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Item ACUTE APPENDICITIS(2013-12-09) Naeder, S.B.; Clegg-Lamptey, J.N.; Dakubo, J.C.B.There is considerable variation in the incidence of acute appendicitis worldwide. The disease is common in western nations but much less so in developing countries. However recent reports suggest that the incidence of acute appendicitis is declining in the developed world and the reverse is occurring in developing countries. Acute appendicitis is now the leading cause of the acute abdomen in Africa including Ghana and West Africa. The aetiology of acute appendicitis has been attributed to the substitution of high residue diets with refined foods but this hypothesis has been disputed. Appendicular luminal obstruction by a faecolith is thought to initiate the inflammatory changes associated with acute appendicitis as the majority of cases are due to an obstructing faecolith. Diagnosis of acute appendicitis is largely clinical with the symptomatology essentially similar globally. In children, the elderly and pregnancy acute appendicitis may present a formidable diagnostic challenge and therefore a high index of suspicion is required. Sophisticated investigations are not necessary in the majority of cases. However ancillary investigations may be done to improve diagnostic accuracy and minimize the negative appendicectomy rate. The treatment of acute appendicitis is appendicectomy. Prophylactic antibiotics are required in all cases to reduce the incidence of surgical site infection. However in resource-limited settings conservative management with antibiotics may be the only option as the natural history of acute appendicitis includes spontaneous resolution. Recurrence rates following conservative treatment are, however, unacceptably high. Generally mortality and morbidity rates are low in acute appendicitis but are higher in those with complicated appendicitis.Item Acute appendicitis(Current Challenges with their Evolving Solutions in Surgical Practice in West Africa: A Reader, 2013) Naaeder, S.B.; Clegg-Lamptey, J.N.; Dakubo, J.C.B.In lieu of an abstract, here is a brief excerpt of the content: •51• Chapter 5 Acute Appendicitis S.B. Naaeder, J.N. Clegg-Lamptey and J.C.B. Dakubo Introduction In 1886 Reginald H. Fitz first described appendicitis in his presentation titled “Perforating inflammation of the vermiform appendix with special reference to its early diagnosis and treatment” to the first meeting of the Association of American Physicians in Washington DC1 . He coined the term appendicitis to distinguish it from other inflammatory conditions in the region of the caecum such as typhilitis and perityphilitis. This was followed by Charles McBurney’s description of his classical sign in the diagnosis of acute appendicitis in 18892 . Appendicitis is now the most common intra-abdominal emergency surgical condition worldwide. It has been postulated that acute appendicitis is the first serious disease to emerge following dietary modification with the adoption of fibre-depleted diets. In 1920 Rendle Short propounded the hypothesis that the rise in the incidence of acute appendicitis in western populations was primarily due to the substitution of high-residue diets with refined low-fibre diets.3 This concept was popularized by Dennis Burkitt4 who reviewed all the available epidemiological and experimental evidence and concluded that undue refining of dietary carbohydrate was the most important causative factor of acute appendicitis, diverticular disease and large bowel cancer. He noted the rarity of these large bowel diseases in African populations who consumed diets high in fibre and the high incidence of these diseases in populations living on low fibre diets.4 The incidence of acute appendicitis is rising in Africa and this has been attributed to socio-economic advancement with its accompanying life-style changes and adoption of low-residue diets. However, current evidence suggests that low-residue diet may not be the important aetiological factor in acute appendicitis as has been postulated. This is •52• Chapter 5 because, in Africa, patients with acute appendicitis consume traditional high -residue diets and urbanization has been shown to have no effect on the dietary fibre intake and bowel function of Africans5 . Incidence There is considerable variation in the incidence of appendicitis all over the world. The disease is common in western nations but much less so in developing countries, however, this is changing. Recent reports suggest that the incidence of acute appendicitis is declining in the developed world. The reason for this decline is not clear but it has been suggested that this may be related to an increase in dietary fibre intake in these populations6 . Between 1989 and 2000 the age-standardized hospital admission rates for acute appendicitis in England was noted to have decreased by 12.5 per cent in males and 18.8 percent in females7 . In the USA the incidence of appendicitis decreased by 14.6 per cent between 1970 and 1984.6 All reports on acute appendicitis were unanimous that acute appendicitis was rare in Africa six to seven decades ago.8,9 This is no longer the situation as the incidence of the disease has been increasing progressively ever since. Adekunle O.O et al. reported a progressive increase in the annual