Incidence of advanced cutaneous malignant melanoma in the UK: a systematic review

Objectives: Cutaneous melanoma (CM) is one of the most aggressive forms of skin cancer. In 2008, CM was found to be the sixth most common cancer in the UK. The aim of this review was to systematically identify patients with advanced CM, limited to stage IIIc and stage IV disease. Methods: Literature searches were undertaken in the Cochrane Library, MEDLINE, CINAHL and EMBASE between December 2010 and March 2011. Webpages of the Office of National Statistics, Cancer Research UK and the Welsh Cancer Intelligence and Surveillance Unit were also scanned. A narrative synthesis was undertaken due to the heterogeneity of included studies. Results: Three observational studies were identified. One study was in East Anglia, England while the remaining two were in Scotland. Both studies in Scotland estimated that 2% of all melanoma patients had advanced CM at the time of diagnosis. It was also noted that, in East Anglia, the incidence of stage IV CM decreased from 0.42 to 0.13 per 100,000 population per year between 1991 and 2004. The review highlighted the challenges in identifying patients with advanced CM from available data. Conclusions: This review highlighted the lack of, and the need for primary studies to estimate the incidence of advanced CM in the UK. Defining this subgroup of patients is important for identifying patients for targeted treatment. We suggest that researchers must clearly define this population of patients in future studies

Modeling Road Traffic Fatality Cases in Ghana.

Road traffic fatalities are of major concern in Ghana. According to the annual report of National Road Safety Commission (NRSC), 2,047 road traffic fatality cases were recorded in the year 2007 which is an increase of 29.5% over that of the year 2000 (NRSC, 2007 Report). Relative to the year 2001(NRSC, 2001) the 2010 figures for fatal crashes and fatalities also recorded corresponding increases of 34.1% and 19.6% respectively. Using annual road fatality data for the period 1991-2011 from the National Road Safety Commission and Building and Road Research Institute (BRRI) in Ghana, the Autoregressive Integrated Moving Average (ARIMA) model has been utilized to study the trend and pattern of road fatalities in Ghana. The results showed that road traffic fatalities in the country increased over the period of study. Moreover, a forecasting approach indicates that road traffic fatalities would continue to increase over the next five years. Keywords: Accident, Autoregressive (AR), Moving average (MA) and ARIMA

Exposition of Discriminatory Variables in a Family of Hypertensive and Non hypertensive Diabetic Patients: A Case Study of Komfo Anokye Teaching Hospital – Kumasi, Ghana

This study sought to expose variable(s) capable of predicting hypertensive status of diabetic patients. To this end, data on 260 diabetic  patients at the Komfo Anokye Teaching Hospital’s Diabetic Centre in Ghana were collected using data extraction form. The majority (144) of the 260 diabetic patients representing about 55% were also hypertensive as against 116 (45%) who were not hypertensive. Frequency analysis also revealed female dominance as far as the two diagnoses (Diabetes with hypertension and diabetes without hypertension) were concerned. However, the percentage of females in diabetes with hypertension (77%) was greater than the percentage of females in diabetes without hypertension (67%). The minimum age of hypertensive diabetic patients was 30 years as against 11 years for those diagnosed as non-hypertensive diabetic. A discriminant analysis was adopted to expose the discriminatory variables as far as the two diagnoses were concerned. The study indicated a strong association between diagnosis (diabetes with hypertension and diabetes without hypertension) and body mass index (BMI), and to some extent, also between diagnosis and age. BMI and age were identified as principal discriminating variables for separating patients diagnosed with diabetes with hypertension from those with diabetes without hypertension. The index of discrimination (canonical correlation) associated with the resulting discriminant model was 0.42 (42%). This is good since it is greater than 30. The hit ratio, (or the percentage of cases correctly classified) is 0.654 or 65.4%. Also, leave-one-out cross-validation which was used instead of an independent holdout sample correctly classified 64.2% of the cases. Finally, it was concluded that ageing and extra BMI gained are risk factors for diabetic patients to develop hypertension. Therefore, the model was good for prediction. Keywords: Diabetes, Hypertension, Model, Discriminant Analysis, Ghan

