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

Person-Centered Care Research in Ghana: a Scoping Review Protocol

Abstract Background: Person-centered care (PCC) is provision of care that is respectful of and responsive to in­dividual patient preferences, needs, and values, and ensures that patient values guide all clinical decisions. While there is a large body of evidence on the benefits of PCC in high-income countries, little research exists on PCC in Ghana and Sub-Saharan Africa at large. Most studies on PCC have focused on maternity care as part of the global movement of respectful maternity care. The few studies on patient experiences and health system responsiveness beyond maternal health also highlight gaps in patient experience and satisfaction, as well as discrimination in health facilities which leads to the most vulnerable having the poorest experiences. This scoping review aims to systematically map the extent of literature focused on PCC in Ghana by identifying patient expectations and preferences, barriers and facilitators, and interventions regarding PCC in Ghana.Methods: This protocol will be guided by the Arksey and O’Malley methodological framework and recommendations by Levac, Colquhoun and O'Brien. A comprehensive search strategy will be used to search for published articles in PubMed, EMBASE, Web of Science, and the African Journals Online (AJOL) from their inception to December 2021. Grey literature and reference lists of included studies will also be searched. Two independent reviewers will perform the literature search, eligibility assessments, and study selection. Any disagreements will be resolved through discussion with a third reviewer. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram for the scoping reviews (PRISMA-ScR) will be used to outline the study selection process. Extracted data from the included articles will be synthesised and reported under key concepts derived from the outcomes of the scoping review.Discussion: The findings from this proposed scoping review on documented person-centeredness of care and patient expectations and preferences regarding PCC will be useful information for policymakers to consider in rolling out healthcare strategies that are driven by patient interest. Also, identification of various barriers and facilitators and evidence of effective PCC interventions will have implications on policy, practice, and further research in Ghana.Scoping review registration: OSF Registration DOI 10.17605/OSF.IO/ZMDH

Morbidity and complications of diabetes mellitus in children and adolescents in Ghana: study design and rationale

Background:Diabetes is associated with premature morbidity and mortality from its many complications. There is limited data on the chronic complications of diabetes in children and adolescents in sub-Saharan Africa. Objective:The study aims to: i) determine the burden and related factors of chronic diabetes complications, and non-diabetes ocular conditions in children and adolescents and ii) the quality of life (QoL) of the participants compared to healthy controls. Methods:After ethics approval from all the participating institutions, and written informed consent or assent, a cohort of children and adolescents (4 – 19 years) with diabetes was recruited from health facilities from two cities in Ghana, Accra (Korle Bu Teaching Hospital) and Cape Coast (Cape-Coast Teaching Hospital). Demographic, medical history, anthropometric measurements and laboratory characteristics were collected, and the participants screened for microvascular and macrovascular complications as well as non-diabetic ocular disease. QoL questionnaires were administered to participants, their care givers and controls. Participants were followed up annually to determine the natural history and trends in the above conditions. The statistical package for social sciences (SPSS Version 25.0) will be used for data analysis. Continuous and categorical data will be presented as mean and standard deviation (SD) and as percentages (%), respectively. T-test and ANOVA will be used to compare means and Chi-square for categorical data. Correlation, regression and logistic regression will be employed to establish linear associations and causal associations as appropriate. Relative risk and Odds ratios will be used to estimate risk. Quality of life (QoL) outcomes in Ghanaian children and adolescents with diabetes mellitus compared with caregivers and healthy controls will be assessed using the PedsQL™ inventory. Significance will be set at α=0.05. Results:The study was approved by the Ethical and Protocol Review Committee of the College of Health Sciences, University of Ghana (protocol identification number: MS-Et/M.12-P4.5/2013-2014) and received funding support from University of Ghana Research Fund (large multi-disciplinary grant). Data collection started from August 2017 to September 2019. Currently, patient recruitment, clinical examinations, and some laboratory analysis have been completed. A total of 59 children and adolescents with diabetes mellitus have been recruited. Blood samples are stored at -80 degrees Celsius for analysis. Data has been captured to date and analysis is currently underway. Investigators are planning to submit results for publication by October, 2020. Conclusions:The prevalence, natural history, trends in diabetic complications and non-diabetic ocular disease, and quality of life will be provided. Our data may inform policies and interventions to improve care given to children and adolescents with diabetes