incidence of acute appendicitis in Nigeria between 1973 and 198310 . Similar trends have been reported in both rural and urban communities in Ghana11-15 and other parts of Africa.16-17 Acute appendicitis was uncommon in Ghana in the 1940s; by 1966 the annual incidence was 2.2 per 10,000 population.12 This rose to 2.63 per 10,000 population by 197113 and currently the reported annual incidence of acute appendicitis is 3.18 per 10,000 population.14 This is still lower than the annual incidence rate of 11 per 10,000 population reported in the USA with an even higher rate (25 per 10,000 population) in the young (10-19 years).6 Acute appendicitis is now the leading cause of the acute abdomen in Africa including the West African sub-region18-21 . Aetiology of acute appendicitis The cause of appendicitis has been attributed to a number of factors. Diets low in residue have been blamed4 but studies in Ghana have disputed this notion.5,22 These studies noted that urbanization had •53• Acute Appendicitis no effect on the dietary habits of Ghanaians and that dietary fibre intake was high in patients with acute appendicitis. Gelfand found that patients admitted with acute appendicitis in Africa followed a traditional diet.23 Appendicular luminal obstruction is thought to initiate the inflammatory changes associated with acute appendicitis. The obstruction is by a faecolith in...Item Appropriateness of referrals for upper gastrointestinal endoscopy(West African Journal of Medicine, 2011) Dakubo, J.C.B.; Clegg-Lamptey, J.N.; Sowah, P.Item Appropriateness of referrals for upper gastrointestinal endoscopy [Adéquation des parrainages pour l'endoscopie digestive haute](West African Journal of Medicine, 2012-07) Dakubo, J.C.B.; Clegg-Lamptey, J.N.; Sowah, P.Background: Uncomplicated dyspepsia has a low predictive value in diagnosing upper gastrointestinal organic disease making early endoscopy essential. Objective: To assess the reliability of clinical information in the diagnosis of organic disease in patients referred for upper gastrointestinal endoscopy. Methods: Patients who were referred for gastroscopy to the Korle Bu Teaching Hospital, in Accra between January and December, 2008 were interviewed and evaluated for this study. The patients' clinical data were correlated with the endoscopic findings to determine how appropriate the referrals were, based on the clinical information. Results: One thousand, six hundred and forty three patients were studies of whom 372 presented with alarm symptoms. Uncomplicated dyspepsia was the principal presenting symptom in 1271 patients. Overall, 522 (31.8%) patients had organic disease, 440 (26.8%) inflammatory conditions and 681 (41.4%) were negative endoscopies. Two hundred and nine (56.2%) patients with alarm symptoms and 313 (24.6%) without alarm symptoms (p value, OR, 95% CI; <0.001, 3.92, 3.083-5.00) had organic disease. Presentations with bleeding and suspicion of malignancy showed statistical significance with the finding of organic disease while anaemia did not. Dyspepsia was strongly associated with negative endoscopy, 84% vrs 60%, p value <0.001. Gastric malignancies were associated with age 50 years and above. The three common benign diseases of peptic ulcer, gastric ulcer and gastritis showed strong similarity in presentation and were unpredictable clinically. Conclusion: Patients referred for endoscopy were young in whom there was a high prevalence of organic disease which were mostly benign.Item The burden and characteristics of peripheral arterial disease in patients undergoing amputation in Korle Bu Teaching Hospital, Accra, Ghana(Ghana Medical Journal, 2017-09) Bediako-Bowan, A.A.A.; Adjei, G.O.; Clegg-Lamptey, J.N.; Naaeder, S.B.Background: To determine the prevalence of Peripheral Arterial Disease (PAD) and associated risk factors in patients undergoing amputation at the Korle Bu Teaching Hospital (KBTH), Accra, Ghana. Objectives: A cross- sectional study of all patients undergoing lower extremity amputation at the Department of Surgery, KBTH. Materials: A coded questionnaire was used to ascertain risk factors for PAD. The Edinburgh Claudication Questionnaire was used to determine symptomatic PAD and a 5 mmHz hand held Summit® Doppler together with an Accoson ® sphygmomanometer was used to determine PAD and its severity. Method: Clinical diagnosis of symptomatic PAD was made using a symptom-based questionnaire and signs of PAD determined by measuring the ankle brachial pressure index (ABPI) by means of a handheld Doppler and sphygmomanometer. Risk factors were determined using the coded questionnaire and related to the occurrence and severity of PAD. Results: The prevalence of PAD among recruited participants was 71%. Twenty-eight per cent of participants with PAD in the index limb also showed signs of PAD in the other limb. The diagnosis of PAD was made in 71%, using ABPI, and 13%, using ECQ. Twenty-seven per cent of patient with hypertension, seventeen per cent with diabetes and all patients with hypercholesterolemia were not on any form of medication. Conclusion: There is a high prevalence of PAD among patients undergoing lower extremity amputation at the KBTH. The majority of PAD patients presented with moderate to severe PAD. Instituting measures to identify and control risk factors of PAD may reduce this high burden.Item