Research Articles
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A research article reports the results of original research, assesses its contribution to the body of knowledge in a given area, and is published in a peer-reviewed scholarly journal. The faculty publications through published and on-going articles/researches are captured in this community
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Item The pathologist in Ghana and potential for research(Ghana Medical Journal, 2018-06) Anim, J.T.One of the neglected areas of clinical medical practice in developing countries is the field of Laboratory Medicine. As a result, the important role of the laboratory physician in diagnosis of disease and subsequent management of patients is not much appreciated. Even more worrying is lack of appreciation of the research potential of laboratory medicine, considering that it provides a repository of confirmatory data on many human disorders; data that have been usefully employed for the study of various diseases in developed parts of the world. It is perhaps, the reason that many diseases peculiar to developing countries still remain untamed. My experience in the practice of anatomical pathology in several countries has taught me that the specialty, as with other specialties of laboratory medicine in Ghana needs more attention, with regards to its development to the level where it can meet its clinical functions satisfactorily. When this is ensured, it would also provide the necessary vital contribution to research that has characterised its practice in more advanced countries. More exposure of the specialty to undergraduate medical students must be encouraged in order to attract trainees into the specialty. Along with this exposure must go an increase in infrastructure and the necessary facilities to permit growth of the specialty. Research potential of the specialty must be harnessed and fully supported financially to help in unravelling peculiar disease problems of our locality. To achieve this, I have re-emphasised the need for a special fund to drive scientific research in GhanaItem Carcinoma of the pancreas: A review of autopsy material at the Korle Bu Teaching Hospital for the period 1972-1981.(Ghana Medical Journal, 1988-06) Dankwa, K.E.; Anim, J.T.A retrospective study of autopsies has been carried out and this shows the death rate from pancreatic carcinoma to be 5.8% of all cancer deaths in the Korle Bu Teaching Hospital Mortuary between the period 1972-1981. This relatively high incidence would lend support to findings of other studies which indicate that the disease is more common in US blacks and some parts of Africa. The high case fatality rate as found in our hospital-based cancer registry coupled with the increasing trend in females in recent years indicate that the disease requires a closer study from the point of view of aetiology and natural history in Ghana. The greater preference to the head of the pancreas would obviously pose problems to effective managementItem Towards an Improved Pathology Service in Ghana(Ghana medical journal, 2013-03) Anim, J.T.Pathology service in Ghana is still in its infancy due to inadequate personnel (Pathologists) and a poor perception of the role of the pathologist in health care delivery. The state of affairs in Ghana may be partly blamed on an accident of history, the anomaly resulting from which has been allowed to become the norm. In the days of the colonial administration of the Gold Coast, as a result of non-availability of forensic doctors, hospital pathologists, and in some cases other medical officers, performed medico-legal autopsies for the Coroner. The first health care laboratory in the then Gold Coast was the Accra Laboratory which was established around 1900. It subsequently, underwent improvements, including relocation in the 1920s, to the newly constructed Korle Bu Hospital. Its main function was to undertake research into tropical diseases, but it also carried out routine diagnostic laboratory work, including autopsies, both hospital and medico-legal.Item Pregnancy Related Causes of Deaths in Ghana: A 5-Year Retrospective Study(Ghana medical journal, 2013-12) Der, E.M.; Moyer, C.; Gyasi, R.K.; Akosa, A.B.; Tettey, Y.; Akakpo, P.K.; Blankson, A.; Anim, J.T.Objective: Data on maternal mortality varies by region and data source. Accurate local-level data are essential to appreciate its burden. This study uses autopsy results to assess maternal mortality causes in southern Ghana. Method: Autopsy log books of the Department of Pa-thology, Korle-Bu Teaching Hospital Mortuary were reviewed from 2004 through 2008 for pregnancy relat-ed deaths. Data were entered into a database and ana-lyzed using SPSS statistical software (Version 19). Results: Of 5,247 deaths among women aged 15-49, 12.1% (634) were pregnancy-related. Eighty one per-cent of pregnancy-related deaths (517) occurred in the community or within 24 hours of admission to a health facility and 18.5% (117) occurred in a health facility. Out of 634 pregnancy-related deaths, 79.5% (504) re-sulted from direct obstetric causes, including: haemor-rhage (21.8%), abortion (20.8%), hypertensive disor-ders (19.4%), ectopic gestation (8.7%), uterine rupture (4.3%) and genital tract sepsis (2.5%). The remaining 20.5% (130) resulted from indirect obstetric causes, including: infections outside the genital tract, (9.2%), anemia (2.8%), sickle cell disease (2.7%), pulmonary embolism (1.9%) and disseminated intravascular coag-ulation (1.3%). The top