Retinopathy in severe malaria in Ghanaian children - overlap between fundus changes in cerebral and non-cerebral malaria

<p>Abstract</p> <p>Background</p> <p>In malaria-endemic areas, reliably establishing parasitaemia for diagnosis of malaria can be difficult. A retinopathy with some features unique to severe malaria with a predictive value on prognosis, has been described. Detection of this retinopathy could be a useful diagnostic tool. This study was designed to determine the diagnostic usefulness of retinopathy on ophthalmoscopy in severe malaria syndromes: Cerebral malaria (CM) and non-cerebral severe malaria (non-CM), i.e. malaria with respiratory distress (RD) and malaria with severe anaemia (SA), in Ghanaian children. Secondly, to determine any association between retinopathy and the occurrence of convulsions in patients with CM.</p> <p>Methods and subjects</p> <p>A cross-sectional study of consecutive patients on admission with severe malaria who were assessed for retinal signs, at the Department of Child Health, Korle-Bu Teaching Hospital, Accra, from July to August 2002 was done. All children had dilated-fundus examination by direct and indirect ophthalmoscopy.</p> <p>Results</p> <p>Fifty-eight children aged between six months and nine years were recruited. Twenty six(45%) had CM, 22 with convulsion; 26(45%) had SA and six(10%) had RD.</p> <p>Any retinopathy was seen in: CM 19(73%), SA 14(54%), RD 3(50.0%), CM with convulsion 15(68%) and CM without convulsion 4(100%). Comparison between CM versus non-CM groups showed a significant risk relationship between retinal whitening and CM(OR = 11.0, CI = 2.2- 56.1, p = 0.001). There was no significant association with papilloedema(OR = 0.9, CI = 0.3 - 3.0, p = 0.9), macular whitening(OR = 1.6, CI = 0.5 - 4.8, p = 0.4), macular haemorrhage(OR = 0.28, CI = 0.03 - 2.7 p = 0.2), retinal haemorrhage(OR = 1.9, CI = 0.6 - 5.6, p = 0.3), vessel abnormality(OR = 1.9, CI = 0.6 - 6.1, p = 0.3) and cotton wool spots(OR not calculated, p = 0.08).</p> <p>Tortuous and engorged retinal veins, not previously described as a feature of CM, was the most common vascular abnormality(15/58 = 26%) and was detected even in the absence of papilloedema.</p> <p>Conclusion</p> <p>Retinal whitening, a sign suggestive of retinal ischaemia, was significantly more common in CM than in non-CM syndromes. However, the high prevalence of any retinopathy in the latter suggests that the brain and the retina may be suffering from ischaemia in both CM and non-CM.</p

Effect of music on blood pressure, respiratory and pulse rate in patients undergoing tooth extraction at UGDS dental clinic, Accra-Ghana

Backgroud: Fear and anxiety are known to be associated with dental treatment. Reasons include fear of injection and pain associated with tooth extraction. In addition, the fear sometimes leads to increased blood pressure, respiratory and pulse rates. One method of relieving dental anxiety is listening to music. Therefore, the study assesses the impact of classical music on the blood pressure, respiratory, and pulse rates of the patients undergoing tooth extraction. Materials And Methods: A total of 124 patients for tooth extraction at the University of Ghana Dental School clinic were randomly assigned to intervention and control groups. A revised modified dental anxiety scale assessed dental anxiety and collected demographic data prior to the extraction. The intervention group(62) listened to classical music for 5 minutes, but the control group(62) did not. Blood pressures, respiratory and pulses rates were taken before and after tooth extraction. We then evaluated the impact of the intervention on the physiological changes. Results: There were 46.8% males and 53.2% females. The mean age was 46.2±18.0yrs. No significant differences were observed in sex distribution and mean age between intervention and control groups. Overall dental anxiety prevalence was 52(41.9%). The music group had significantly reduced mean systolic blood pressure by 8.8mmHg (p=0.001). The respiratory rate was significantly lower for the music group (19.7±4.1) as compared to the control group (21.2±3.33), p=0.023.Conclusion: Classical music was associated with reducing systolic blood pressure and the respiratory rate, which are some of the physiological indicators of dental anxiety. &nbsp

Root canal filling removal during endodontic retreatment - a survey of Ghanaian dentists

Background : Endodontic treatment aims to thoroughly clean and shape the root canal system to rid it of any infected pulpal tissue or bacteria and to provide a three-dimensional hermetic seal to the root canal system to prevent re-infection. Despite the high rates of success of endodontic treatment, failures do occur, and these may be attributed to the persistence of bacteria in the root canal system, lack of a hermetic seal during obturation, inadequate condensation of gutta-percha, inadequate cleaning and shaping of the canal, coronal leakage or the presence of unidentified accessory canals.For successful endodontic retreatment to occur, all traces of the root filling material (gutta-percha and the sealant) must be removed from the canal walls to enable access to the apical third of the root canal system to be regained. Removal of gutta-percha can be carried out by thermal, laser, chemical, and mechanical techniques or a combination of the above.General Aim : To determine which instruments and solvents Ghanaian dentists use to remove gutta-percha during endodontic retreatment.Methodology : A cross-sectional study was done by giving out a structured questionnaire at a Continuous Professional Development (CPD) event held for dentists. Simple descriptive statistics were used together with Chi-square (χ2) and one-way Analysis of Variance (ANOVA) tests. The chosen level of significance was set at p &lt; 0.05. Unanswered questions were treated as missing values.Results : A total of 64 dental practitioners were surveyed in this study. 32 out of 63(50.8%) respondents performed 2-4 root canal treatments (RCTs) per week, and 49 out of 62(79.0%) performed 0-1% of re-RCTs per week. 59 out of 62(95.2%) practitioners used hand files during root canal treatment. 44 out of 57(77.2 %) practitioners used hand files in combination with solvents, Gates Glidden burs, and barbed broaches during endodontic retreatment. Eucalyptol was the most used solvent during endodontic retreatment, accounting for 31 out of 39(79.5%) positive responses by practitioners.Conclusion : Most Ghanaian dentists use hand files (K-files-54.3%) with solvents (Eucalyptol-79.5%) in the removal of gutta-percha during endodontic retreatment