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Hydrocalyx is an obstructed renal calyx from infundibulo-pelvic diminution or stenosis which leads to dilatation of the calyx. It becomes clinically important when associated with flank pains, haematuria, infection, renal impairment or stone formation. On intravenous urography the finding of a cystic dilatation of a calyx that communicates with the renal pelvis supports the diagnosis. This case is A 50-year-old man with recurrent flank pains who was diagnosed with left hydrocalyx on a Computed Tomography Urography (CT Urography). He opted for conservative management. Management of hydrocalyx can be conservative for patients without significant renal damage or symptoms and surgical with nephron sparing intent for those who have severe symptoms and complications.

Background Radiological examinations have a significant role in the diagnosis and management of Coronavirus disease 2019 (COVID-19), the disease caused by the novel coronavirus SARS-CoV-2. Many COVID-19 patients show typical Chest Computed Tomography (CT Scan) features which can aid in the diagnoses and triaging of such patients. This is especially so in resource-limited settings where access to molecular diagnostic techniques such as Reverse Transcription Polymerase Chain Reaction (RT-PCR) is not optimal. We report chest CT findings in 28 patients diagnosed with COVID-19 in Ghana. Objective To document common chest CT scan findings amongst patients with COVID-19 infection in Ghana. Method Chest CT scans of twenty-eight COVID-19 patients (n = 28) were retrieved and reviewed independently by two experienced radiologists and their findings documented. Two 64 and one 32 slice spiral CT scanners were used at three centres. Results Chest CT Images from 16 males (57.1.7%) and 12 females (42.9%) patients aged between 36 and 65 years with mean age of 55.9 years (SD-8.4years) were evaluated. Of these, 21 (75.0%) of them were COVID-19 patients who were undiagnosed at the time of imaging while 7 (25.0%) were known confirmed COVID-19 patients. On the chest CT scans (n = 28), 17 (66.7%) patients showed predominantly ground glass opacities while 12 (42.9%) had evidence of consolidation predominantly. In 26 (92.9%) of the patients, the opacities were bilateral and peripheral in distribution. None of these patients had pleural effusion. Conclusion COVID-19 patients tend to manifest typical imaging features on chest CT scan. The most common chest imaging finding was bilateral, peripheral and predominantly basal ground glass opacities. Importantly, these findings were frequently obtained before PCR diagnosis. Chest CT scan can help in the diagnosis and triaging of suspected or confirmed COVID-19 patients in jurisdictions with limited PCR diagnostic capacity and can improve early isolation, contact tracing and treatment thus helping to reduce community spread, morbidity and mortality.

Background: The use of Magnetic Resonance Imaging (MRI) is new in Ghana compared with some Western countries.A number of studies have observed increased MRI utilization due to increased sensitivity to diagnosis, and the paradigm shift to modalities that do not use radiation. Challenges with MRI use include high cost of the examination and inappropriate requests by referring clinicians. Objective: To determine the MRI utilisation trend in Korle Bu Teaching Hospital (KBTH), Ghana and its policy implications. Materials and Methods: A retrospective study undertaken in the Radiology Department, KBTH, from February to March, 2017. Eight hundred and forty request forms for MRI studies between January, 2013 and December 2016 were reviewed. Information on patient’s age and sex, number of MRI studies done, body parts and clinical conditions evaluated, appropriateness of clinical requests and existing policies on MRI in Ghana was gathered. Measures of central tendency and spread were obtained. Chi square, Pearson’s correlation and linear regression analysis were also used in the analysis. Results: The top three body parts requested were Spine (55 %), Brain (19%) and Joints (6 %); degenerative disease was the most common clinical condition evaluated.Significant association and correlation were obtained between of the number of body parts evaluated and examination year as well as the variety of clinical conditions requested and examination year. Conclusion: A progressive increase was noted in MRI utilisation both in number and diversity but no policy guiding MRI use in Ghana exists.

This is a case report of a 55-year-old man with Type 2 Diabetes Mellitus who presented with progressive breathlessness, chest pain and hyperglycaemia. An initial impression of a chest infection was made. Management was initiated with antibiotics, but this was unsuccessful, and he continued to desaturate. A screen for Coronavirus Disease of 2019 (COVID-19) returned positive. There was no prodrome of fever or flu-like illness or known contact with a patient known to have COVID-19. This case is instructive as he didn’t fit the typical case definition for suspected COVID-19. There is significant community spread in Ghana, therefore COVID-19 should be a differential diagnosis in patients who present with hyperglycaemia and respiratory symptoms in the absence of a febrile illness. Primary care doctors must have a high index of suspicion in cases of significant hyperglycaemia and inability to maintain oxygen saturation.Patients known to have diabetes and those not known to have diabetes may develop hyperglycaemia subsequent to COVID-19. A high index of suspicion is crucial for early identification, notification for testing, isolation, treatment, contact tracing and possible referral or coordination of care with other specialists. Early identification will protect healthcare workers and patients alike from cross-infection.