A Multicenter, International Collaborative Study for American Joint Committee on Cancer Staging of Retinoblastoma. Part II: Treatment Success and Globe Salvage

Purpose: To evaluate the ability of the 8th edition of the American Joint Committee on Cancer (AJCC) Cancer Staging Manual to estimate metastatic and mortality rates for children with retinoblastoma(RB).Design: International, multicenter, registry-based retrospective case series PARTICIPANTS: 2190 patients from 18 ophthalmic oncology centers from 13 countries over 6 continents.Methods: Patient-specific data fields for RB were designed by participating eye cancer specialists. All RB patients with adequate records to allow tumor staging by the AJCC criteria and follow-up for metastatic disease were studied.Main outcome measures: Metastasis-related 5- and 10-year survival data after initial tumor staging were estimated with the Kaplan-Meier method depending on AJCC clinical (cTNM) and pathological (pTNM) tumor, node, metastasis category and age, tumor laterality, and presence of heritable trait.Results: Of the 2190 patients, the records of 2085 patients(95.2%) with 2905 eyes were complete. The median age at diagnosis was 17.0 months. 1260 (65.4%) had unilateral RB. Amongst the 2085 patients, tumor categories were cT1a in 55 (2.6%), cT1b 168 (8.1%), cT2a 197 (9.4%), cT2b 812 (38.9%), cT3 835 (40.0%) and cT4 in 18 (0.9%) patients. Of these, 1397 eyes in 1353 patients(48.1%) were treated with enucleation. One hundred and nine patients (5.2%) developed metastases and died. The median time(n=92) from diagnosis to metastasis was 9.50 months. The 5- year Kaplan-Meier cumulative survival estimates by clinical tumor categories were 100% for category cT1a, 98% (95% confidence interval[CI], 97-99) for cT1b and cT2a, 96% (95% CI, 95-97) for cT2b, 89%(95% CI, 88-90) for cT3 tumors, and 45%(95% CI, 31-59) for cT4 tumors, respectively. Risk of metastasis increased with increasing cT (and pT) category(p < .001). Cox proportional hazards regression analysis confirmed a higher risk of metastasis in category cT3 (hazard rate [HR], 8.09; 95% CI, 2.55-25.70; p<0.001) and cT4 (HR, 48.55; 95% CI, 12.86-183.27; p< 0.001) compared to category cT1. Age, tumor laterality and presence of heritable trait did not influence the incidence of metastatic disease.Conclusion: Multicenter, international, internet-based data sharing facilitated analysis of the 8th edition AJCC RB Staging System for metastasis-related mortality and offered a proof of concept yielding quantitative, predictive estimates per category in a large, real life, heterogenous RB patient population.Fil: Singh Tomar, Ankit. The New York Eye Cancer Center; Estados UnidosFil: Finger, Paul T.. The New York Eye Cancer Center; Estados UnidosFil: Gallie, Brenda. Princess Margaret Cancer Centre; CanadáFil: Mallipatna, Ashwin. University Of Toronto. Hospital For Sick Children; CanadáFil: Kivelä, Tero T.. University of Helsinki; FinlandiaFil: Zhang, Chengyue. Beijing Children's Hospital; ChinaFil: Zhao, Junyang. Beijing Children's Hospital; ChinaFil: Wilson, Matthew W.. University of Tennessee; Estados UnidosFil: Brenna, Rachel C.. University of Tennessee; Estados UnidosFil: Burges, Michala. University of Tennessee; Estados UnidosFil: Kim, Jonathan. The Vision Center at Children's Hospital Los Angeles; Estados UnidosFil: Khetan, Vikas. Sankara Nethralaya; IndiaFil: Ganesan, Suganeswari. Sankara Nethralaya; IndiaFil: Yarovoy, Andrey. The S.N. Fyodorov Eye Microsurgery Federal State Institution; RusiaFil: Yarovaya, Vera. The S.N. Fyodorov Eye Microsurgery Federal State Institution; RusiaFil: Kotova, Elena. The S.N. Fyodorov Eye Microsurgery Federal State Institution; RusiaFil: Yousef, Yacoub A.. King Hussein Cancer Center; JordaniaFil: Nummi, Kalle. University of Helsinki; FinlandiaFil: Ushakova, Tatiana L.. N.N. Blokhin National Medical Research Center Oncology of Russian Federation; RusiaFil: Yugay, Olga V.. N.N. Blokhin National Medical Research Center Oncology of Russian Federation; RusiaFil: Polyakov, Vladimir G.. N.N. Blokhin National Medical Research Center Oncology of Russian Federation; RusiaFil: Ramirez Ortiz, Marco A.. Hospital Infantil de México Federico Gómez; MéxicoFil: Esparza Aguiar, Elizabeth. Hospital Infantil de México Federico Gómez; MéxicoFil: Chantada, Guillermo Luis. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Schaiquevich, Paula Susana. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Fandino, Adriana. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; ArgentinaFil: Yam, Jason C.. The Chinese University of Hong Kong; Hong KongFil: Lau, Winnie W.. The Chinese University of Hong Kong; Hong KongFil: Lam, Carol P.. The Chinese University of Hong Kong; Hong KongFil: Sharwood, Phillipa. University of Sydney; AustraliaFil: Moorthy, Sonia. KK Women’s and Children’s Hospital; SingapurFil: Long, Quah Boon. KK Women’s and Children’s Hospital; SingapurFil: Essuman, Vera Adobea. University of Ghana; GhanaFil: Renner, Lorna A.. University of Ghana; GhanaFil: Semenova, Ekaterina. The New York Eye Cancer Center; Estados UnidosFil: Català, Jaume. Hospital Sant Joan de Déu; EspañaFil: Correa Llano, Genoveva. Hospital Sant Joan de Déu; EspañaFil: Carreras, Elisa. Hospital Sant Joan de Déu; Españ

