232 research outputs found
Colon bypass with a colon-flap augmentation pharyngoesophagoplasty
Extensive caustic stricture of the upper aero-digestive system (oro- and hypo-pharynx) is a severe injury with limited surgical options. We adopted augmentation of the cicatrized upper aero-digestive tract with colon as our preferred management option. The aim of this report is to describe our initial experience with the technique of colon-flap augmentation pharyngo-esophagoplasty (CFAP) for selected patients with severe pharyngoesophageal stricture. Between October 2011 and June 2013, three male patients (aged 16, 4 and 18 years respectively) underwent CFAP following extensive pharyngo-esophageal stricture. Postoperative recovery was uneventful in all three cases and all started swallowing within 7 - 10 days after surgery without significant dysphagia. Colon-flap augmentation pharyngo-esophagoplasty is an effective procedure for reconstruction of the pharynx and the hypopharynx after extensive caustic pharyngoesophageal structure in selected cases
Surgical management of constrictive pericarditis
Background: Constrictive pericarditis is a disease characterized by marked thickening and dense scarring of the pericardium with pericardial sac obliteration, or calcification of the pericardium. Without treatment this disease is characterized by high morbidity and mortality.Objective: To review the surgical management of constructivepericarditis and the post operative challenges. Methods: Eleven patients who had pericardiectomy for constructive pericarditis between 2000 and 2005 were studied. Data was obtained from the operating theatre register, histopathological reports and patientâs casenotes. Results: The mean age was 33 years with a range of 14to 53 years. There were seven males (63.6%) and four females (36.4%). Seven (63.6%) out of the eleven patients operated were treated for pulmonary tuberculosis. The cause of pericardial constriction in four patients (36.4%) was undetermined. Follow up period was between 4-59 months. The mean follow up was 17.5 months. Seven patients (63.6%) were off diuretics and had no exercise intolerance. Patients were classified using the New York Heart Association (NYHA) n (NYHA) functional and therapeutic classification in class I-V. Two patients preoperatively in class III are now in class I after surgery on low dose diuretics. One patient who had calcific constrictive pericarditis and came in class III was now in class II with diuretics after 3 years of follow up. There was no postoperative mortality. One patient was lost to follow up. Conclusion: Pericardiectomy is a useful procedure for constrictive pericarditis and was beneficial to all thepatients in this study with an improvement in theirfunctional capacity. Intensive peri-operative monitoringand management reduced morbidity and mortality
Impalement injuries of the chest
Impalement injuries of the chest are uncommon in civilian practice with few reports in the literature. We report three cases of thoracic impalement seen over a 5 year period with unusual underlying mechanisms. In two of the cases, the impalement was obvious; in thethird, the impalement was concealed having occurred 5 months earlier. In Case 1, the underlying mechanism was a high-speed road traffic accident. The patient was impaled by a metallic square pipe piled by the roadside. In Case 2, the gun-housing of a locally-made rifle gave way as it was fired and allowed a reverse ejection of the barrel during recoil that impaled the hunterâs chest. In Case 3, a domestic assault with an old umbrella caused an impalement injury as one of the umbrella spokes broke off, penetrated and lodged in the left chest going unnoticed for 5 months. Persistent chest pain and haemoptysis led to a request for chest radiographic examination upon which the foreign body was discovered. Massive haemoptysis brought the patient to emergency thoracotomy. All three patients underwent thoracotomy with a successful outcom
Institutionalizing quality within national health systems: Key ingredients for success
Quality improvement initiatives can be fragmented and short-term, leading to missed opportunities to improve quality in a systemic and sustainable manner. An overarching national policy or strategy on quality, informed by frontline implementation, can provide direction for quality initiatives across all levels of the health system. This can strengthen service delivery along with strong leadership, resources, and infrastructure as essential building blocks for the health system. This article draws on the proceedings of an ISQua conference exploring factors for institutionalizing quality of care within national systems. Active learning, inclusive of peer-to-peer learning and exchange, mentoring and coaching, emerged as a critical success factor to creating a culture of quality. When coupled by reinforcing elements like strong partnerships and coordination across multiple levels, engagement at all health system levels and strong political commitment, this culture can be cascaded to all levels requiring policy, leadership, and the capabilities for delivering quality healthcare.Fil: Kandasami, Stephanie. No especifĂca;Fil: Babar Syed, Shamsuzzoha. No especifĂca;Fil: Edward, Anbrasi. No especifĂca;Fil: Sodzi Tettey, Sodzi. Institute for Healthcare Improvement; Estados UnidosFil: Garcia Elorrio, Ezequiel. Instituto de Efectividad ClĂnica y Sanitaria; Argentina. Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas; ArgentinaFil: Mensah Abrampah, Nana. No especifĂca;Fil: Hansen, Peter M.. No especifĂca
Chest CT features of patients under investigation for Covid-19 pneumonia in a Ghanaian tertiary hospital: a descriptive study
Background: Coronavirus disease 2019 (COVID-19) has since December 2019 become a problem of global concern. Due to the virusâ novelty and high infectivity, early diagnosis is key to curtailing spread. The knowledge and identification of chest Computerized Tomography (CT) features in Patients Under Investigation (PUI) for the disease would help in its management and containment.
