Bilateral ulna hemimelia with humeroradial synostosis and oligodactyly: A case report.

Hemimelia denotes the partial or complete absence of the distal half of a limb. Ulna hemimelia, a rare congenital anomaly, involves the complete or partial absence of the ulna in the upper limb, with an incidence of 1 in 150,000. This condition has been classified into 4 types, with the rare Type 4 variant involving humeroradial synostosis. We present a unique case of bilateral complete ulna hemimelia, humeroradial synostosis, and oligodactyly, in an 11-month-old female with bilateral upper limb shortening and restricted elbow movement since birth. Clinical examination revealed bilateral upper limb shortening, medial deviation of both wrist joints, fixed extension of both elbow joints, and bilateral absence of the cubital fossa. Radiographs confirmed bilateral micromelia, absence of ulna, humeroradial synostosis, and oligodactyly. This case, exhibiting bilateral Type 4 ulna hemimelia with Class 1 humeroradial synostosis, is a complex variant, rarely reported, and the first documented in Ghana. It also highlights the importance of radiological assessment in ensuring accurate diagnosis. Long-term follow-up and potential surgical interventions are crucial for optimizing upper limb function in such cases.

Participant Evaluation of a Multi-disciplinary Oncology Preceptorship Training Program for Oncology Health Professionals from Kumasi, Ghana.

A critical shortage of skilled healthcare workers is a primary cause of disparate global cancer outcomes. We report participant evaluation of a multidisciplinary preceptorship program. In collaboration with the city of Kumasi, Ghana, Mayo Clinic and the City Cancer Challenge hosted a preceptorship program for comprehensive multidisciplinary breast and cervix cancer training. A total of 14 healthcare workers from Kumasi received two weeks of training at Mayo Clinic in November and December 2021. Each participant and preceptor were requested to complete an anonymous post-participation survey. Of the 14 trainee participants, 10 (71%) completed the survey. All respondents found the program "valuable and applicable to their clinical practice." Ninety percent reported they were able to "review effective and critical elements in the development and expansion of the multidisciplinary team" and able to "solve practical clinical cases as a team". General themes of satisfaction included: (1) organization and administration, (2) clinical observations and demonstrations, (3) guidelines development, and (4) recognizing the central importance of cultivating a team-based approach. Of the 40 preceptors, 16 (40%) completed the survey. All respondents reported they felt the training would meaningfully "influence patient care in Ghana", that participation "added value or joy to their clinical practice," and all wished to "participate in future preceptorship programs". After a focused two-week program, trainees reported high satisfaction, usefulness from observing specialized cancer care, and value in closely observing a multidisciplinary oncology team. Preceptors reported the experience added joy and perspective to their clinical practice and wished to participate in future programs.

Spontaneous resolution of tuberculosis related Rasmussen aneurysm in a young West African: A case report.

Rasmussen aneurysm (RA) is an uncommon cause of hemoptysis in pulmonary tuberculosis, first described in 1868 by Rasmussen. It is often treated with surgery or endovascular coiling. A few cases of spontaneous resolution with conservative management have been recorded in literature. We present the case of a 44-year old patient who reported with hemoptysis, weight loss, chronic cough and night sweats and was diagnosed of pulmonary tuberculosis on the basis of clinical assessment and chest X-ray. Subsequently, chest CT scan done showed a giant left RA, treated conservatively with antituberculous chemotherapy with complete radiological resolution of aneurysm after 18-month follow-up. We conclude that conservative management of RA is a good alternative in a low resource setting for hemodynamically stable patients.

Perspectives of radiologists in Ghana about the emerging role of artificial intelligence in radiology.