Retinoblastoma seeds: impact on American Joint Committee on Cancer clinical staging

AimTo investigate whether the American Joint Committee on Cancer (AJCC) clinical category cT2b needs to be subclassified by the type and distribution of retinoblastoma (RB) seeding.MethodsMulticentre, international registry-based data were collected from RB centres enrolled between January 2001 and December 2013. 1054 RB eyes with vitreous or subretinal seeds from 18 ophthalmic oncology centres, in 13 countries within six continents were analysed. Local treatment failure was defined as the use of secondary enucleation or external beam radiation therapy (EBRT) and was estimated with the Kaplan-Meier method.ResultsClinical category cT2b included 1054 eyes. Median age at presentation was 16.0 months. Of these, 428 (40.6%) eyes were salvaged, and 430 (40.8%) were treated with primary and 196 (18.6%) with secondary enucleation. Of the 592 eyes that had complete data for globe salvage analysis, the distribution of seeds was focal in 143 (24.2%) and diffuse in 449 (75.8%). The 5-year Kaplan-Meier cumulative globe-salvage (without EBRT) was 78% and 49% for eyes with focal and diffuse RB seeding, respectively. Cox proportional hazards regression analysis confirmed a higher local treatment failure risk with diffuse seeds as compared with focal seeds (hazard rate: 2.8; pConclusionThis international, multicentre, registry-based analysis of RB eyes affirmed that eyes with diffuse intraocular distribution of RB seeds at diagnosis had a higher risk of local treatment failure when compared with focal seeds. Subclassification of AJCC RB category cT2b into focal vs diffuse seeds will improve prognostication for eye salvage