five causes of maternal death were: haemorrhage (21.8%), abortion (20.7%), hyper-tensive disorders (19.4%), infections (9.1%) and ectop-ic gestation (8.7%). Conclusion: Ghana continues to have persistently high levels of preventable causes of maternal deaths. Com-munity based studies, on maternal mortality are urgent-ly needed in Ghana, since our autopsy studies indicates that 81% of deaths recorded in this study occurred in the community or within 24 hours of admission to a health facility.Item Autopsy Practice in Ghana — Reflections of a Pathologist(Ghana Medical Journal, 2015-06) Anim, J.T.Autopsy practice in Ghana can be said to be far from satisfactory. Most Ghanaians do not know that there are different categories of death, which categories of death require an autopsy and who is required to perform the autopsy. The problems have further been complicated by the fact that, unlike other countries where separate facilities are available for storage of the different categories of dead bodies, all dead bodies in Ghana are conveyed to the hospital mortuary, thus encouraging hospitals to expand body storage facilities in their mortuaries to meet the increasing demand. Public or community mortuaries used elsewhere for storage of bodies of deaths occurring in the community pending the Coroner's directions are non-existent in Ghana. Storage of all categories of dead bodies in hospital mortuaries has resulted in virtually all autopsies being done by the hospital pathologists, especially in the large centres, at the expense of other very important diagnostic functions of the pathologist. This paper explains relevant portions of the Coroner's Act of 1960 and emphasises the need to separate the few hospital autopsies that require the expertise of the pathologist from Coroner's autopsies that may be carried out by any registered medical officer, as specified in the Act, or better still, by specially trained Forensic Physicians/Medical Examiners, as pertains in other countries. The paper also clarifies the different categories of death, those that fall in the jurisdiction of the Coroner and the personnel required to assist the Coroner in his investigastions. Suggestions have also been made on how to approach manpower development to ensure that appropriate personnel are trained to assist the Coroner in the investgation of medico-legal cases.Item Ovarian Cancer in Ghana, a 10 Year Histopathological Review of Cases at Korle Bu Teaching Hospital(African Journal of Reproductive Health, 2015-12) Akakpo, P.K.; Derkyi-Kwarteng, L.; Gyasi, R.K.; Quayson, S.E.; Anim, J.T.To determine the histopathological types, age distribution, presenting signs and symptoms of ovarian cancers diagnosed at the Korle-Bu Teaching Hospital, Ghana. All histopathology slides and request cards of ovarian cancers diagnosed over a ten-year period (2001 to 2010) were reviewed and the cancers classified according to the World Health Organization 1999 classification. Biographical and clinical data of the patients were collected and results entered into Epi-info to determine the frequency, age distribution and clinical presentation of the various types of ovarian cancer. There were 192(27.2%) ovarian cancers out of 706 ovarian tumours. Epithelial cancers were the most common: 100 (52.1%), followed by sex cord stromal cancers 66 (34.4%). Majority of epithelial cancers were serous adenocarcinomas (71/100) while most sex cord stromal cancers were adult granulosa cell tumours 46 (69.7%). The mean age of patients with adenocarcinoma was 49 years while that of the 46 adult granulosa cell tumours was 46.5years. Patients present with varying combinations of symptoms and signs and ovarian cancers present at an earlier age compared to other populations, with the age of presentation being slightly lower for sex cord stromal cancers compared to adenocarcinomas. There are no specific symptoms or signs associated with ovarian cancer at presentation, to assist with diagnosis. (Afr J Reprod Health 2015; 19[4]: 102-106).Item Lithium protects against toxic effects of cadmium in the rat testes(Journal of Assisted Reproduction and Genetics, 2010-08) Al-Azemi, M.; Omu, F.E.; Kehinde, E.O.; Anim, J.T.; Oriowo, M.A.; Omu, A.E.Purpose: To investigate the protective effect of Lithium against the toxic effect of Cadmium in the rat testes. Methods: Twenty four adult male Sprague-Dawley rats were treated with four different regimens: Cadmium only, Cadmium and lithium, lithium only and controls. Rats were sacrificed after 6 weeks and testicular levels of pro-inflammatory cytokine (IL-4), anti-inflammatory cytokine (TNF-α), Pro-apoptotic protein (Bax) and anti-apoptotic protein (Bcl-2) were measured by ELISA while serum levels of FSH, LH, Prolactin and Testosterone were measured using the Vidas parametric system. Antioxidant status (MDA, SOD) was also assessed in serum. Histopathological changes of testes were examined using light and electron microscopy. Immunohistochemical staining for Bax, Bcl-2 and Caspase 3 were performed. Results: Treatment with lithium was associated with significant reduction in the toxic effects of Cadmium as shown by reduced testicular levels of TNF-α, serum levels of Malondialdehyde and testicular level of Bax, and increased levels of IL-4, Zn-Cu SOD, Bcl-2 and Testosterone. Testicular histopathology showed that Cadmium produced an extensive germ cells apoptosis and the addition of lithium in Cadmium-treated rats significantly reduced cadmium-induced testicular damage. Conclusion(s): Lithium has a protective effect