patients at Korle Bu Teaching Hospital (KBTH), and reasons for patients absconding before and during treatment. Design: Questionnaire survey. Setting: Out patient departments and surgical wards of KBTH. Participants: Women newly diagnosed with breastcancer and breast cancer patients who previously absconded and were returning for treatment. Results: Sixty six newly-diagnosed patients aged between 20 and 84 (mean 44.8, median 43) years and35 previous absconders aged 20 to 74 (mean 44.5, median 44) years were interviewed. The causes of delayed presentation were: previous medical consultations 26(29.4%), ignorance 19(28.8%), fear of mastectomy 16(24.2%), herbal treatment 13(19.7%), prayer/prayer camps 13(19.7%) and financial incapability 12(18.2%). Fear of mastectomy 20(57.1%), herbal treatment 13(37.1%), financial incapability 11(31.4%) and prayers/prayer camps 10(28.6%)which were prominent causes of late presentation, were the main reasons for absconding. Newly diagnosed patients had duration of symptoms one week to five years (mean 46, median 34 weeks). Thosewhose lumps were found by clinical breast examination in the community presented to hospital between six weeks to two years (mean 47, median 39 weeks). Married women were more likely to abscond(p=0.001). Conclusions: There are similar reasons for delayedpresentation and absconding among Ghanaian patients. These must be addressed in outreach programmes, and patients must be counselled at time of diagnosis. Dealing with the causes of delayed presentationappears more important than attempts to screen for breast cancer, since patients identified through community screening still present late to hospital

Gastro-duodenal peptic ulcer perforation

Objectives: To determine the epidemiology of, and define the morbidity and mortalityfactors following emergency surgery for patients with perforated peptic ulcer disease in Accra, Ghana. Design: A retrospective and prospective hospital-based study. Setting: The general and paediatric surgical wards of the Korle-Bu Teaching Hospital. Main outcome measures: Demography, the systolic BP, pulse rate and haemoglobin on admission at ER, co-morbid conditions, site of perforation, surgical method and treatment outcome. Subjects: A total of 326 cases treated for peptic ulcer perforation, 267 males and 59 females; ratio 4.5:1, with mean age of 40.9, SD 16.4 and range 4-87 years, were studied. Results: The incidence of peptic ulcer perforation rose from 1.6% in 1998 to 5.3% in 2002 and stabilised at 5%, and overall accounted for 4.6% of acute abdomen. Co-morbid conditions were present in 48 (18.2%) of cases. Ulcerogenic substance intake was in 177 (67%) patients. One hundred and twenty two (46.2%) patients reported to hospital within 24 hours of perforation. There were 287 (88%) duodenal, 22 (7.1%) prepyloric, and 19(4.9%) type 1 gastric ulcer perforations. Simple closure with omental patch was performed in 299(94.3%), truncal vagotomy and drainage in 10 (3.2%), and Billroth II partial gastrectomy in seven (2.2%). Post-operative complications occurred in 62 (19%); overall mortality was 36 (11%). Logistic regression analysis of the patients clinical variables showed that age less that 60 years (p-value, OR and 95% CI; 0.002, 3.964 and 1 .668-9.420), duration of perforation of more than 24 hours before admission (p-value, OR and 95%CI; 0.011,2.471 and 1.228-4.971), alcohol intake (p-value, OR and 95%CI; 0.009, 2.543 and 1.259-5.135) and resectional surgery (p-value, OR and 95%CI; 0.000, 8.25E and 74204908.138-9162648048.1) were statistically significant in determining postoperative complications. Age 60 years and above (p-value, OR and 95%CI; 0.018,4.359 and 1.284-14.802), alcohol intake (p-value, OR and 95%CI; 0.042, 3.238 and 1.046- 10.021) and resectional surgery (p-value, OR and 95% CI; 0.000, 1.20E and 938112920.94- 1.54E+ 11) were the factors that showed statistical significance in determining post-operative mortality. Conclusion: Perforated peptic ulcer disease is emerging as a frequent cause of acute abdomen in our centre and affects the youth commonly. Age 60 years and above, duration of perforation for more than 24 hours before admission, alcohol intake and resectional surgery were the variables that showed statistical significance in predicting post-operative morbidity and/or mortality

Penetrating abdominal injuries in adults seen at two teaching hospitals in Ghana

Background: The incidence of penetrating abdominal injuries (PAI) has increased in the West African sub-region.Objective: To determine the pattern and management outcome of penetrating abdominal injuries (PAI) in the two main teaching hospitals in Ghana.Study Design: A prospective and retrospective descriptive study.Setting: Komfo Anokye Teaching Hospital (KATH), Kumasi and Korle-Bu Teaching Hospital (KBTH), Accra.Methods: Relevant details of all adult patients admitted with penetrating abdominal injuries over a 11-year period were recorded at KATH and KBTH in Accra. The study in KATH was prospective pro forma based and that in the KBTH was a retrospective case review of all penetrating abdominal injuries.Results: There were 411 patients, mostly men (M: F-8:1). The peak age of patients was 20-29 years, 164 patients (39.9%). Abdominal stab wound injuries accounted for 251 (61.1%). Three hundred and thirty – one patients (80.5%) had an emergency laparotomy. Twelve patients required 16 emergency thoracotomies. The small bowel (23.2%), stomach (12.9%), colon (10.2%), the liver (10.0%), were the most commonly injured organs. In 92 patients (29.0%) no significant intra-abdominal injury was detected at laparotomyConclusion: Stab wounds are the main penetrating abdominal injuries seen mostly among young male adults in Ghana. Management was by a mandatory laparotomy after clinical assessment. The overall mortality was 4.4%. Selective non-operative management of abdominal stab wounds is possible