Background: The integration of Artificial Intelligence (AI)-based technologies in medicine is advancing rapidly especially in the field of radiology. This however, is at a slow pace in Africa, hence, this study to evaluate the perspectives of Ghanaian radiologists. Methods: Data for this cross-sectional prospective study was collected between September and November 2021 through an online survey and entered into SPSS for analysis. A Mann-Whitney U test assisted in checking for possible gender differences in the mean Likert scale responses on the radiologists' perspectives about AI in radiology. Statistical significance was set at P ≤ 0.05. Results: The study comprised 77 radiologists, with more males (71.4%). 97.4% were aware of the concept of AI, with their initial exposure via conferences (42.9%). The majority of the respondents had average awareness (36.4%) and below average expertise (44.2%) in radiological AI usage. Most of the participants (54.5%) stated, they do not use AI in their practices. The respondents disagreed that AI will ultimately replace radiologists in the near future (average Likert score = 3.49, SD = 1.096) and that AI should be an integral part of the training of radiologists (average Likert score = 1.91, SD = 0.830). Conclusion: Although the radiologists had positive opinions about the capabilities of AI, they exhibited an average awareness of and below average expertise in the usage of AI applications in radiology. They agreed on the potential life changing impact of AI and were of the view that AI will not replace radiologists but serve as a complement. There was inadequate radiological AI infrastructure in Ghana.

Pattern of chest computerized tomography scan findings in symptomatic RT-PCR positive Covid-19 patients at the Korle Bu Teaching Hospital, Ghana.

Background: Chest Computerized Tomography (CT) features of Corona Virus Disease 2019 (COVID-19) pneumonia are nonspecific, variable and sensitive in detecting early lung disease. Hence its usefulness in triaging in resource-limited regions. Objectives: To assess the pattern of chest CT scan findings of symptomatic COVID-19 patients confirmed by a positive RT-PCR in Ghana. Methods: This study retrospectively reviewed chest CT images of 145 symptomatic RT-PCR positive COVID-19 patients examined at the Radiology Department of the Korle Bu Teaching Hospital (KBTH) from 8th April to 30th November 2020. Chi-Squared test was used to determine associations among variables. Statistical significance was specified at p≤0.05. Results: Males represent 73(50.3%). The mean age was 54.15±18.09 years. The age range was 5 months-90 years. Consolidation 88(60.7%), ground glass opacities (GGO) 78(53.8%) and crazy paving 43(29.7%) were the most predominant features. These features were most frequent in the elderly (≥65years). Posterobasal, peripheral and multilobe disease were found bilaterally. The most common comorbidities were hypertension 72(49.7%) and diabetes mellitus 42(29.2%) which had significant association with lobar involvement above 50%. Conclusion: The most predominant Chest CT scan features of COVID-19 pneumonia were GGO, consolidation with air bronchograms, crazy paving, and bilateral multilobe lung disease in peripheral and posterior basal distribution.

Career in radiology; the ghanaian clinical medical Student's perception.

Background: The importance of radiology in this era of evidence-based medicine cannot be disputed. This has resulted in the increase in demand for radiologists. Thus, the issue of whether there would be sufficient numbers of medical students to meet this growing demand needs further probing. Purpose: To assess Ghanaian clinical medical students' perceptions about a career in radiology. Materials and methods: This was an online questionnaire-based survey of 575 clinical medical students in five public medical schools in Ghana from September 2020 to February 2021. Student's t-test and one way analysis of variance was used to compare means. For the Likert scale questions, differences in the mean Likert scale responses were assessed among various clinical year groups and across gender using Kruskal-Wallis test and Mann-Whitney U tests. A logistic regression was used to determine the significant predictors of the choice of radiology as a career. Results: Most 340 (59.1%) of the participants were males. The average age of participants was 24.64 ± 3.084 years. Students agreed that, radiology is relevant in this era of evidence-based medicine (mean Likert score = 4.62, SD = 0.819), which yielded significant responses in the third clinical year (p = 0.004). Nearly 30% of respondents stated they did not receive enough didactic lectures or tutorials in radiology, citing insufficient lectures (89.9%), a lack of lecturers (9.5%), and trouble grasping ideas (0.7%) as their main concerns. 133 (23.1%) stated they would choose radiology as a specialty, with flexible working schedule (61.9%) and high income (68.3%) as their topmost reasons. Less patient contact (8.0%) was the least observed reason. A flexible working schedule increased the choice of radiology as a specialty by 2.319 folds (95% CI: 1.413-3.805, P = 0.001). Teleradiology significantly contributed to the choice of radiology as a career (p = 0.001). Conclusion: Generally, the clinical students had varied but positive perceptions on radiology as a specialty.

