Delayed diagnosis of cardiac amyloidosis in a West African octogenarian.

Left ventricular hypertrophy (LVH) is a common finding on cardiac imaging. Although there are multiple aetiologies for LVH, hypertension is frequently a presumed cause due to its high prevalence in the African region. Establishing a specific cause of LVH however requires thorough clinical evaluation with multimodality cardiac imaging playing a key role in the diagnostic pathway. We report on a case of a West African octogenarian who was treated presumptively for heart failure with preserved ejection fraction from hypertensive heart disease, based on his initial clinical presentation and echocardiographic findings three years earlier. By adopting a stepwise approach to his evaluation, including revisiting the history, and the application of multimodality cardiac imaging, the patient was diagnosed with cardiac amyloidosis.

Quality of acute coronary syndrome care and in hospital outcome in a resource-poor setting in Northern Ghana

Introduction: African countries are facing an epidemic of cardiovascular diseases. Information on the quality of acute coronary syndrome care offered in underserved communities in Ghana is limited. Using objective criteria, we examined the quality of acute coronary syndrome care offered to patients presenting to a tertiary referral center in Northern Ghana. Methods: we conducted a retrospective review of patients ≥ 18 years old with acute coronary syndrome managed in Tamale Teaching Hospital. We assessed in-hospital outcomes and the extent of compliance to key performance and quality indicators as contained in the 2017 American Heart Association/American College of Cardiology guideline for adults with myocardial infarction. Results: sixty-two (62) patients with a mean age of 56.0 ± 16.1 years were recruited. The median delay to presentation was 24 hours (IQR 15-96 hours). 33.9% had ST-elevation myocardial infarction, of which only 14.3% received reperfusion therapy. About three-quarters of patients received dual antiplatelet therapy at discharge, with fewer patients receiving recommended high-intensity statin therapy (65.5%) or beta-blockers (69.1%). Only 38.2% of patients had their left ventricular ejection fraction documented. No cardiac rehabilitation program existed. Risk stratification of patients with non-ST-elevation myocardial infarction or stress testing for conservatively managed patients was not part of routine practice. Conclusion: acute coronary syndrome management remains a challenging issue in Northern Ghana. Several gaps exist in the care quality, timeliness of interventions and rehabilitation of affected patients. There is an urgent need for measures to improve the delivery of acute coronary syndrome care alongside primary prevention strategies.

Advancing the Cardiovascular Workforce in Africa to Tackle the Epidemic of Cardiovascular Disease: The Time is Now.

The African region is experiencing an epidemic of cardiovascular disease with dire consequences of increasing morbidity and mortality. Compared with high-income countries where older populations are most affected, the burden of CVD in Africa is higher in the younger populations, which hampers regional socioeconomic development. Strategies to increase and advance the cardiovascular workforce are urgently needed to help address this problem. This commentary highlights the critical lack of skilled cardiovascular healthcare professionals, including cardiologists, cardiac surgeons, and cardiovascular nurses in the African region. Multilevel viable solutions to advance the cardiovascular workforce in Africa based on successful models in Africa are also presented.

Electrical storm in a middle-aged man.

Electrical storm (ES) refers to a life-threatening condition characterised by three or more episodes of ventricular tachycardia (VT), ventricular fibrillation (VF), or appropriate implantable cardioverter defibrillator (ICD) shocks in 24 hours. We report a case of a 58-year-old man who suffered recurrent episodes of sustained VT despite appropriate defibrillation and antiarrhythmic drug therapy. On stepwise evaluation, arrhythmogenic right ventricular cardiomyopathy (ARVC) was considered the most likely substrate for his dysrhythmia. He was managed conservatively on antiarrhythmic drugs with no further clinical episodes of VT, and ICD implantation for secondary prophylaxis was recommended. Funding: None declared.

Outcome of life-threatening arrhythmias among patients presenting in an emergency setting at a tertiary hospital in Accra-Ghana.