Colour and Architecture: An Empirical Study of a New Paradigm of Painting of Residential Buildings and Ownership in Kumasi

Colours have been classically used to inspire taste in architecture from antiquity. Colours provide ‘joie de vivre’ (joy of life). However, a cursory observation reveals a noticeable trend in Ghana where residential buildings are receiving paints and colour notations of multinational companies. This paper presents empirical research on colour through multiple methodological approaches and tactics. The research findings presented in this paper used Kumasi, the Capital of the Ashanti Region of Ghana as main case study area. The data analysis of findings revealed that about seventy-five percent of the houses painted in multinational companies’ colours along major arterial roads in Kumasi were approached for advertisement purposes. In addition, the owners of the sampled houses chose to paint with a particular colour for a mark of distinction and monetary reasons. This paper concludes that the companies’ objectives were adhoc and were not guided by any planned scheme as required to enhance the sensibility and aesthetic appeals through the use of colour for buildings and their genus loci in an urban environment. The paper recommends revisions to the current Ghana National Building Regulations of 1996 – The Legislative Instruments 1630 to recognize the importance of colour aesthetics in city environments. Keywords: Company colour and paint, Architecture, Incentivization, Building regulations, Kumasi-Ashant

Procedure Volume and the Association with Short-term Mortality Following Abdominal Aortic Aneurysm Repair in European Populations: A Systematic Review

Objective: To evaluate the relationship between the volume of abdominal aortic aneurysm (AAA) procedures undertaken and the primary outcome of mortality in Europe. Previous systematic reviews of this relationship are outdated and are overwhelmingly based on US data. Data sources: Comprehensive searching within MEDLINE and other bibliographic databases supplemented by citation searching and hand-searching of journals was undertaken to identify studies that reported the effect of hospital or clinician volume on any reported outcomes in adult, European populations, undergoing AAA repair and published in the last 10 years. Methods: Two reviewers conducted study selection with independent, duplicate data extraction and quality assessment. A planned meta-analysis was not conducted because of the high risk of bias, the likelihood of individual study subjects being included in more than one study and diversity in the clinical populations studied and methods used. Results: Sixteen studies (n = 237,074 participants) from the UK (n = 11 studies), Germany (n = 3 studies), Norway (n = 1 study), and one from the UK and Sweden were included. Data in the included studies came from administrative databases and clinical registries incorporating a variety of clinical and procedural groups; the study quality was limited by the use of observational study designs. Overall, the evidence favoured the existence of an inverse volume outcome relationship between hospital volume and mortality. Insufficient evidence was available to reach conclusions on the relationship between clinician volume and outcome and between hospital or clinician volume and secondary outcomes including complications and length of hospital stay. Conclusions: The evidence from this review suggests a relationship between the hospital volume of AAA procedures conducted and short-term mortality; however, as volume typically represents a complex amalgamation of factors further research will be useful to identify the core characteristics of volume that influence improved outcomes

Clinical Risk Factors for Osteoporosis in Ireland and the UK: A Comparison of FRAX and QFractureScores

Recently two algorithms have become available to estimate the 10-year probability of fracture in patients suspected to have osteoporosis on the basis of clinical risk factors: the FRAX algorithm and QFractureScores algorithm (QFracture). The aim of this study was to compare the performance of these algorithms in a study of fracture patients and controls recruited from six centers in the United Kingdom and Ireland. A total of 246 postmenopausal women aged 50-85 years who had recently suffered a low-trauma fracture were enrolled and their characteristics were compared with 338 female controls who had never suffered a fracture. Femoral bone mineral density was measured by dual-energy X-ray absorptiometry, and fracture risk was calculated using the FRAX and QFracture algorithms. The FRAX algorithm yielded higher scores for fracture risk than the QFracture algorithm. Accordingly, the risk of major fracture in the overall study group was 9.5% for QFracture compared with 15.2% for FRAX. For hip fracture risk the values were 2.9% and 4.7%, respectively. The correlation between FRAX and QFracture was R = 0.803 for major fracture and R = 0.857 for hip fracture (P ≤ 0.0001). Both algorithms yielded high specificity but poor sensitivity for prediction of osteoporosis. We conclude that the FRAX and QFracture algorithms yield similar results in the estimation of fracture risk. Both of these tools could be of value in primary care to identify patients in the community at risk of osteoporosis and fragility fractures for further investigation and therapeutic intervention. © 2011 Springer Science+Business Media, LLC