Pattern of chest computerized tomography scan findings in symptomatic RT-PCR positive COVID-19 patients at the Korle Bu Teaching Hospital, Ghana

Background: Chest Computerized Tomography (CT) features of Corona Virus Disease 2019 (COVID-19) pneumonia are nonspecific, variable and sensitive in detecting early lung disease. Hence its usefulness in triaging in resource-limited regions. Objectives: To assess the pattern of chest CT scan findings of symptomatic COVID-19 patients confirmed by a positive RTPCR in Ghana. Methods: This study retrospectively reviewed chest CT images of 145 symptomatic RT-PCR positive COVID-19 patients examined at the Radiology Department of the Korle Bu Teaching Hospital (KBTH) from 8th April to 30th November 2020. Chi-Squared test was used to determine associations among variables. Statistical significance was specified at p≤0.05. Results: Males represent 73(50.3%). The mean age was 54.15±18.09 years. The age range was 5 months-90 years. Consolidation 88(60.7%), ground glass opacities (GGO) 78(53.8%) and crazy paving 43(29.7%) were the most predominant features. These features were most frequent in the elderly (≥65years). Posterobasal, peripheral and multilobe disease were found bilaterally. The most common comorbidities were hypertension 72(49.7%) and diabetes mellitus 42(29.2%) which had significant association with lobar involvement above 50%. Conclusion: The most predominant Chest CT scan features of COVID-19 pneumonia were GGO, consolidation with air bronchograms, crazy paving, and bilateral multilobe lung disease in peripheral and posterior basal distribution

Audit of the appropriateness of the indication for obstetric sonography in a tertiary facility in Ghana.

INTRODUCTION: the use of ultrasound is one of the most vital tools in the management of pregnancies and contributes significantly in improving maternal and child health. Certain indications in pregnancy, guide the obstetrician as to which obstetric scan deems appropriate. The full realization of the benefits of ultrasound depends on whether it is being used appropriately or not, and hence this study aimed at auditing for the appropriate indications for obstetric ultrasound. METHODS: a review of all request forms for obstetric scan between June 2019 and July 2020 was performed to assess the appropriateness of requests for obstetric ultrasound at the Cape Coast Teaching Hospital. The data obtained was analyzed using SPSS (SPSS Inc. Chicago, IL version 20.0). A Chi-squared test of independence was used to check for statistically significant differences between variables at p ≤ 0.05. RESULTS: three hundred and fourteen (314) out of the 527 request forms had clinical indications stated. 174 (81.7%) of requests from Cape Coast Teaching Hospital and 39 (18.3%) from other health centers did not indicate patients clinical history/indication on the request forms. Majority 76 (68.5%) of scans in the first trimester were done without indications/history. Only 29 of requests with clinical history were inappropriate. CONCLUSION: practitioners should be mindful of adequately completing request forms for obstetric investigations since a large number of practitioners do not state the history/indications for the scans. There should be continuous medical education on the importance of appropriate indication for obstetric ultrasound.

Evaluation of the Clinical and Imaging Findings of Breast Examinations in a Tertiary Facility in Ghana.

