Aesthetic outcome and the need for revision of unilateral cleft lip repair at Komfo Anokye Teaching Hospital

Background: The Millard method of unilateral cleft lip repair has been  associated with a short lip and a flattened nose on the cleft side. The aim of this study was to determine the need for revision surgery followingrepair of unilateral cleft lip repair at the Komfo Anokye Teaching HospitalMethod: Satisfaction with facial appearance (upper lip, nose and general facial appearance) was assessed quantitatively by means of a Visual Analogue Scale (VAS), where 0cm indicates totally unsatisfied or “highly unattractive” and 10cm indicates totally satisfied or “highly attractive”. Three assessors - parents, surgeon and layperson - were purposively selected to score their level of satisfaction with repair of complete and incomplete unilateral cleft lip. The assessors also indicated the need for any revision.Results: The total sample size was 120, of which 40.0% were male and 60.0% were female. There were 79 cases of repaired complete unilateral cleft lip and 41 incomplete unilateral cleft lip. Average scores of satisfactionof parents were 6.6, 6.8 and 7.2 for nose, lip and general facial  appearance (GFA) respectively. Satisfaction scores for surgeon were  6.1(nose), 6.0(lip) and 6.5(GFA), while those of the lay-assessor were5.2(nose), 5.4 (lip) and 6.0(GFA). Concerning the need for revision, parents indicated 30.2% as needing revision, surgeon 33%; and  lay-assessor 40%. Of the cases that needed revision, 33.3% were complete cleft lip and 0.1% were incomplete cleft lip.Conclusion: Parents were more satisfied with unilateral cleft lip repair using the Millard procedure than either the surgeon or lay assessor. Those who needed revision were mostly children who presented with complete unilateral cleft lip

Lipid and Lipoprotein Levels in Type 2 Diabetes Patients Attending the Central Regional Hospital in the Cape Coast Metropolis of Ghana

Purpose: To ascertain the prevalence of dyslipidaemia in diabetics in Cape Coast.Methods: This preliminary outpatient-based cross-sectional study was conducted in 79 diabetic patients (22 males and 57 females) receiving treatment at the Central Regional Hospital (CRH) in the Cape Coast Metropolis. Serum lipid profiles of the fasting diabetic patients were determined between September, 2008 and May, 2009. In addition, demographic information, height and weight were measured and BMI was computed.Results: BMI was significantly (P = 0.001) higher in females than in males, but the mean values of all the remaining measured parameters were comparable (P>0.05) between the sexes. No significant (P>0.05) correlation was observed between age or BMI and cholesterol levels. Percentage dyslipidaemia ranged from 7.60% to 55.70% in the studysample. A significantly (P<0.05) higher proportion of females than males in the entire sample were overweight/obese, had higher levels of total cholesterol (TCHOL) and TRG. No significant difference (P>0.05) was observed between proportions of individuals in both sexes who exhibited higher LDL-c but lower levels of HDL-c..Conclusion: Lipid profile should be a routine test for all diabetics receiving treatment at the CRH to identify those at increased cardiovascular risk for immediate attention.Keywords: Dyslipidaemia, Cardiovascular, Cholesterol, Body mass inde

Understanding the roles of forests and tree-based systems in food provision

Forests and other tree-based systems such as agroforestry contribute to food and nutritional security in myriad ways. Directly, trees provide a variety of healthy foods including fruits, leafy vegetables, nuts, seeds and edible oils that can diversify diets and address seasonal food and nutritional gaps. Forests are also sources of a wider range of edible plants and fungi, as well as bushmeat, fish and insects. Treebased systems also support the provision of fodder for meat and dairy animals, of “green fertiliser” to support crop production and of woodfuel, crucial in many communities for cooking food. Indirectly, forests and tree-based systems are a source of income to support communities to purchase foods and they also provide environmental services that support crop production. There are, however, complexities in quantifying the relative benefits and costs of tree-based systems in food provision. These complexities mean that the roles of tree-based systems are often not well understood. A greater understanding focuses on systematic methods for characterising effects across different landscapes and on key indicators, such as dietary diversity measures. This chapter provides a number of case studies to highlight the relevance of forests and tree-based systems for food security and nutrition, and indicates where there is a need to further quantify the roles of these systems, allowing proper integration of their contribution into national and international developmental policies

Widespread West Nile virus activity, eastern United States, 2000.

In 1999, the U.S. West Nile (WN) virus epidemic was preceded by widespread reports of avian deaths. In 2000, ArboNET, a cooperative WN virus surveillance system, was implemented to monitor the sentinel epizootic that precedes human infection. This report summarizes 2000 surveillance data, documents widespread virus activity in 2000, and demonstrates the utility of monitoring virus activity in animals to identify human risk for infection

Urban Movement and Alcohol Intake Strongly Predict Defaulting from Tuberculosis Treatment: An Operational Study