Current Challenges with their Evolving Solutions in Surgical Practice in West Africa: A Reader(Current Challenges with their Evolving Solutions in Surgical Practice in West Africa: A Reader, 2013) Archampong, E.Q.; Essuman, V.A.; Dakubo, J.C.B.; Clegg-Lamptey, J.N.Worldwide, there is a plethora of study materials in the form of authoritative review articles on disease entities afflicting the Western world but relatively few publications exploring similar problems confronting the developing countries, where resource limitation adds an extra dimension to the challenges facing the clinician. The contributions in this Reader address common surgical challenges and what measures have evolved to countenance these problems. This therefore addresses �Current Surgical Practice�, placing emphasis on the principles underlying the consensus opinions prevailing in surgical management. The approach is practical, avoiding the minutiae of procedures for which appropriate references detailing such information are provided. The contributions have come from a broad suave of critical management problems in the salient fi elds of surgery. Regrettably some urgent areas of public interest are not covered but it is clear that this volume represents the beginning of a process, yea, the initiation of an epoch of Recent Advances in Surgical Practice; we are confi dent that such yawning gaps in coverage would soon be made good by subsequent developments, stimulated by issuance of this publication.Item Current global developments in breast cancer and management in Ghana(Current Challenges with their Evolving Solutions in Surgical Practice in West Africa: A Reader, 2013) Clegg-Lamptey, J.N.; Vanderpuye, V.In lieu of an abstract, here is a brief excerpt of the content: •19• Chapter 3 Current Global Developments in Breast Cancer and Management in Ghana J. N. Clegg-Lamptey and V. Vanderpuye Introduction Breast cancer is the leading female malignancy in the world with about one million new cases diagnosed annually, over 400,000 annual deaths and about 4.4 million women living with the disease.1 In Ghana it is one of the leading cancers in all institutional data, constituting 16 percent of all cancers from the pathology records of the Korle Bu Teaching hospital and 28 percent of presenting cases at the Radiotherapy Centre of the same hospital. The management of the disease is however continually changing and it is necessary to alter management strategies from time to time in the light of current clinical evidence. In this chapter we will look at some of the current developments and trends in breast cancer management. We will also discuss some established current practice that, in our view, is not yet manifest in our practice in Ghana. General developments a. Multidisciplinary team work Breast cancer used to be managed solely by the surgeon whose word was final. Currently this method is outmoded. Management decisions are now so complex, taking into consideration a variety of factors and involving other specialties, that it is not advisable to leave them in the hands of a single decision maker including the physician. It is now widely accepted that multidisciplinary teams (MDTs) form the basis for best practice in the management of breast disease.2 Multidisciplinary team work was appropriately the first key recommen- •20• Chapter 3 dation of the National Institute for Clinical Excellence (NICE) in the United Kingdom.3 Their recommendations were as follows: • All patients with breast cancer should be managed by multidisciplinary teams and all multidisciplinary teams should be actively involved in network-wide audit of processes and outcomes. • Multidisciplinary teams should consider how they might improve the effectiveness of the way they work. The recommended team is made up of all key players in the patient’s management, namely the surgeon, breast care nurse, pathologist, radiologist , radiation oncologist, medical oncologist, psychologist, clinical pharmacist, plastic/reconstruction surgeon and the social worker. Other specialties may form part of the team based on local circumstances: a clinical psychologist and clinical pharmacist play a very important role in the breast MDT at the Korle Bu Teaching Hospital. Patients should be considered members of the team and their views considered in arriving at management decisions. The guidelines by the Association of Breast Surgery, Royal College of Surgeons of England suggest two teams, a diagnostic team and a management team2 In the Korle Bu Teaching Hospital, a MDT runs a ‘Breast Clinic’ every Tuesday. A tumour board is also run at the Komfo Anokye Teaching Hospital. These teams discuss patients with breast cancer and reach consensus about treatment. Often patients are brought to the meeting, examined and discussed. b. Patient -centred care Breast cancer is a heterogeneous disease and management should be individualized, taking the circumstances of each patient into consideration . Many factors, including the pathology of the disease, stage and quality of life issues have to be considered. In developing countries, the availability of resources and sometimes the high cost of some forms of treatment influence management decisions to a large extent4 . c. Use of protocols To prevent arbitrariness, agreed protocols should guide patient management. Protocols