against cadmium-induced testicular apoptosis in the rat.Item Percutaneous pericardial biopsy: Technique, efficacy, safety, and value in the management of pericardial effusion in children and adolescents(Pediatric Cardiology, 1997-11) Uthaman, B.; Endrys, J.; Abushaban, L.; Khan, S.; Anim, J.T.This study describes our technique of nonsurgical percutaneous pericardial biopsy (PPB) its efficacy and safety, and its diagnostic and therapeutic usefulness in the management of pericardial effusion (PE) in children and adolescents. In an 8-year period, 19 selected patients, aged 2 to 20 years, had PPB for evaluation and treatment of PE. Using this procedure we procured multiple biopsy specimens from various areas of the thickened parietal pericardium, and also procured pericardial fluid for investigation. The biopsy material helped establish a specific etiologic diagnosis in 63% and helped II exclude tuberculosis and malignancy in the rest (37%). The histopathologic diagnoses were tuberculous pericarditis (37%) uremic pericarditis (16%) radiation pericarditis (5%), connective tissue disease (5%), and idiopathic pericarditis (37%). In tuberculous pericarditis, the biopsy specimen provided an immediate histopathologic diagnosis and a higher culture positivity (71%) than pericardial fluid (29%). In addition the procedure was therapeutically effective in relieving tamponade and in treating effusion. Our experience indicates that the PPB procedure has both diagnostic and therapeutic value and it can be performed easily, safely, and without complications even in small children.Item Relative contribution of digital rectal examination and transrectal ultrasonography in interpreting serum prostate-specific antigen values for screening prostate cancer in Arab men(Annals of Saudi Medicine, 2007-03) Sheikh, M.; Sinan, T.; Kehinde, E.O.; Hussein, A.Y.T.; Anim, J.T.; Al-Hunayan, A.A.Background: This study was conducted to determine the utility of digital rectal examination (DRE), transrectal ultrasonography (TRUS) and serum prostate-specific antigen (PSA) in the diagnosis of prostate cancer in men in Arabia, an are of the world with a relatively low incidence of this disease. Patients and methods: 329 patients suspected of having prostate cancer on account of raised serum PSA level (> 4 ng/ml), DRE or TRUS findings, underwent TRUS-guided prostate biopsy. Raised PSA individually as well as combined, or a lesion suspicious of carcinoma on DRE or TRUS was recorded as PSA (+), DRE (+) or TRUS (+), respectively. The contribution of DRE, TRUS and serum PSA to the diagnosis of prostate cancer was analysed. Results: Of the 329 patients who had prostate biopsies 109 cases (33.1%) had PCa. Of these 109 patients 56 (51 %) had DRE (+), 77 (42%) had TRUS (+) and 49 (66%) had both DRE (+) and TRUS (+). Statistical analysis revealed that DRE (+) tripled the probability for cancer. PSA over a range of 10-50 ng/mL demonstrated an increasing cancer probability ranging from 2 to 3 fold. TRUS (+) was only significantly associated with cancer risk if PSA was elevated. The presence of all three factors increased the cancer probability by 6 to 7 fold. Conclusion: TRUS findings are dependent on PSA for interpretation while DRE (+) with elevated PSA makes PCa more likely.Item Patients' tolerance and early complications of transrectal sonographically guided prostate biopsy: Prospective study of 300 patients(Journal of Clinical Ultrasound, 2005-12) Sheikh, M.; Hussein, A.Y.T.; Kehinde, E.O.; Al-Saeed, O.; Rad, A.B.; Ali, Y.M.; Anim, J.T.Purpose. To determine the degree of pain and discomfort associated with transrectal sonography (TRS)-guided biopsy of the prostate and to analyze the complications associated with this procedure. Methods. Three hundred men referred as part of an investigation to exclude prostate cancer were studied. The reasons for referral were suspected prostate cancer due to increased serum prostate-specific antigen level (>4 ng/ml), the finding of a palpable nodule or greater firmness of one prostatic lobe than the other on digital rectal examination, or the finding of a suspicious area of neoplasm of the prostate on TRS biopsy. All TRS-guided biopsies were performed as outpatient procedures without anesthesia. Ciprofloxacin prophylaxis was used in all patients before biopsy. Tolerance of the procedure was recorded immediately after the examination and graded on a scale of 0-4 as follows: 0, no pain; 1, very mild pain; 2, moderate pain; 3, severe pain; 4, intolerable pain. Complications recorded in the first week after the procedure were analyzed. They included mild pain, self-limiting hematuria, hematospermia, rectal bleeding, severe hematuria, septicemia, severe hemorrhage of the anus, and vasovagal attack. Results. Out of 300 TRS-guided biopsies, 10 early complications were recorded. The most frequent was septicemia, which was seen in 5 cases (1.7%). Hematuria occured in 29 patients, 3 of which were severe. Rectal bleeding and vasovagal attack occurred in 1 patient each. All patients made a full recovery with appropriate conservative management. Ten cases (3.33%) of severe pain (grade 3) and intolerable pain (grade 4) were observed. Three out of these 10 patients completed the procedure. The procedure was terminated in 1 patient, and 6 patients required local anesthetic due to perianal disease. Conclusions. TRS-guided prostate biopsy can be performed without local anesthesia in 90% of patients. Prophylactic antibiotics are mandatory to minimize approximately infectious complications.