Evaluation of some basic traits of a promising coconut hybrid: Sri Lankan green dwarf crossed to Vanuatu tall (sgd x vtt)

The Lethal Yellowing Disease locally referred to as the “Cape St Paul Wilt Disease” is the single most important disease that has devastated several hectares of coconut plantations in Ghana. Two decades of coconut screening for tolerant planting material has identified the Sri LankanGreen Dwarf crossed Vanuatu Tall (SGD x VTT) coconut hybrid as the most promising planting material in the context of disease. To provide farmers with planting material that has high disease tolerance and also good agronomic characteristics, the study compared some basic traits ofthe coconut hybrid with other important coconut varieties with the objective of determining the suitability of the SGD x VTT as alternative planting material to revamp the coconut industry in Ghana. Mean sample size of 25 palms per coconut variety under the study was analyzed using two sample t-test procedure. The study indicated that the yield performance of the SGD x VTT coconut hybrid was better than the tall coconut types including the local West African Tall (WAT) and compared favourably with the Malayan Yellow Dwarf crossed Vanuatu Tall (MYD x VTT) coconut hybrid. The good agronomic characteristics of the SGD x VTT coupled with itshigh resistance to the CSPWD proved its suitability as alternative planting material to revamp the coconut industry in Ghana

Analysis of drug resistance among difficult-to-treat tuberculosis patients in Ghana identifies several pre-XDR TB cases

BACKGROUND: Resistance to tuberculosis (TB) drugs has become a major threat to global control efforts. Early case detection and drug susceptibility profiling of the infecting bacteria are essential for appropriate case management. The objective of this study was to determine the drug susceptibility profiles of difficult-to-treat (DTT) TB patients in Ghana. METHODS: Sputum samples obtained from DTT-TB cases from health facilities across Ghana were processed for rapid diagnosis and detection of drug resistance using the Genotype MTBDRplus and Genotype MTBDRsl.v2 from Hain Life science. RESULTS: A total of 298 (90%) out of 331 sputum samples processed gave interpretable bands out of which 175 (58.7%) were resistant to at least one drug (ANY(r)); 16.8% (50/298) were isoniazid-mono-resistant (INH(r)), 16.8% (50/298) were rifampicin-mono-resistant (RIF(r)), and 25.2% (75/298) were MDR. 24 (13.7%) of the ANY(r) were additionally resistant to at least one second line drug: 7.4% (2 RIF(r), 1 INH(r), and 10 MDR samples) resistant to only FQs and 2.3% (2 RIF(r), 1 INH(r), and 1 MDR samples) resistant to AMG drugs kanamycin (KAN), amikacin (AMK), capreomycin (CAP), and viomycin (VIO). Additionally, there were 4.0% (5 RIF(r) and 2 MDR samples) resistant to both FQs and AMGs. 81 (65.6%) out of 125 INH-resistant samples including INH(r) and MDR had katG-mutations (MT) whereas 15 (12%) had inhApro-MT. The remaining 28 (22.4%) had both katG and inhA MT. All the 19 FQ-resistant samples were gyrA mutants whereas the 10 AMGs were rrs (3), eis (3) as well as rrs, and eis co-mutants (4). Except for the seven pre-XDR samples, no sample had eis MT. CONCLUSION: The detection of several pre-XDR TB cases in Ghana calls for intensified drug resistance surveillance and monitoring of TB patients to, respectively, ensure early diagnosis and treatment compliance