Browsing by Author "Asumanu, E."
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Item Audit of diabetic soft tissue infection and foot disease in Accra(West African Journal Med. 29(2): 86-90, 2010) Asumanu, E.; Ametepi, R.; Koney, C.T.Background: Soft tissue infection and foot disease are well known complications among diabetes mellitus patients. With an increasing prevalence of diabetes mellitus in Africa, management of these complications is expected to become a major problem. Objective: To audit the surgical management of diabetic soft tissue infection and foot disease over a two-year period in Accra, Ghana.Item Improving emergency attendance and mortality - the case for unit separation(West African Journal Med. 28(1): 28-32, 2009) Asumanu, E.; Richardson, R.Emergency attendance and mortality which are reliable indicators of quality of care, have been of concern to many health institutions. Different models are being proposed to improve emergency outcomes in different parts of the world. A model to separate a single emergency unit into multiple emergency units has been tried in Ghana. Objective: The objective of the study was to find the effect of the Unit Separation Model (USM) on the quality of emergency care delivery in a developing country.Item Intestinal obstruction caused by retained surgical sponge: two case reports(Ghana Medical Journal, 2005) Adu-Aryee, N.; Asumanu, E.; Tetteh, A.; Fordjour, E.; Naaeder, S.Summary We present two cases of intestinal obstruction from retained laparotomy packs and their management. Attention to detail in theatre procedure should reduce such occurrence. Go to: Introduction Retention of sponges in the peritoneal cavity after laparotomy is an avoidable complication which unfortunately still occurs. Various methods including radio opaque markers have been used to try and minimize this occurrence or to ensure its early detection. Adherence to theater protocol such as counting packs before and after surgery remains the most useful in the sub-region as theatre X-ray facilities may not be available to detect retained packs. Case 1 A 39-year-old woman with a lower midline incisional hernia was seen in the emergency room with a day's history of colicky abdominal pain and vomiting. She had experienced similar episodes in the preceding 6 months associated with incisional herniation and for which she had sought no medical help. The patient had an emergency caesarean section for failed induction of labour 10 months earlier. On examination she was in moderate discomfort, her blood pressure was 153/113mmHg, the heart rate was 75 beats/min and temperature 36°C. Her abdomen was not distended and the incisional hernia was easily reducible. A tender mass initially palpated in the left iliac fossa was later palpated in the right iliac fossa on repeated examination. Bowel sounds were increased in frequency and pitch. Vaginal examination confirmed the presence of a right adnexal mass with a normal sized uterus shifted to the left. The rectum was empty on digital rectal examination. A preliminary diagnosis of intestinal obstruction caused by adhesions was made. Her leukocyte count was 14.5 x 109 with a neutrophilia of 87%. Plain abdominal x-rays revealed distended loops of bowel suggestive of small bowel obstruction possibly due to adhesions. Abdominal ultrasonography showed a normal sized uterus and cervix. The right ovary could not be identified but in its place, a hypoechoic mass of 8x8cm was found. The left ovary was normal. An emergency laparotomy was performed because the symptoms did not resolve over the next 24 hours. At operation multiple adhesions between loops of bowel were found. An intraluminal ileal mass about 40cm from the ileocaecal valve was found to be the cause of obstruction. The right ovary was normal. Enterotomy revealed an intact laparotomy towel (Figure 1). The enterotomy was closed in two layers and the hernia repaired. The patient made an uneventful recovery and was discharged on the tenth postoperative day. She was seen weeks postoperatively with no complaints. Case 2 A 33 year-old woman was admitted to the emergency department with a 3-day history of vomiting, constipation and left upper quadrant abdominal pain. The vomit was bile-stained and contained undigested food. This was followed a day later by absolute constipation. The patient had had a laparotomy 5 months earlier following a road traffic accident in which she suffered liver laceration and had intra-abdominal packs placed in order to control haemorrhage. The abdominal packs were presumably all removed as bleeding was controlled at the end of the procedure and there was no record of a “second look” operation. On examination she looked ill and dehydrated with a heart rate of 100 beats/min, blood pressure of 100/60mmHg and a temperature of 37.2°C. Her abdomen had an upper midline scar, was not tender and had a palpable mass in the left hypochondrium. Bowel sounds were increased in frequency and pitch. Her white cell count was 21.7x109 with 65% neutrophils. Plain x-rays of her abdomen showed small bowel air fluid levels and a radio-opaque mass suggestive of a retained abdominal pack (rayon marker). An emergency laparotomy was performed to relieve presumed adhesions and to retrieve the pack. At surgery several of the small bowel adhesions were found and lysed but were not thought to be the cause of the obstruction. An intraluminal foreign body was found to be the cause of the obstruction about 30cm from the ileocaecal valve. A laparotomy sponge was retrieved through an enterotomy, which was closed in two layers. The patient was discharged on the tenth postoperative day, has been reviewed at three and six months post operatively and she remains well. Go to: Discussion Intestinal obstruction remains a major indication for emergency surgery in Ghana The following popper user interface control may not be accessible. Tab to the next button to revert the control to an accessible version. Destroy user interface control1. Foreign bodies are listed as a rare cause of intestinal obstruction. The commonest