should be based on current global clinical evidence, evidence from local practice, peculiarities of local practice •21• Current Global Developments in Breast Cancer and Management in Ghana and any on-going clinical trials as this will most likely lead to optimal outcomes5 . d. Clinical trials Breastunitsareencouragedtosupportclinicalresearchandareexpected to participate in multicentre studies aimed at improving treatment for breast cancer. There is some evidence that patients treated in clinical trials have improved outcomes.6 In spite of difficulties in obtaining funding for research, developing countries need to carry out clinical trials of their own. This is because genetic, social, demographic, environmental, and geographic attributes affect outcomes across countries and communities.7 Diagnosis of breast cancer a. Current developments in screening: Screening for cancer has become a standard of practice in contemporary health care.8 Mammographic screening has been shown to be effective. Indeed, the Cochrane 2006 report estimates a 15percent relative risk reduction following mammographic screening.9 Breast -self examination has, however, not been found to have a similar benefit in reducing mortality from breast cancer.10 The current recommendations are biennial screening mammography for women aged 50 to 74...Item Current Global Developments in Breast Cancer and Management in Ghana(2013-12-09) Clegg-Lamptey, J.N.; Vanderpuye, V.Breast cancer is the leading malignancy globally, and one of the leading cancers in Ghana. Global developments in the management of breast cancer have led to better patient management. These include the use of multidisciplinary teams (MDTs) in the formulation of management plans. These teams form the basis for best practice in the management of breast disease, and there are attempts to incorporate them in the management of Breast cancer in the two main treatment centres in Ghana. Others include the concept of patient-centred care, use of protocols and clinical trials. Developments in mammographic screening have not been reproduced in developing countries like Ghana for many reasons. These include the absence of mammographic facilities and the relatively young age of patients. A suggested programme that involves Clinical Breast examination, Breast self examination and opportunistic screening has been recommended. Triple assessment remains the basis for diagnosis. Of the various means of biopsy now possible, methods for taking biopsy of non-palpable lesions need to be developed in Ghana, since more patients now have mammograms with some of them reporting with non-palpable abnormalities There have been advances in treatment: surgery, radiotherapy and chemotherapy. Biological therapy in the treatment of patients with HER2 receptor overexpression is often hindered by the high cost of treatment. Generally, Breast cancer management in Ghana has kept pace with global developments. The young age breast cancer patients in Ghana, sociocultural differences and financial limitations require some modifications in the approach of the management of this condition in our country.Item Department of surgery profile(Current Challenges with their Evolving Solutions in Surgical Practice in West Africa: A Reader, 2013) Clegg-Lamptey, J.N.In lieu of an abstract, here is a brief excerpt of the content: •1• Department of Surgery Profile Chapter 1 Department of Surgery Profile J. N. Clegg-Lamptey The Department of Surgery was one of the first Departments established in the University of Ghana Medical School. The Clinical Department currently spans the main six-storey Surgical Block, Cardiothoracic Centre, National Burns Plastic and Reconstruction centre, Accident Centre and Allied Surgery wards of the Korle Bu Teaching Hospital. It is arguably the largest department in the University of Ghana, with a teaching staff strength of 49. The Department boasts a unique blend of many generations of teachers. They include some of the pioneers who established the Department ( Professors E. A. Badoe and E.Q. Archampong) and others such as Dr. B. A. Kuma and Prof. E. D. Yeboah who have taught for many decades and trained generations of teachers and students. Their rich experience and dedication combined with the youthful dynamism and technological savvy of some of the very young teachers have greatly enriched the Department. SomepastseniormembershaveputGhanaontheworldmapthrough their innovations and achievements. They include Prof. Kwashie Quartey (who introduced the Quartey Urethroplasty operation), Prof. E. A. Badoe (Badoe intravenous fluid) and Prof. Frimpong-Boateng (First black African to carry out heart transplantation). Starting off with General Surgery, the Department has expanded into nine units that are currently striving to subspecialize: 1. General Surgery, 2. Plastic Surgery, 3. Trauma and Orthopaedic Surgery, 4. Urology, 5. Neurosurgery, 6. Cardiothoracic Surgery, 7. Paediatric Surgery, 8. Ophthalmology, 9. Ear, Nose and Throat surgery. •2• Chapter 1 The first Head of the Department was Professor Charles Easmon (in 1966) who also served as the first Dean of the Medical School. The Department has since had many illustrious heads: Prof. C. O. Easmon 1 January 1966 – 31 December 1971 Prof. E. A. Badoe 1 January 1972 – 31March 1981 Prof. E. Q. Archampong 1 April 1981 – 