Background and Purpose: To identify the qualitative and quantitative contributions of conventional risk factors for occurrence of ischemic stroke and its key pathophysiologic subtypes among West Africans. Methods: The SIREN (Stroke Investigative Research and Educational Network) is a multicenter, case-control study involving 15 sites in Ghana and Nigeria. Cases include adults aged ≥18 years with ischemic stroke who were etiologically subtyped using the A-S-C-O-D classification into atherosclerosis, small-vessel occlusion, cardiac pathology, other causes, and dissection. Controls were age- and gender-matched stroke-free adults. Detailed evaluations for vascular, lifestyle, and psychosocial factors were performed. We used conditional logistic regression to estimate adjusted odds ratios with 95% CI. Results: There were 2431 ischemic stroke case and stroke-free control pairs with respective mean ages of 62.2±14.0 versus 60.9±13.7 years. There were 1024 (42.1%) small vessel occlusions, 427 (17.6%) large-artery atherosclerosis, 258 (10.6%) cardio-embolic, 3 (0.1%) carotid dissections, and 719 (29.6%) undetermined/other causes. The adjusted odds ratio (95% CI) for the 8 dominant risk factors for ischemic stroke were hypertension, 10.34 (6.91–15.45); dyslipidemia, 5.16 (3.78–7.03); diabetes, 3.44 (2.60–4.56); low green vegetable consumption, 1.89 (1.45–2.46); red meat consumption, 1.89 (1.45–2.46); cardiac disease, 1.88 (1.22–2.90); monthly income $100 or more, 1.72 (1.24–2.39); and psychosocial stress, 1.62 (1.18–2.21). Hypertension, dyslipidemia, diabetes were confluent factors shared by small-vessel, large-vessel and cardio-embolic subtypes. Stroke cases and stroke-free controls had a mean of 5.3±1.5 versus 3.2±1.0 adverse cardio-metabolic risk factors respectively ( P Conclusions: Traditional vascular risk factors demonstrate important differential effect sizes with pathophysiologic, clinical and preventative implications on the occurrence of ischemic stroke among indigenous West Africans.

Computed Tomography (CT) scan of the chest plays an important role in the diagnosis and management of Coronavirus disease 2019 (COVID-19), the disease caused by the novel coronavirus SARS-CoV-2. COVID-19 pneumoniashows typical CT Scan features which can aid diagnoses and therefore help in the early detection and isolation of infected patients. CT scanners are readily available in many parts of Ghana. It is able to show findings typical for COVID-19 infection of the chest, even in instances where Reverse Transcription Polymerase Chain Reaction (RTPCR) misses the diagnosis. Little is known about the diagnostic potential of chest CT scan and COVID-19 among physicians even though CT scan offers a high diagnostic accuracy.

BACKGROUND: Post-stroke seizures (PSS) are associated with significant morbidity and mortality across the globe. There is a paucity of data on PSS in Africa. PURPOSE: To assess the frequency and factors associated with PSS by stroke types across 15 hospitals in Nigeria and Ghana. METHODS: We analyzed data on all stroke cases recruited into the Stroke Investigative Research and Educational Network (SIREN). We included adults aged ≥18 years with radiologically confirmed ischemic stroke (IS) or intracerebral hemorrhage (ICH). PSS were defined as acute symptomatic seizures occurring at stroke onset and/or during acute hospitalization up until discharge. We used logistic regression to estimate adjusted odds ratios (aOR) with 95% Confidence Interval. RESULTS: Among 3,344 stroke patients, 499 (14.9%) had PSS (95% CI: 13.7 – 16.2%). The mean duration of admission in days for those with PSS vs no PSS was 17.4 ± 28.6 vs 15.9 ± 24.7, p=0.72. There were 294(14.1%) PSS among 2091 ischemic strokes and 159(17.7%) among 897 with ICH, p=0.01. The factors associated with PSS occurrence were age

