School of Medicine and Dentistry
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Item Ambiguous genitalia: clinical management of adult female with male assigned gender: a case report(Journal of Medical Case Reports, 2021-07) Ali, M.A.; Donkor, Y.O.; Mensah, J.E.; Ayamba, M.Background: Disorders of sex development are anomalies in which the development of urogenital ridge is undif‑ ferentiated for the male and female child. Imaging plays a vital role in investigating the gross anatomy and associated anomalies. Ultrasonography, such as genitography and magnetic resonance, is the primary modality for demonstrat‑ ing internal gonads and genitalia. Early multidisciplinary approach in the management of ambiguous genitalia includ‑ ing early surgical intervention is the predominant practice, with few current considerations on deferral of genital reconstruction until adolescent age. Case presentation: We report the rare case of a 24-year-old adult female from a majority ethnic group of the Volta region, Ghana who was diagnosed and raised as male, now requiring surgical restoration to the female gender. The surgical team decided to assign external genitalia to correspond with the already intact internal organs, thus con‑ structing the vulva. Consent was given by the client and her family members for management and surgical interven‑ tion. The surgery was scheduled and duly performed with a successful outcome. Understanding and consent was sought from the patient for the purpose of using her images for teaching, scientific publication, and demonstrations. Conclusion: The advantages of deferring surgical reconstruction with psychological counseling after early assessment need to be considered to prevent inappropriate gender assignmentItem Ghana Medical Journal (Index of 1962-2013)(Ghana Medical Journal, 2014) Sackey, A.H.The Ghana Medical Journal (GMJ), a product of the Ghana Medical Association (GMA), was first published in September 1962. The first edition contained a message from Osagyefo Dr Kwame Nkrumah, President of Ghana and GMA patron, in which he expressed the hope that the “GMJ will afford the means of disseminating medical knowledge among yourselves and your colleagues throughout Africa and beyond”, and “May the pages of the Journal demonstrate the tireless efforts of medical men all over the world in the crusade against disease and ill health.”Item Highly Prevalent Hyperuricaemia Is Associated With Adverse Clinical Outcomes Among Ghanaian Stroke Patients: an Observational Prospective Study(Ghana Medical Journal, 2015-09) Sarfo, F.S.; Akassi, J.; Antwi, N.K.B.; Obese, V.; Adamu, S.; Akpalu, A.; Bedu-Addo, G.Background: Although a direct causal relationship between hyperuricaemia and stroke continues to be debated, strong associations between serum uric acid (SUA) and cerebrovascular disease exist. Very few studies have been conducted to evaluate the frequency and association between this potentially modifiable biomarker of vascular risk and stroke in sub-Saharan Africa. Therefore the aim of this study was to examine the association between hyperuricaemia and the traditional risk factors and the outcomes of stroke in Ghanaian patients. Methods: In this prospective observational study, 147 patients presenting with stroke at a tertiary referral centre in Ghana were consecutively recruited. Patients were screened for vascular risk factors and SUA concentrations measured after an overnight fast. Associations between hyperuricaemia and stroke outcomes were analysed using Kaplan-Meier and Cox proportional hazards regression analysis. Results: The frequency of hyperuricaemia among Ghanaian stroke patients was 46.3%. Non-significant associations were observed between hyperuricaemia and the traditional risk factors of stroke. SUA concentration was positively correlated with stroke severity and associated with early mortality after an acute stroke with unadjusted hazards ratio of 2.3 (1.4 - 4.2, p=0.001). A potent and independent dose-response association between increasing SUA concentration and hazard of mortality was found on Cox proportional hazards regression, aHR (95% CI) of 1.65 (1.14-2.39), p=0.009 for each 100μmol/l increase in SUA. Conclusions: Hyperuricaemia is highly frequent and associated with adverse functional outcomes among Ghanaian stroke patients. Further studies are warranted to determine whether reducing SUA levels after a stroke would be beneficial within our setting.Item Massive Inguino-scrotal Hernia(Management of Abdominal Hernias: Fifth Edition, 2018-04) Ohene-Yeboah, M.Introduction Inguinal hernia is very common worldwide. In low- and middle-income countries, the estimated repair rate is 30 per 100,000 population per year. Inguino-scrotal Hernia Definition. Kingsnorth H3 and H4 hernias that are 20–30 cm below the pubic crest are massive. Massive hernias are associated with loss of domain as abdominal contents lie in the hernia sac over time. These massive hernias often cause difficulty in walking, sitting or lying down, with mobility dramatically restricted. These hernias are repaired with the patient in the standard prone position with general anaesthesia and endotracheal intubation. The standard oblique groin incision that is extended 1 or 2 cm beyond the pubic tubercle onto the crest adequately exposes the mass of tissue entering the scrotum. Operative steps: The inguinal canal is opened in the standard manner. The internal ring is extended lateral, and the hernia is reduced. If this fails, an omentectomy and/or a colectomy is performed. The posterior wall is repaired with the Lichtenstein procedure. Preoperative progressive pneumoperitoneum and plastic techniques or procedures may be used to increase the capacity of the abdominal cavity and prevent postreduction intra-abdominal hypertension. Closure: The groin and the lower abdominal incisions are closed in the standard manner. Post-operative management: In the immediate post-operative hours, the blood pressure, the urine output and the nasogastric aspirate have to be closely monitored. Department of PsychiatryCollection Department of RadiologyCollection Department of Restorative DentistryCollection Department of SurgeryCollection Department of Medicine and TherapeuticsCollection