BACKGROUND: High levels of defaulting from treatment challenge tuberculosis control in many African cities. We assessed defaulting from tuberculosis treatment in an African urban setting. METHODS: An observational study among adult patients with smear-positive pulmonary tuberculosis receiving treatment at urban primary care clinics in Kampala, Uganda. Defaulting was defined as having missed two consecutive monthly clinic visits while not being reported to have died or continued treatment elsewhere. Defaulting patients were actively followed-up and interviewed. We assessed proportions of patients abandoning treatment with and without the information obtained through active follow-up and we examined associated factors through multivariable logistic regression. RESULTS: Between April 2007 and April 2008, 270 adults aged ≥15 years were included; 54 patients (20%) were recorded as treatment defaulters. On active follow-up vital status was established of 28/54 (52%) patients. Of these, 19 (68%) had completely stopped treatment, one (4%) had died and eight (29%) had continued treatment elsewhere. Extrapolating this to all defaulters meant that 14% rather than 20% of all patients had truly abandoned treatment. Daily consumption of alcohol, recorded at the start of treatment, predicted defaulting (adjusted odds ratio [OR(adj)] 4.4, 95%CI 1.8-13.5), as did change of residence during treatment (OR(adj) 8.7, 95%CI 1.8-41.5); 32% of patients abandoning treatment had changed residence. CONCLUSIONS: A high proportion of tuberculosis patients in primary care clinics in Kampala abandon treatment. Assessing change of residence during scheduled clinic appointments may serve as an early warning signal that the patient may default and needs adherence counseling

Informed Consent under the Ghana Health Service Patients Charter: Practice and Awareness

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Novel <i>GREM1 </i>Variations in Sub-Saharan African Patients With Cleft Lip and/or Cleft Palate

Objective: Cleft lip and/or cleft palate (CL/P) are congenital anomalies of the face and have multifactorial etiology, with both environmental and genetic risk factors playing crucial roles. Though at least 40 loci have attained genomewide significant association with nonsyndromic CL/P, these loci largely reside in noncoding regions of the human genome, and subsequent resequencing studies of neighboring candidate genes have revealed only a limited number of etiologic coding variants. The present study was conducted to identify etiologic coding variants in GREM1, a locus that has been shown to be largely associated with cleft of both lip and soft palate. Patients and Method: We resequenced DNA from 397 sub-Saharan Africans with CL/P and 192 controls using Sanger sequencing. Following analyses of the sequence data, we observed 2 novel coding variants in GREM1. These variants were not found in the 192 African controls and have never been previously reported in any public genetic variant database that includes more than 5000 combined African and African American controls or from the CL/P literature. Results: The novel variants include p.Pro164Ser in an individual with soft palate cleft only and p.Gly61Asp in an individual with bilateral cleft lip and palate. The proband with the p.Gly61Asp GREM1 variant is a van der Woude (VWS) case who also has an etiologic variant in IRF6 gene. Conclusion: Our study demonstrated that there is low number of etiologic coding variants in GREM1, confirming earlier suggestions that variants in regulatory elements may largely account for the association between this locus and CL/P. </jats:sec

Estimating malaria transmission risk through surveillance of human–vector interactions in northern Ghana

Background: Vector bionomics are important aspects of vector-borne disease control programs. Mosquito-biting risks are affected by environmental, mosquito behavior and human factors, which are important for assessing exposure risk and intervention impacts. This study estimated malaria transmission risk based on vector–human interactions in northern Ghana, where indoor residual spraying (IRS) and insecticide-treated nets (ITNs) have been deployed. Methods: Indoor and outdoor human biting rates (HBRs) were measured using monthly human landing catches (HLCs) from June 2017 to April 2019. Mosquitoes collected were identified to species level, and Anopheles gambiae sensu lato (An. gambiae s.l.) samples were examined for parity and infectivity. The HBRs were adjusted using mosquito parity and human behavioral observations. Results: Anopheles gambiae was the main vector species in the IRS (81%) and control (83%) communities. Indoor and outdoor HBRs were similar in both the IRS intervention (10.6 vs. 11.3 bites per person per night [b/p/n]; z = −0.33, P = 0.745) and control communities (18.8 vs. 16.4 b/p/n; z = 1.57, P = 0.115). The mean proportion of parous An. gambiae s.l. was lower in IRS communities (44.6%) than in control communities (71.7%). After adjusting for human behavior observations and parity, the combined effect of IRS and ITN utilization (IRS: 37.8%; control: 57.3%) on reducing malaria transmission risk was 58% in IRS + ITN communities and 27% in control communities with ITNs alone (z = −4.07, P < 0.001). However, this also revealed that about 41% and 31% of outdoor adjusted bites in IRS and control communities respectively, occurred before bed time (10:00 pm). The mean directly measured annual entomologic inoculation rates (EIRs) during the study were 6.1 infective bites per person per year (ib/p/yr) for IRS communities and 16.3 ib/p/yr for control communities. After considering vector survival and observed human behavior, the estimated EIR for IRS communities was 1.8 ib/p/yr, which represents about a 70% overestimation of risk compared to the directly measured EIR; for control communities, it was 13.6 ib/p/yr (16% overestimation). Conclusion: Indoor residual spraying significantly impacted entomological indicators of malaria transmission. The results of this study indicate that vector bionomics alone do not provide an accurate assessment of malaria transmission exposure risk. By accounting for human behavior parameters, we found that high coverage of ITNs alone had less impact on malaria transmission indices than combining ITNs with IRS, likely due to observed low net use. Reinforcing effective communication for behavioral change in net use and IRS could further reduce malaria transmission