Clinical implications and utility of field cancerization

Cancer begins with multiple cumulative epigenetic and genetic alterations that sequencially transform a cell, or a group of cells in a particular organ. The early genetic events might lead to clonal expansion of pre-neoplastic daughter cells in a particular tumor field. Subsequent genomic changes in some of these cells drive them towards the malignant phenotype. These transformed cells are diagnosed histopathologically as cancers owing to changes in cell morphology. Conceivably, a population of daughter cells with early genetic changes (without histopathology) remain in the organ, demonstrating the concept of field cancerization. With present technological advancement, including laser capture microdisection and high-throughput genomic technologies, carefully designed studies using appropriate control tissue will enable identification of important molecular signatures in these genetically transformed but histologically normal cells. Such tumor-specific biomarkers should have excellent clinical utility. This review examines the concept of field cancerization in several cancers and its possible utility in four areas of oncology; risk assessment, early cancer detection, monitoring of tumor progression and definition of tumor margins

The pseudo-mitochondrial genome influences mistakes in heteroplasmy interpretation

BACKGROUND: Nuclear mitochondrial pseudogenes (numts) are a potential source of contamination during mitochondrial DNA PCR amplification. This possibility warrants careful experimental design and cautious interpretation of heteroplasmic results. RESULTS: Here we report the cloning and sequencing of numts loci, amplified from human tissue and rho-zero (ρ(0)) cells (control) with primers known to amplify the mitochondrial genome. This paper is the first to fully sequence 46 paralogous nuclear DNA fragments that represent the entire mitochondrial genome. This is a surprisingly small number due primarily to the primer sets used in this study, because prior to this, BLAST searches have suggested that nuclear DNA harbors between 400 to 1,500 paralogous mitochondrial DNA fragments. Our results indicate that multiple numts were amplified simultaneously with the mitochondrial genome and increased the load of pseudogene signal in PCR reactions. Further, the entire mitochondrial genome was represented by multiple copies of paralogous nuclear sequences. CONCLUSION: These findings suggest that mitochondrial genome disease-associated biomarkers must be rigorously authenticated to preclude any affiliation with paralogous nuclear pseudogenes. Importantly, the common perception that mitochondrial template "swamps" numts loci precluding detectable amplification, depends on the region of the mitochondrial genome targeted by the PCR reaction and the number of pseudogene loci that may co-amplify. Cloning and relevant sequencing data will facilitate the correct interpretation. This is the first complete, wet-lab characterization of numts that represent the entire mitochondrial genome

GASTRO-DUODENAL PEPTIC ULCER PERFORATION

Objectives: To determine the epidemiology of, and define the morbidity and mortalityfactors following emergency surgery for patients with perforated peptic ulcer diseasein Accra, Ghana.Design: A retrospective and prospective hospital-based study.Setting: The general and paediatric surgical wards of the Korle-Bu TeachingHospital.Main outcome measures: Demography, the systolic BP, pulse rate and haemoglobinon admission at ER, co-morbid conditions, site of perforation, surgical method andtreatment outcome.Subjects: A total of 326 cases treated for peptic ulcer perforation, 267 males and 59 females;ratio 4.5:1, with mean age of 40.9, SD 16.4 and range 4-87 years, were studied.Results: The incidence of peptic ulcer perforation rose from 1.6% in 1998 to 5.3% in2002 and stabilised at 5%, and overall accounted for 4.6% of acute abdomen. Co-morbidconditions were present in 48 (18.2%) of cases. Ulcerogenic substance intake was in177 (67%) patients. One hundred and twenty two (46.2%) patients reported to hospitalwithin 24 hours of perforation. There were 287 (88%) duodenal, 22 (7.1%) prepyloric,and 19(4.9%) type 1 gastric ulcer perforations. Simple closure with omental patch wasperformed in 299(94.3%), truncal vagotomy and drainage in 10 (3.2%), and Billroth IIpartial gastrectomy in seven (2.2%). Post-operative complications occurred in 62 (19%);overall mortality was 36 (11%). Logistic regression analysis of the patients clinicalvariables showed that age less that 60 years (p-value, OR and 95% CI; 0.002, 3.964 and1 .668-9.420), duration of perforation of more than 24 hours before admission (p-value,OR and 95%CI; 0.011,2.471 and 1.228-4.971), alcohol intake (p-value, OR and 95%CI;0.009, 2.543 and 1.259-5.135) and resectional surgery (p-value, OR and 95%CI; 0.000,8.25E and 74204908.138-9162648048.1) were statistically significant in determining postoperativecomplications. Age 60 years and above (p-value, OR and 95%CI; 0.018,4.359and 1.284-14.802), alcohol intake (p-value, OR and 95%CI; 0.042, 3.238 and 1.046- 10.021)and resectional surgery (p-value, OR and 95% CI; 0.000, 1.20E and 938112920.94- 1.54E+11) were the factors that showed statistical significance in determining post-operativemortality.Conclusion: Perforated peptic ulcer disease is emerging as a frequent cause of acuteabdomen in our centre and affects the youth commonly. Age 60 years and above,duration of perforation for more than 24 hours before admission, alcohol intake andresectional surgery were the variables that showed statistical significance in predictingpost-operative morbidity and/or mortality