Leiomyomatosis peritonealis disseminata (LPD), a rare and unusual condition affecting mainly women of reproductive age, causes peritoneal and subperitoneal nodules formed by smooth muscle. Very few cases have been diagnosed since the disease was first described. We present a 42year old female who was managed for infertility and uterine myomata at a Municipal hospital in Ghana. Following a pelvic ultrasound diagnosis of multiple uterine myomata the patient was booked for myomectomy. At surgery to remove her myomata, the patient was found to have several peritoneal nodules some of which were attached to peritoneum, omentum and the surface of bowel loops in addition to a uterine myoma. The disease has since recurred twice after two laparotomies. The diagnosis was made by histopathology of ultrasound-guided biopsy of the nodules, and she has since been on GnRH analogue treatment. LPD simulates peritoneal carcinomatosis; thus, a good history, clinical evaluation, radiological imaging, and histopathologic analysis must be accurately diagnosed. Surgeons’ and Radiologists’ knowledge of the condition is fundamental to ensuring correct diagnosis and appropriate treatment and to minimising the probability of malignant transformation.

Introduction: The novel corona virus disease 2019 (COVID-19) was diagnosed in Wuhan, China in December 2019 and, in Ghana, in March 2020 As of 30th July 2020, Ghana had recorded 35,142 cases COVID-19 which can be transmitted by both symptomatic and asymptomatic individuals usually manifest as pneumonia with symptoms like fever, cough, dyspnoea and fatigue The current non-availability of a vaccine or drug for COVID-19 management calls for early detection and isolation of affected individuals Chest imaging has become an integral part of patient management with chest radiography serving as a primary imaging modality in many centres Methods: The study was a retrospective study conducted at Ga East Municipal Hospital (GEMH) Chest radiographs of patients with mild to moderate disease managed at GEMH were evaluated The age, gender, symptom status, comorbidities and chest x-ray findings of the patients were documented Results: 11 4 % of the patients had some form of respiratory abnormality on chest radiography with 88 9% showing COVID-19 pneumonia features 93 8% showed ground glass opacities (GGO), with 3 1% each showing consolidation (CN) only and CN with GGO There was a significant association between COVID-19 radiographic features and patient's age, symptom status and comorbidities but not with gender Conclusion: Most radiographs were normal with only 11% showing COVID-19-like abnormality There was a significant association between age, symptom status and comorbidities with the presence of COVID-19 like features but not for gender There was no association between the extent of the lung changes and patient characteristics © 2021 Bioexcel Publishing LTD All rights reserved

Introduction:breast cancer is the commonest malignant disease in Ghanaian women and accounts for 17% of cancer-related deaths in the country. It has been classified into molecular subtypes depending on the presence or absence of hormone receptors and the human epidermal growth factor receptor 2. Computed tomography is often the preferred modality for monitoring metastatic disease due to its ability to determine the extent of local and metastatic disease. Methods:this was a retrospective study conducted at Sweden Ghana Medical Centre (SGMC). Hospital records and chest and abdominal computed tomography (CT) scan images of breast cancer patients who had been managed at SGMC between June 2016 and August 2019 were used to document age, gender, histological group, type of surgical intervention done, molecular subtypes of the disease and imaging findings. Microsoft Excel 2016 and SPSS version 20.0 were used to summarise the data obtained into tables, charts and to test for significant associations. Results:the most common site of breast cancer metastasis was lymph nodes. The three commonest sites of distant metastases were the lung seen in 44 patients (55.3%), bone in 37 patients (44.6%) and liver in 33 patients (39.8%). Chi square test for association between the molecular subtypes of the breast cancer and proportion of patients that showed a particular type of metastases revealed that, the differences noted for lung, pleural and cardiac metastases were statistically significant, that for bone and liver were not. Conclusion:breast cancer commonly metastasised to lymph nodes, lung, bone, liver, pleura and heart in descending order. The commonest CT patterns for metastases were multiple nodules for lung, effusion for pleura and heart and osteolytic lesions for bone.