31 March 1990 Prof. E. D. Yeboah 1 April 1990 – 30 September 1997 Prof. S. B. Naaeder 1 October 1997 – 31 December 2000 Prof. K. Frimpong-Boateng 1 January 2001 – 31 August 2002 Prof. R. Darko 1 September 2002 – 31 July 2008 Prof. A. A .J. Hesse 1 August 2008 – 31 July 2010 Prof. J. N. Clegg-Lamptey 1 August 2010 - Present Core Functions 1. Teaching/ Training The Department offers teaching and training of medical students in the University of Ghana Medical School during the three clinical years: First Clinical Year General Surgery, Paediatric Surgery, Urology, Neurosurgery, Orthopaedics & Trauma: Second Clinical Year ENT, Ophthalmology. Third Clinical Year General Surgery, Paediatric Surgery, Cardiothoracic Surgery, Plastic Surgery, Orthopaedic Surgery, Neurosurgery, Urology. We also offer training to students from other Schools and Postgraduate colleges: • Dental students from the University of Ghana Dental School; • Nursing students from School of Nursing; •3• Department of Surgery Profile • Postgraduate surgical trainees of the Ghana College of Physicians and Surgeons and the West African College of Surgeons; • Foreign medical students on Exchange and Elective programmes; • Foreign-trained doctors, in preparation for Ghana Medical & Dental Council examinations; • House officers and nursing interns. 2. Service The Department provides specialist consultancy and theatre services for referred surgical cases from all over the country and the West African subregion. Many senior members go on outreach programmes to various parts of the country, and some offer weekly breast screening to the public in the Korle Bu Teaching hospital. 3. Research The Department undertakes research in all its specialties and also does collaborative research with other institutions such as the University of Ghana, Ministry of Health, and external agencies. There is an active monthly Research Forum that promotes research in the department. Future Directions Teaching sites With the forthcoming relocation of the College of Health Sciences to Legon campus, the Department envisages that it will soon be operating from two main sites (Legon and Korle Bu) as well as the Military Hospital. We will explore the possibility of additional sites so that medical students can be taught more effectively in the light of increasing student numbers. Manpower development More strenuous efforts at recruiting young faculty will continue. The Department hopes to have young faculty in every unit who are motivated to develop their specialties. •4• Chapter 1 Young faculty will be trained in Israel under the programme to build a new Teaching Hospital at the Legon campus. We will also look for other avenues for young specialists to spend some time in highly specialized centres overseas in order to encourage sub-specialization. Academic degrees Senior members will actively encourage young specialists to aim at academic degrees...Item Eosinophilic enteritis--a diagnostic dilemma(West African journal of medicine, 2002-07) Clegg-Lamptey, J.N.; Tettey, Y.; Wiredu, E.K.; Kwawukume, E.Y.Eosinophilic enteritis is a rare condition of unknown aetiology, although it is generally believed to be due to intestinal allergy. It may mimic peptic ulcer, subacute (or chronic) intestinal obstruction, gastroenteritis, irritable bowel syndrome, and inflammatory bowel disease. The diagnosis is often difficult to make and most cases are only diagnosed after laparotomy/ laparoscopy and biopsy. It can be successfully treated with corticosteroids. We report a case of Eosinophilic enteritis in a 27 year old woman the symptoms of which appeared within six weeks of childbirth. With repeated episodes of abdominal pain, vomiting, occasional loose stools with weight loss, she was investigated and treated for many weeks in three hospitals without success. All investigations were inconclusive. Finally laparotomy revealed inflamed segments of small bowel, a biopsy of which showed Eosinophilic enteritis. The patient was subsequently treated successfully with Prednisolone.Item Experiences of Women with Advanced Breast Cancer: A Study at the Kumasi Metropolis(University of Ghana, 2013-06) Bonsu, A.B.; Aziato, L.; Clegg-Lamptey, J.N.The purpose of this study was to explore and describe the experiences of Ghanaian women living with advanced breast cancer in the Kumasi Metropolis. The study employed a qualitative exploratory descriptive design. A purposive sampling was used and data was saturated with 10 participants varying in age between 32 years and 65 years. All interviews were audio-taped and transcribed. Data was analyzed based on the techniques of content analysis. During the study, anonymity and confidentiality were ensured. Research supervisors audited data to ensure credibility. Eight major themes describing the participants‘ lived experiences emerged: impaired activities of daily living, malignant wound, body image, physiological effects, emotional reactions, support, coping, and lost hopes. The women indicated that they experienced distress because of concerns about body image and worries about the effect of stress on their illness. The stress emanated from fear of dying, fear of disease progression and debilitation, the loss of their future, and practical concerns. The women also experienced a decline in their daily activities due to physical symptoms of the illness and the side effects of the treatments. Most of the women had emotional, social, financial, and spiritual support from spouses, families, churches, work place, and health professionals. It was recommended that health care providers involved in breast cancer management need opportunities for training to enhance effective and holistic care of women diagnosed with the disease. Also, patients with advanced disease should be given multidisciplinary management by trained oncology and palliative care team.Item Gastro-duodenal peptic ulcer perforation.