Objectives: To describe the chest CT findings of PUI for COVID-19 pneumonia referred to the Department of Radiology of the Korle Bu Teaching Hospital; as well as to determine the relationship between symptom onset and severity of the chest CT findings.
Methods: The study was retrospective and included 63 PUI for COVID-19 referred to the Department between 11th April, 2020 and 10th June, 2020, for non-enhanced chest CT imaging. Clinical data were obtained from patientsâ records and Reverse TranscriptaseâPolymerase Chain Reaction (RT-PCR) results were acquired after the CT evaluation.
Results: The mean age in years was 51.1±19.9 SD. More males (52.8%) than females (47.2%) tested positive for COVID-19 and the age range for positive cases was 7 months to 86 years, with a mean of 53.2±21 SD years. Common features of COVID-19 pneumonia were bilateral posterior basal consolidations, Ground Glass Opacities (GGO) and air bronchograms. Findings were worse in patients scanned 5â9 days after onset of symptoms.
Conclusion: Adequate knowledge of chest CT features of COVID-19 pneumonia, proves a valuable resource in triaging of symptomatic patients and consequent containment of the disease in the hospital setting
Communication
This chapter discusses research on the
capacity and effectiveness of governmentâs
communications strategy as South Africa
went through the various stages of lockdown
during the Covid-19 pandemic in 2020. It
probes the working relationship between
communications from all spheres of
government and community, private, digital,
and social media, as well as organised civil
society before and during the lockdown and
assesses its impact and efficacy.
Recognising the multilingual nature of
South African society, the urbanârural
digital divide, and the prohibitive costs of
data, the chapter identifies lessons and
reaffirms the relevance of the development
communications approach to governmentâ
citizen communications. It motivates for the prioritisation of accessible, multilingual digital
communications with a citizen feedback loop
that is transparent and responsive to ensure
people are informed and empowered, as
envisioned in the Constitution.
Such responsiveness needs an enabling
environment from government and from
the public, private, and community media
landscape. Collaboration and cooperation
across these sectors with government
communications and with the nongovernmental
health and communications
sectors is critical in such an all-encompassing
crisis. The chapter highlights the need to
continue to understand South Africaâs highly
diverse communication space, in which
digital new media platforms exist alongside
loudhailers, and make accommodations in
legislation, policy, and government coordination
with social partners to reach all people across
the digital, class, and language divides.This chapter 4 is published in the first edition of South Africa Covid-19 country report in June 2021.https://www.gov.za/sites/default/files/gcis_document/202206/sa-covid-19-reporta.pd
Integrating community outreach into a quality improvement project to promote maternal and child health in Ghana
Quality improvement (QI) is used to promote and strengthen maternal and child health services in middle and low-income countries. Very little research has examined community-level factors beyond the confines of health facilities that create demand for health services and influence health outcomes. We examined the role of community outreach in the context of Project Fives Alive!, a QI project aimed at improving maternal and under-5 outcomes in Ghana. Qualitative case studies of QI teams across 6 regions of Ghana were conducted. We analyzed the data using narrative and thematic techniques. QI team members used two distinct outreach approaches: community-level outreach, including health promotion and education efforts through group activities and mass media communication; and direct outreach, including one-on-one interpersonal activities between health workers and pregnant women and/or mothers of children under-5. Specific barriers to community outreach included structural, cultural, and QI team-level factors. QI efforts in both rural and urban settings should consider including context-specific community outreach activities to develop ties with communities and address barriers to health services. Sustaining community outreach as part of QI efforts will require improving infrastructure, strengthening QI teams, and ongoing collaboration with community members
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Incidental ultrasound finding of cholelithiasis in an 8-week-old infant: A case report
Infantile cholelithiasis is a rare occurrence. It is often diagnosed incidentally during ultrasonography for other conditions as most cases are asymptomatic and may be self-limiting. A few cases may however present with prolonged neonatal or infantile jaundice. We report our initial experience with an incidental case of infantile cholelithiasis in an 8-week-old male infant who was brought to our ultrasound unit in Accra, Ghana, for an abdominal ultrasound on account of conjugated hyperbilirubinemia and pigmented stools. The patient had presented initially at the children's emergency unit of the Korle-Bu Teaching Hospital, 2 days after an uneventful delivery, with a history of yellowing of the eyes, noticed on the first day of life, which necessitated the request for the ultrasound examination, leading to this rare finding of infantile cholelithiasis. The availability and use of modern sonographic equipment are likely to result in more effective detection of this incidental finding and its subsequent management
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