Breast diseases have been one of the major battles the world has been fighting. In winning this fight, the role of medical imaging cannot be overlooked. Breast imaging reveals hidden lesions which aid physicians to give the appropriate diagnosis and definitive treatment, hence this study, to determine the clinical and imaging findings of breast examinations to document the radiologic features in our setting. This cross-sectional retrospective study reviewed the sociodemographics, imaging reports (mammography and ultrasonography with BI-RADS scores and their features), and the clinical data of 425 patients from September 2017 to September 2020 in the Cape Coast Teaching Hospital. 72 solid lesions with their histology reports were also reviewed. Data obtained were organized, coded, and analyzed using Statistical Package for Social Sciences (SPSS Inc., Chicago, IL, USA) version 20.0. The results obtained were presented in appropriate tables and charts. A chi-squared test was employed for associations and statistical significance was specified at p ≤ 0.05. 63.29% of the patients were married, but only 18.59% had a positive family history of breast cancer. BI-RADS scores 1(57.46%) and 2(27.99%) were the most recurrent findings. The most common BI-RADS 2, 3, 4, and 5 imaging features were benign-looking axillary lymph nodes (66.33%), well-defined solid masses (61.54%), ill-defined solid masses (42.86%), and ill-defined solid masses with suspicious-looking axillary lymph nodes (100.00%), respectively. The most frequent indications were routine screening (49.18%), mastalgia (26.59%), and painless breast masses (19.77%). There was significant association between duration of symptoms and breast cancer (p value = 0.007). In conclusion, routine breast screening and mastalgia were the topmost indications for breast imaging. BI-RADS 1 and 2 were the commonest BI-RADS scores, and benign-looking axillary lymph nodes and simple cysts were the most frequent imaging features for BI-RADS 2 and ill-defined solid masses and suspicious-looking axillary lymph nodes for BI-RADS 4 and 5.

Comparing radiological presentations of first and second strains of COVID-19 infections in a low-resource country.

INTRODUCTION: The novel corona virus popularly referred to as COVID-19 disease and SARS-CoV-2 was first detected in Wuhan, China in December 2019. It was declared a pandemic by the World Health Organization (WHO) on March 11, 2020. In Ghana, the first two cases of COVID-19 infection were recorded on March 13, 2020 with a strain imported from Europe. In December 2020, a new strain from South Africa was detected in Ghana which was associated with higher transmission rates, severity of the disease, and higher number of recorded deaths. Our study aimed to record notable differences and similarities between infections due to the initial, and second strains of COVID-19 infections detected in Ghana during the last 12-months. METHOD: This was a retrospective study involving 50 patients infected with the first strain, and another 50 patients infected with the second strain of the SARS-CoV-2 virus. Microsoft Excel-2013 was the analytical tool. RESULTS: The data analysis supported publications suggesting that the new strain of the virus caused more severe infections, which were manifested on high resolution CT (HRCT) scans as more widespread alveolar disease, most commonly presenting as large areas of consolidation. CONCLUSION: Despite numerous similarities in terms of the manifestation of COVID-19 infection on HRCT scans, notable difference supporting the notion of increased virulence and severity of disease were also recorded. The study findings demonstrate the need for heightened and sustained preventive measures needed to reduce, and eventually curb COVID-19 infection and mortality rates associated with the introduction of new virulent strains.

A case of spontaneous intramural duodenal hematoma in a young African man: Imaging findings.

Intramural duodenal hematoma has been reported as a rare condition first described by McLauchlan in 1838. It is now thought to be an uncommon condition due to the increase in the number of reported cases in the medical literature. It has been reported to usually occur secondary to blunt trauma mainly in young men and children, with 82% of the patients being younger than 30 years. Association between spontaneous intramural duodenal hematoma and coagulopathy, coagulating drugs, endoscopic procedures, acute pancreatitis, and pancreatic malignancy has been made. We present the case of a 35-year-old African male lumberjack with no known previous history of trauma, risk factors, or associated predisposing condition that presented to our facility with acute abdominal pain and vomiting and diagnosed as spontaneous intramural duodenal haematoma on CT scan and MR imaging with a complete resolution on conservative management.