(East African Medical Journal, 2009) Dakubo, J.C.B.; Naaeder, S.B.; Clegg-Lamptey, J.N.OBJECTIVES: To determine the epidemiology of, and define the morbidity and mortality factors following emergency surgery for patients with perforated peptic ulcer disease in Accra, Ghana. DESIGN: A retrospective and prospective hospital-based study. SETTING: The general and paediatric surgical wards of the Korle-Bu Teaching Hospital. MAIN OUTCOME MEASURES: Demography, the systolic BP, pulse rate and haemoglobin on admission at ER, co-morbid conditions, site of perforation, surgical method and treatment outcome. SUBJECTS: A total of 326 cases treated for peptic ulcer perforation, 267 males and 59 females; ratio 4.5:1, with mean age of 40.9, SD 16.4 and range 4-87 years, were studied. RESULTS: The incidence of peptic ulcer perforation rose from 1.6% in 1998 to 5.3% in 2002 and stabilised at 5%, and overall accounted for 4.6% of acute abdomen. Co-morbid conditions were present in 48 (18.2%) of cases. Ulcerogenic substance intake was in 177 (67%) patients. One hundred and twenty two (46.2%) patients reported to hospital within 24 hours of perforation. There were 287 (88%) duodenal, 22 (7.1%) prepyloric, and 19(4.9%) type 1 gastric ulcer perforations. Simple closure with omental patch was performed in 299 (94.3%), truncal vagotomy and drainage in 10 (3.2%), and Billroth II partial gastrectomy in seven (2.2%). Post-operative complications occurred in 62 (19%); overall mortality was 36 (11%). Logistic regression analysis of the patients clinical variables showed that age less that 60 years (p-value, OR and 95% CI; 0.002, 3.964 and 1.668-9.420), duration of perforation of more than 24 hours before admission (p-value, OR and 95% CI; 0.011, 2.471 and 1.228-4.971), alcohol intake (p-value, OR and 95% CI; 0.009, 2.543 and 1.259-5.135) and resectional surgery (p-value, OR and 95% CI; 0.000, 8.25E and 74204908.138-9162648048.1) were statistically significant in determining postoperative complications. Age 60 years and above (p-value, OR and 95% CI; 0.018,4.359 and 1.284-14.802), alcohol intake (p-value, OR and 95% CI; 0.042, 3.238 and 1.046-10.021) and resectional surgery (p-value, OR and 95% CI; 0.000, 1.20E and 938112920.94-1.54E+ 11) were the factors that showed statistical significance in determining post-operative mortality. CONCLUSION: Perforated peptic ulcer disease is emerging as a frequent cause of acute abdomen in our centre and affects the youth commonly. Age 60 years and above, duration of perforation for more than 24 hours before admission, alcohol intake and resectional surgery were the variables that showed statistical significance in predicting post-operative morbidity and/or mortality.Item Impact of childhood and adolescence cancer on family caregivers: a qualitative analysis of strains, resources and coping behaviours(BMC Psychology, 2023) Mensah, A.B.B.; Nunoo, H.; Clegg-Lamptey, J.N.; et al.Background The physical demands of caring for children and adolescents diagnosed with cancer, over a lengthy period, exert significant strain on the health and well-being of family caregivers. The capacity of family caregivers to surmount and cope with the various strains they experience due to the diagnosis and treatment trajectory is essential to the quality of life of the child and adolescent who has been diagnosed with cancer. However, the experiences of family caregivers have been under-explored. This study explored the strains, resources, and coping strategies of family caregivers of children and adolescents diagnosed with cancer in Ghana. Methods Guided by a descriptive phenomenological design, 20 semi-structured interviews with family caregivers were conducted at a tertiary health facility that provides paediatric oncology services. The study was conducted between June and October 2022. The interviews were transcribed verbatim, translated and coded using NVivo software. An inductive thematic analysis approach using Vaismoradi et al.’s thematic analysis framework was followed in analysing the data. Results The study revealed that family caregivers of children diagnosed with cancer experienced three main strains: somatic strains (poor sleep quality, loss of appetite, and unintended weight loss), economic strains (financial burden and loss of economic livelihood), and psychosocial strains (isolation from social activities and network, frustration and helplessness, and balancing multiple family needs). The following themes emerged as coping resources: family cohesiveness, community support, and support from health care providers. Coping strategies that emerged included trusting in God and being self-motivated. Conclusion The study concludes that family caregivers experience somatic, economic, and psychosocial strains. However, they can leverage available resources (family cohesiveness, community support, and support from healthcare providers) to cope with these strains. There is a need to educate and sensitize family caregivers about the potential strains that they are likely to experience prior to the assumption of care roles. Also, the formal inclusion of non-governmental organizations and religious bodies will ensure that family caregivers receive sufficient community support to cope with the strains of caregivingItem Pattern of breast diseases in Accra: review of mammography reports.