foreign body causing intestinal obstruction remains laparotomy sponges The following popper user interface control may not be accessible. Tab to the next button to revert the control to an accessible version. Destroy user interface control2. Other foreign bodies include vaginal pessaries The following popper user interface control may not be accessible. Tab to the next button to revert the control to an accessible version. Destroy user interface control3, surgical drains The following popper user interface control may not be accessible. Tab to the next button to revert the control to an accessible version. Destroy user interface control4, vascular grafts The following popper user interface control may not be accessible. Tab to the next button to revert the control to an accessible version. Destroy user interface control5, migrating Angelchik prosthesis The following popper user interface control may not be accessible. Tab to the next button to revert the control to an accessible version. Destroy user interface control6 and ventriculaoperitoneal shunts The following popper user interface control may not be accessible. Tab to the next button to revert the control to an accessible version. Destroy user interface control7. There is a single case report of a metallic ring being left for over 40 years before becoming symptomatic The following popper user interface control may not be accessible. Tab to the next button to revert the control to an accessible version. Destroy user interface control8. The interval after which a retained laparotomy sponge becomes symptomatic may be determined by its position in the peritoneal cavity The following popper user interface control may not be accessible. Tab to the next button to revert the control to an accessible version. Destroy user interface control9. Crossen in 1940 reported that extrusions into hollow viscera may occur into the intestinal lumen, rectum, vagina or bladder The following popper user interface control may not be accessible. Tab to the next button to revert the control to an accessible version. Destroy user interface control10. Both cases presented in this report had symptoms of intestinal obstruction within one year of the pack being retained. The mechanism was probably through slow pressure necrosis of the bowel wall with migration of the sponge into the lumen and sealing off of the wall with minimal peritoneal soiling. There have been anecdotal reports of this in Ghana but this appears to be the first documentation of this event at the Korle Bu Teaching Hospital. It is important that we pay attention to detail in order to minimize these occurrences. Swab and instrument count should be done before any wound is closed.Item Pattern of breast disease in Ghana(Ghana Medical Journal, 2000-12) Asumanu, E.; Vowotor, R.; Naaeder, S.B.A study of breast diseases as seen at a surgical clinic in the Korle Bu Teaching Hospital (KBTH) over a period of 12 months is presented. There were 300 patients, 295 women and 5 men with a mean age of 33.6 years. Benign breast disorders were present in all groups but were commoner in the younger age groups. Lumps were more common in the upper lateral quadrants. Fibroadenosis, 100(33.3%), was found to be the commonest breast disorder among Ghanaian women. Mastitis/breast abscess, 56( 18.7%), was the second most common breast disease affecting mainly nursing mothers. Fibroadenoma constituted 16.3% (52/300) of cases and was the third most common lesion. Nearly 47% of 47 patients with breast carcinoma presented with stages III and IV disease. Male breast disorders were relatively uncommon and constituted 1.7%(5/300) of breast diseases. Thus, the pattern of breast diseases in Ghana contrasts those of other places where fibroadenoma is reported to be the commonest breast diseases. The incidence of breast carcinoma is increasing in Ghana but many patients present late. Efforts must therefore be directed at public education as well as research into the epidemiology and outcome of breast carcinoma in Ghana.Item Whole Genome Sequencing and Antimicrobial Resistance of Staphylococcus aureus from Surgical Site Infections in Ghana(MDPI, 2021) Egyir, B.; Bentum, J.; Attram, N.; Fox, A.; Obeng-Nkrumah, N.; Appiah-Korang, L.; Behene, E.; Kumordjie, S.; Yeboah, C.; Agbodzi, B.; Bentil, R.E.; Tagoe, R.; Tabi, B.K.A.; Owusu, F.; Dayie, N.T.K.D.; Donkor, E.S.; Nsaful, J.; Asah-Opoku, K.; Nyarko, E.; Asumanu, E.; Larsen, A.R.; Wolfe, D.M.; Letizia, A.G.Staphylococcus aureus (S. aureus) is a common cause of surgical site infections (SSIs) globally. Data on the occurrence of methicillin-susceptible S. aureus (MSSA) as well as methicillin-resistant S. aureus (MRSA) among patients with surgical site infections (SSIs) in sub-Saharan African are scarce. We characterized S. aureus from SSIs in Ghana using molecular methods and antimicrobial susceptibility testing (AST). Wound swabs or aspirate samples were collected from subjects with SSIs. S. aureus was identified by matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF-MS); AST was performed by Kirby-Bauer disk diffusion, and results were interpreted according to the Clinical and Laboratory Standards Institute (CLSI) guideline. Detection of spa, mecA, and pvl genes was performed by polymerase chain reaction (PCR). Whole-genome sequencing (WGS) was done using the Illumina MiSeq platform. Samples were collected from 112 subjects, with 13 S. aureus isolates recovered. Of these, 92% were sensitive to co-trimoxazole, 77% to clindamycin, and 54% to erythromycin. Multi-drug resistance was detected in 5 (38%) isolates. The four mecA gene-positive MRSA isolates detected belonged to ST152 (n = 3) and ST5 (n = 1). In total, 62% of the isolates were positive for the Panton-Valentine leukocidin (pvl) toxin gene. This study reports, for the first time, a pvl-positive ST152-t355 MRSA clone from SSIs in Ghana. The occurrence of multi-drug-resistant S. aureus epidemic clones suggests that continuous surveillance is required to monitor the spread and resistance trends of S. aureus in hospital settings in the country.