Evaluation of the Anatomical Locations of Stroke Events From Computed Tomography Scan Examinations in a Tertiary Facility in Ghana.

Introduction Stroke events are leading causes of mortalities globally and currently increasing alarmingly in low- and middle-income nations including Ghana, thus overburdening national healthcare delivery sectors. This trend is predicted to ultimately have an impact on the socio-economic development of these countries, thus gaining the attention of policy-makers and implementers. This study was therefore conducted to evaluate the anatomical locations of stroke events from CT scan examinations and the possibly associated variables to assist in managing this non-communicable pandemic. Methods All computed tomography (CT) scans performed for stroke events at the Cape Coast Teaching Hospital from June 2016 to June 2020 were retrieved and reviewed for this study. The socio-demographics and the presence of hypertensive risk factor were also retrieved. Data were then collated, grouped, coded, inputted, and used for analysis. Chi-square test of independence was employed for assessing possible associations, and logistic regression analysis was performed to predict the anatomical locations of stroke events using sex and hypertension. Statistical significance level was specified at p ≤ 0.05. Results A total of 1,750 stroke cases were recorded during the study period, comprising 1,237 (70.7%) ischemic strokes and 513 (29.3%) hemorrhagic strokes. Majority (54.3%) of the patients were males. The average age of participants was 62.46±14.74 years. Basal ganglia (43.0%), parietal lobe (26.7%), and frontal lobe (6.9%) were the commonest anatomical locations. The elderly (≥ 60 years) were significantly affected at the basal ganglia (p=0.006), parietal lobe (p=0.005), frontal lobe (p=0.013), temporal lobe (p=0.048), and cerebellum (p=0.049). Basal ganglia lesions were significantly recorded in men, whereas lesions located at the pons were significantly seen in females. The regression model revealed that the risk of stroke at the pons increased by 2.155-folds in males (p=0.043; 95% CI=1.026-4.528). Generally, gender and hypertension were not significant predictors of stroke lesion locations. Conclusions The basal ganglia area, which falls under the middle cerebral artery territory, was the commonest anatomical location for stroke events in our setting. Knowing the anatomical locations of these stroke events has an impact on the type of interventions needed, especially at the early stages of these stroke events. CT perfusion, CT angiography, and magnetic resonance imaging (MRI) with MR angiography (MRA) when available can further assist in determining the exact cause so that urgent interventions such as endovascular treatments can be offered.

Incidence rate and age of onset of first stroke from CT scan examinations in Cape Coast metropolis.

INTRODUCTION: The trends in the incidence and age of onset of first stroke is lacking in Ghana and with an increasing elderly population, such trends are projected to increase in developing countries. Through the review of Computed Tomography (CT) scan examinations and patients' records; we assessed the incidence rate and age of onset of first stroke in Cape Coast Metropolis. METHODS: This study retrospectively reviewed all imaging records and clinical data of all stroke patients referred for CT scans in the radiology department of the Cape Coast Teaching Hospital (CCTH) between January 2017 and December 2019. All CT confirmed cases of stroke were classified as either hemorrhagic stroke or ischemic stroke. Age adjusted annual incidence rate with 95% Confidence Intervals (CIs) were calculated assuming a Poisson distribution. Mean difference were tested using one way Analysis of Variance (ANOVA). RESULTS: 840 patients with first onset of stroke were identified, comprising 417 (49.6%) males and 423 (50.4%) females. There was a statistically significant difference in the mean age of onset of first stroke in males (61.47 ± 13.36 years) and in females (63.41 ± 15.41 years), p = 0.049. The incidence of first stroke for the entire age categories were higher in males compared to the same age categories in females, except for patients aged 35-44 years in 2017, 25-34 years in 2018, 15-24 years and 75 years or older age groups in 2019. Males had hemorrhagic stroke at an older age (64.41 ± 15.31 years) compared to ischemic stroke (60.40 ± 12.42 years) in this study. This difference was statistically significant (p = 0.014). There was no significant difference in the mean age of onset of first stroke for the respective years under study: F (3, 836) = 0.693, P = 0.500. CONCLUSION: The findings of this study imply that the incidence rate of stroke is higher in males than in females and increases with age. The majority of the strokes were ischemic.