(Ghana medical journal, 2013-09) Brakohiapa, E.K.; Armah, G.E.; Clegg-Lamptey, J.N.; Brakohiapa, W.O.To document the mammographic patterns in females seeking medical attention in Accra. An analytic retrospective study was conducted using data extracted from mammography request forms and corresponding radiological reports of 180 females. The radiology departments of Korle-Bu Teaching Hospital the Trust Hospital and Medical Imaging Ghana all located in Accra. One hundred and eighty radiologic request forms for mammographic evaluations and their corresponding reports from the study period were reviewed. The mean age of the study population was 48.7 years (SD=10.0), and the median age group was the 41-50 group. There were more screening mammography evaluations (115 examinations) than diagnostic mammography evaluations (65 examinations). Most of the cases diagnosed as breast cancer were in the age group 41-50 years. Benign lesions were commoner than cancer (55 and 16 cases respectively). The commonest presenting complaint was of pain. The larger number of screening mammographic evaluations conducted for asymptomatic females during the study period, as compared to diagnostic mammographic evaluations for symptomatic females, suggests that educational programs on early breast cancer detection are having a positive impact on the target population. The observation that 22.8% of lesions had features suggestive of breast cancer in the study is significantly high to also warrant intensification of the existing awareness programs. As non-specific masses were the most common radiographically observed lesions, hospitals equipped with sonography and biopsy facilities that compliment their mammography are better suited for thorough breast disease evaluation.Item Position and susceptibility to inflammation of vermiform appendix in Accra, Ghana(East African Medical Journal, 2006) Clegg-Lamptey, J.N.; Armah, H.; Naaeder, S.B.; Adu-Aryee, N.A.OBJECTIVES: To determine the normal (non-inflamed) position of the vermiform appendix in Ghana and carry out a pilot study to test the hypothesis "The retrocaecal appendix is less prone to inflammation". DESIGN: Retrospective autopsy study. SETTING: The pathology department and the department of surgery theatres of the Korle Bu Teaching hospital in Accra, Ghana SUBJECTS: Consecutive autopsies and inflamed appendices at appendicectomy. Deaths occurring from untreated appendicitis were excluded from the autopsy study. Conversely non-inflamed appendices and appendices from interval appendicectomy were excluded from the appendicitis study. RESULTS: There were 1358 autopsies and 323 inflamed appendices. In the autopsy study the retrocaecal position was the most common (914 [67.3%]). Other positions were pelvic (294 [21.6%]), preileal (66 [4.9%]), postileal (51 [3.8%]) and paracaecal (33 [2.4%]). These positions were similar in males and females. The positions of 323 inflamed appendices were: retrocaecal (183 [56.7%]), pelvic (66 [20.4%]), preileal (20 [6.2%]), postileal (15 [4.6%]) and paracaecal (39 [12.1%]). Comparing the nonretrocaecal to the retrocaecal position by chi square, the non-retrocaecal position was more prone to inflammation (p<0.001). CONCLUSION: The position of the normal appendix in Ghana differs from Western literature. The retrocaecal position appears less prone to inflammation in Ghanaians.Item Recruiting population controls for case-control studies in sub-Saharan Africa: The Ghana Breast Health Study(PLoS ONE, 2019-04) Nyante, S.J.; Biritwum, R.; Figueroa, J.; Graubard, B.; Awuah, B.; Addai, B.W.; Yarney, J.; Clegg-Lamptey, J.N.; Ansong, D.et.al.Background In case-control studies, population controls can help ensure generalizability; however, the selection of population controls can be challenging in environments that lack population registries. We developed a population enumeration and sampling strategy to facilitate use of population controls in a breast cancer case-control study conducted in Ghana. Methods Household enumeration was conducted in 110 census-defined geographic areas within Ghana’s Ashanti, Central, Eastern, and Greater Accra Regions. A pool of potential controls (women aged 18 to 74 years, never diagnosed with breast cancer) was selected from the enumeration using systematic random sampling and frequency-matched to the anticipated distributions of age and residence among cases. Multiple attempts were made to contact potential controls to assess eligibility and arrange for study participation. To increase participation, we implemented a refusal conversion protocol in which initial non-participants were re-approached after several months. Results 2,528 women were sampled from the enumeration listing, 2,261 (89%) were successfully contacted, and 2,106 were enrolled (overall recruitment of 83%). 