BACKGROUND: Management of life-threatening arrhythmia can be incredibly challenging in advanced health systems. In sub-Saharan Africa (SSA), this is likely more challenging because of weak pre-hospital and in-hospital critical care systems. Little is known about life-threatening arrhythmia and their outcomes in SSA. The aim of this study was to examine the types and outcomes of arrhythmias among haemodynamically unstable patients presenting at a tertiary hospital in Accra-Ghana. METHOD: This was a retrospective case series study conducted at the Korle-Bu Teaching Hospital (KBTH), Accra-Ghana. Medical records of patients who presented with or developed haemodynamically unstable arrhythmias within 24h of admission from January 2018 to December 2020 were reviewed. The demographic characteristics and clinical data including outcomes of patients were collected. Descriptive statistics were used and results presented in frequency tables. RESULTS: A total of 42 patients with life-threatening arrhythmias were included. Haemodynamically unstable tachyarrhythmias were the most common arrhythmias found among the patients (66.7%). Approximately 52% of patients had structural heart diseases whereas 26.2% had no apparent underlying cause or predisposing factor. Cardioversion (52.4%), commonly electrical (63.6%), and transvenous pacemaker implantation (23.8%) were the common initial interventions. The majority of the patients (88.1%) survived and were discharged home. CONCLUSION: Tachyarrhythmias are the most common haemodynamically unstable arrhythmias seen among patients presenting emergently in a leading tertiary hospital in Ghana. A high survival rate was observed and cannot be extrapolated to other healthcare settings in sub-Saharan Africa with limited resources to manage these clinical entities.

Corrigendum to "Organizational safety culture perceptions of healthcare workers in Ghana: A cross-sectional interview study".

[This corrects the article DOI: 10.1016/j.ijnsa.2021.100020.].

Organizational safety culture perceptions of healthcare workers in Ghana: A cross-sectional interview study.

Background: Evidence shows that routine occupational safety and health (OSH) training is critical for maintaining good safety culture at healthcare facilities. However, our understanding of how healthcare facility type and routine OSH training interactively influence the number of reported organizational safety culture perceptions is limited. Objectives: This study assesses the interactive effect of healthcare facility type and OSH training on the number of reported organizational safety culture perceptions of healthcare workers in Ghana, secondly it evaluates how the relationship was attenuated when theoretically relevant factors (compositional and contextual) were considered, and lastly examines the magnitude and order of association between the predictors and the number of reported organizational safety culture perceptions. Design: Cross-sectional interview study. Setting and participants: The researchers interviewed 500 healthcare workers in seventeen healthcare facilities in the Central region of Ghana. Methods: Negative binomial regression models were fitted to cross-sectional survey data on 500 healthcare workers in Ghana. Results: Healthcare workers who work in healthcare centers (24%, P<0.05) and hospitals (23%, P<0.05) where routine OSH training was conducted were more likely to report good organizational safety culture perceptions compared with their counterparts who work at healthcare centers where no routine OSH training was conducted. Individuals who were above 39 years (23%, P<0.05) were more likely to report good organizational safety culture perceptions compared with their counterparts in the 20-29-year category. Female healthcare workers (11%, P<0.05) were more likely to report good organizational safety culture perceptions compared with their male counterparts. Conclusions: These findings provide valuable information for policymakers and stakeholders in the healthcare sector to develop interventions necessary for improving safety culture at healthcare facilities.

Self-reported disease symptoms of stone quarry workers exposed to silica dust in Ghana.

BACKGROUND AND AIMS: Understanding the importance of using personal protective equipment (PPE) and the influence of work-post (working distance to main dust source-crusher) in stone quarries is vital for designing tailored interventions in minimizing workers' exposure to silica dust. Nonetheless, studies on silica dust and disease symptoms in Ghana are nascent. This study assessed how work-post and use of required PPE jointly influence exposure to silica dust and disease symptoms in Ghana. METHODS: Generalized linear models (complementary log-log regression) were fitted to cross-sectional survey data of 524 stone quarry workers in Ghana to assess the joint effect of work-post and PPE usage on self-reported disease symptoms while controlling for relevant compositional and contextual factors. RESULTS: Stone quarry workers who work between 1-100 m and beyond 100 m from the crusher with the required PPE were 90% and 87% respectively less likely to report eye irritation compared with their counterparts who work between 1 and 100 m from the crusher without the required PPE. Individuals who work between 1-100 m and beyond 100 m from the crusher with the required PPE were 94% and 95% respectively less likely to report breathing difficulty compared with the reference group. Workers who work between 1-100 m and beyond 100 m from the crusher with the required PPE were 97% and 99% respectively less likely to report coughing compared with the reference group. Workers who work between 1-100 m and beyond 100 m from the crusher with the required PPE were 93% and 97% respectively less likely to report common cold compared with their counterparts who work between 1 and 100 m from the crusher without the required PPE. CONCLUSION: There are adverse health implications for people who work in silica dust polluted environments, suggesting the need for a national safety and health policy to target them.