RESUMEN
Background: The ability to determine accurately, the blood loss during childbirth is of extreme importance in the diagnosis and management of primary postpartum haemorrhage (PPH). Aims: In this study, we evaluate the effectiveness of visual estimation of blood loss, as a method of diagnosing primary postpartum haemorrhage. Methodology: A cross-sectional study on 271 participants was conducted between April and October 2012, at the Komfo Anokye Teaching Hospital. Women who went through spontaneous vaginal delivery were monitored and blood loss after delivery was visually estimated and then measured with a graduated receptacle, up to 1 hour post-delivery. The paired t-test and Bland- Altman plot was used to compare outcomes of the two methods. P<0.05 was considered significant. Results: Mean age of study participants was 27.7±5.7. As per visual estimation, most participants were reported to have lost <200 ml of blood (45.0%) as opposed to that of measured losses where most participants had lost between 200-500 ml of blood (48.7%). The mean measured blood loss was 306.09±218.39 ml against a 250±188.78 ml mean visually estimated blood loss (P < 0.0001). Prevalence of primary PPH as estimated with measured blood losses was 20.3% (55/271). Visual estimation, however gave a prevalence of 15.9% (43/271), an underestimation by 4.4%. A Bland- Altman plot showed a clinical bias large enough to cause significant differences in diagnosis of primary PPH. Conclusion: This study adds to existing evidence that the visual estimation of blood loss in clinical settings underestimates losses and is not reliable. This can lead to misdiagnosis of primary PPH and thus an underestimation of the condition. Health care workers should therefore base diagnosis on calibrated measurement methods.
RESUMEN
Background: Prostate specific antigen (PSA) is useful in the diagnosis of prostate adenocarcinoma. Aims: Our study sought to establish possible effect of age and BMI on serum PSA levels in Ghanaian men with genitourinary complaints. Methods: In this non-randomized, cross-sectional study, we recruited 202 men from the Genitourology and pathology departments of the Korle-Bu Teaching Hospital (KBTH) and MDS-Lancet Laboratories Ghana, between July 2011 and February 2012. Height and weight were measured and body mass index (BMI) calculated for each participant. Serum PSA levels were measured and prostate biopsies from each of the participants were examined histologically for diagnosis. Results: The mean PSA level was 200 ng/ml, mean age of 66.33±8.90 years, and a BMI of 23 kg/m2. The mean Gleason score of all participants was 3.38±3.58 years. There was a positive correlation between age and PSA levels (r=0.020; P=.78). A negative correlation was established between BMI and PSA (r=-0.068; P=.33). There was however a significant positive correlation (r=0.237; P=.001) between PSA levels and Gleason score. Linear regression analysis revealed no relationship between PSA and age (r=0.002; P=.98) and, PSA and BMI (r=-0.068, P=.36). Conclusion: Serum PSA levels correlate with age and BMI, however these factors do not have an effect on the levels of serum PSA at measurement. We suggest that PSA values be used in the context of the clinical scenario and other PSA altering factors.