Computed tomography features of spontaneous acute intracranial hemorrhages in a tertiary hospital in Southern Ghana.

INTRODUCTION: spontaneous acute intracranial hemorrhage (SICH) accounts for approximately 10-15% of all stroke cases. Early detection by computed tomography (CT) and early treatment are key. Hence this study to examine the CT features of SICH. METHODS: this retrospective cohort study reviewed all 435 patients diagnosed with SICH from 1st March, 2017 to 1st January, 2021 in a tertiary facility in Southern Ghana. Data collected (age, sex, SICH type and the CT scan features) were organized and analyzed using GNU PSPP and Libre Office Calc. Statistical significance level was pegged at p≤0.05. RESULTS: the SICH types were acute intracerebral hemorrhage (97.93%), acute subarachnoid/intraventricular hemorrhage (1.15%), acute epidural hemorrhage (0.46%) and acute subdural hemorrhage (0.46%). Acute intracerebral hemorrhage was more common in those >60 years (57.75%, p<0.001). The commonest CT feature for acute intracerebral hemorrhage was hyperdense lesion with perilesional edema (40.98%), with smoking (OR=2.24, 95% CI: 1.14-4.41, p=0.019) and anticoagulants intake (OR=2.56, 95% CI: 1.15-5.72, p=0.022) as the predictive factors; followed by hyperdense lesion extending to the edge of the brain (25.03%), also predictable by smoking (OR=0.23, 95% CI: 0.11-0.47, p<0.001); and hyperdense lesion with mass effects (22.70%) was not predictive with any risk factor. Type 2 diabetes mellitus (60.00%, p<0.001) and smoking (97.83%, p<0.001) were more common in males. CONCLUSION: hyperdense lesion with perilesional edema was the most frequent CT feature for acute intracerebral hemorrhage and was predictable by smoking and anticoagulants intake. Smoking was a predictive factor to the development of most of the features of acute intracerebral hemorrhage.

Use of Magnetic Resonance Imaging (MRI) in the Management of Diagnostic Uncertainty in Low-Resource Settings: A Case Report of Cesarean Ectopic Pregnancy in a Tertiary Hospital in Ghana.

BACKGROUND Low- and middle-income countries (LMICs) account for the overwhelming majority of maternal deaths worldwide. Cesarean section rates have increased globally over the last 10 years, including in LMICs, and are an important intervention to decrease neonatal and maternal mortality. However, cesarean sections also contribute to increased complications in subsequent pregnancies, including invasive placentation and cesarean scar ectopic pregnancies (CSEP). Potential CSEP complications include rupture of the uterus, bladder invasion, and maternal mortality. CASE REPORT We present the case of a 35-year-old Ghanaian woman (gravidity 5, parity 3) with a positive urine pregnancy test and 2 months of amenorrhea. Ultrasound scanning demonstrated a gestational sac with a fetal pole and absent cardiac activity located in the lower uterine segment. Myometrium infiltration was present, with only 2 mm of anterior myometrium between the gestational sac and the urinary bladder. Owing to concern for CSEP with uncertain bladder invasion, a pelvic MRI was obtained for preoperative planning. Following the MRI, which demonstrated an intact bladder, the patient underwent an uncomplicated exploratory laparotomy and excision of the CSEP. CONCLUSIONS In LMICs, pelvic ultrasound continues to be the diagnostic tool of choice for CSEP. However, in cases with diagnostic uncertainty or possible bladder invasion, MRI is an additional imaging tool that can optimize preoperative planning and minimize the risk of maternal mortality and potential post-surgical complications.