170 women were enrolled through refusal conversion. Compared with women enrolled after being first approached, refusal conversion enrollees were younger and less likely to complete the study interview in the study hospital (13% vs. 23%). The most common reasons for non-participation were lack of interest and lack of time. Conclusions Using household enumeration and repeated contacts, we were able to recruit population controls with a high participation rate. Our approach may provide a blue-print for others undertaking epidemiologic studies in populations that lack accessible population registries.Item Supportive and palliative care for metastatic breast cancer: Resource allocations in low- and middle-income countries: A breast health global initiative 2013 consensus statement(Breast, 2013-10) Cleary, J.; Ddungu, H.; Distelhorst, S.R.; Ripamonti, C.; Rodin, G.M.; Bushnaq, M.A.; Clegg-Lamptey, J.N.; Connor, S.R.; Diwani, M.B.; Eniu, A.; Harford, J.B.; Kumar, S.; Rajagopal, M.R.; Thompson, B.; Gralow, J.R.; Anderson, B.O.Many women diagnosed with breast cancer in low- and middle-income countries (LMICs) present with advanced-stage disease. While cure is not a realistic outcome, site-specific interventions, supportive care, and palliative care can achieve meaningful outcomes and improve quality of life. As part of the 5th Breast Health Global Initiative (BHGI) Global Summit, an expert international panel identified thirteen key resource recommendations for supportive and palliative care for metastatic breast cancer. The recommendations are presented in three resource-stratified tables: health system resource allocations, resource allocations for organ-based metastatic breast cancer, and resource allocations for palliative care. These tables illustrate how health systems can provide supportive and palliative care services for patients at a basic level of available resources, and incrementally add services as more resources become available. The health systems table includes health professional education, patient and family education, palliative care models, and diagnostic testing. The metastatic disease management table provides recommendations for supportive care for bone, brain, liver, lung, and skin metastases as well as bowel obstruction. The third table includes the palliative care recommendations: pain management, and psychosocial and spiritual aspects of care. The panel considered pain management a priority at a basic level of resource allocation and emphasized the need for morphine to be easily available in LMICs. Regular pain assessments and the proper use of pharmacologic and non-pharmacologic interventions are recommended. Basic-level resources for psychosocial and spiritual aspects of care include health professional and patient and family education, as well as patient support, including community-based peer support. © 2013 The Authors.Item Utilisation Of Traditional Medicine Among Women Diagnosed With Breast Cancer In Ghana: A Descriptive Phenomenological Study(BMC Complementary Medicine and Therapies, 2024) Mensah, A.B.B.; Asuo, S.B.; Clegg-Lamptey, J.N.; et al.Background: Women living with breast cancer (BC) rely on traditional medicine (TM) in addition to orthodox medicine. There is a need to understand how and why women diagnosed with BC utilise TM. This study explored and described the lived experiences of women living with BC in terms of their utilisation of traditional medicine. Methods A descriptive phenomenology design was used to purposefully conduct 20 face-to-face, in-depth interviews using a semi-structured interview guide. The data were analysed using NVivo-12 based on Collaizzi’s framework for thematic data analysis. Results Overall, five main themes emerged, namely: sources of knowledge on TM, motivations for using TM, treatment modalities, timing for the initiation of TM, the reasons for discontinuing use of TM, and the decision to seek orthodox medicine. Under the category of motivations for using TM, four themes emerged: financial difficulties and perceived cost effectiveness of TM, influence of social networks, including family and friends, assurance of noninvasive treatment, delays at the healthcare facility, and side effects of orthodox treatment. Non-invasive treatments included herbal concoctions, natural food consumption, and skin application treatments. Regarding the timing of initiation, TM was used in the initial stage of symptom recognition prior to the decision to seek orthodox medicine. and was also used complementarily or as an alternative after seeking orthodox medicine. However, patients eventually stopped using TM due to the persistence of symptoms and the progression of cancer to a more advanced stage, and disapproval by orthodox practitioners. Conclusion Women living with BC in Ghana utilise traditional medicine (TM) for many reasons and report their family, friends, and the media as a main source of information. A combination of herbal concoctions and skin Application modalities are obtained from TM practitioners to treat their BC. However, they eventually discontinue TM when symptoms persist or when disapproval is expressed by their orthodox healthcare providers. We conclude that There is an opportunity to better integrate TM into the standard of oncological care for BC patients.