The aim of this study is to estimate the effective dose and assess the lifetime attributable risk of cancer incidence of patients undergoing computed tomography scan at the Korle-Bu Teaching Hospital in the Greater Accra Region of Ghana. Data on Volume CT Dose Index ( ) and Dose Length Product ( ) displayed on the scanner control console was recorded after confirmation of the results by performing independent checks on a phantom. The effective doses were estimated using the displayed and the anatomic region specific conversion factors ( ). The average effective dose for the head, abdomen, chest, neck, and pelvis were 3.63± 2.39mSv, 15.37±8.49 mSv, 12.72 ± 13.97 mSv, 4.04 ± 1.47 mSv and 15.8 ± 3.59 mSv respectively. Effective doses for the head and neck were within the typical range of (1-10mSv) for CT examinations whilst abdomen, chest and pelvis were above 10mSv. The average life attributable risk of cancer incidence for each region of examination were determined from the effective dose, sex and age using the model proposed in BEIR VII Report . The average cancer risk incidence for head, neck, chest, abdomen and pelvis examinations were low in the range 1 in 10,000 to 1 in 1,000. There were wide variations in the effective dose values obtained for the same region under examination. This trend calls for the optimization of CT examination protocols to be established to ensure that patient doses are as low as reasonably achievable, economic and social factors being taken into account especially for chest examinations.

Background Annotation and Image Markup on ClearCanvas Enriched Stroke–phenotyping Software (ACCESS) is a novel stand-alone computer software application that allows the creation of simple standardized annotations for reporting brain images of all stroke types. We developed the ACCESS application and determined its inter-rater and intra-rater reliability in the Stroke Investigative Research and Educational Network (SIREN) study to assess its suitability for multicenter studies. Methods One hundred randomly selected stroke imaging reports from 5 SIREN sites were re-evaluated by 4 trained independent raters to determine the inter-rater reliability of the ACCESS (version 12.0) software for stroke phenotyping. To determine intra-rater reliability, 6 raters reviewed the same cases previously reported by them after a month of interval. Ischemic stroke was classified using the Oxfordshire Community Stroke Project (OCSP), Trial of Org 10172 in Acute Stroke Treatment (TOAST), and Atherosclerosis, Small-vessel disease, Cardiac source, Other cause (ASCO) protocols, while hemorrhagic stroke was classified using the Structural lesion, Medication, Amyloid angiopathy, Systemic disease, Hypertensive angiopathy and Undetermined (SMASH-U) protocol in ACCESS. Agreement among raters was measured with Cohen's kappa statistics. Results For primary stroke type, inter-rater agreement was .98 (95% confidence interval [CI], .94-1.00), while intra-rater agreement was 1.00 (95% CI, 1.00). For OCSP subtypes, inter-rater agreement was .97 (95% CI, .92-1.00) for the partial anterior circulation infarcts, .92 (95% CI, .76-1.00) for the total anterior circulation infarcts, and excellent for both lacunar infarcts and posterior circulation infarcts. Intra-rater agreement was .97 (.90-1.00), while inter-rater agreement was .93 (95% CI, .84-1.00) for TOAST subtypes. Inter-rater agreement ranged between .78 (cardioembolic) and .91 (large artery atherosclerotic) for ASCO subtypes and was .80 (95% CI, .56-1.00) for SMASH-U subtypes. Conclusion The ACCESS application facilitates a concordant and reproducible classification of stroke subtypes by multiple investigators, making it suitable for clinical use and multicenter research.

In medical exposure dose to patients are determine by input parameters including mAs, kVp, pitch factor among other factors. The aim of this study is to provide procedure and protocol of how to assess patients’ dose (organ and effective dose) estimates with preset eff mAs and standard kVp. This is to determine a tradeoff between patient’s dose and the image quality before imaging. In addition to providing appropriate clinical recommendation for clinicians for dose management during CT scan. MVL DICOM application software was used to access image data during abdominal CT scan. Organ and effective dose estimates were estimated as developed by ICRP 103 recommendations. Where on the image data, using MVL platform detail information of the mAs, kVp, CTDIvol and DLP were available for recording. The weighted CTDI (CTDIW) was estimated by multiplying the volume CTDI (CTDIVOL) by the pitch factor. Which was used to estimate organ dose using the normalized organ dose factor and the effective dose was estimated by the product of the region-specific normalizing constant and the dose length product. The mAs is the effective Milliameter per second, which were calculated by dividing the mAs by the pitch factor. The relationship between input and output parameters were modeled as the final component of the modeling process in a form of GUI applications format. This was done to establish the various process and procedures involve in abdominal scan for dose managements. The coding process involve the use of written visual basic code to design an interface and integrated on the MVL application platform for clinical application. The GUI has been recommended for use by various stake holders in CT operations.

The study provided a simple method of using voxel count method to estimate organ volume together with x-ray attenuation coefficient principle. The aim is to discuss the role of x-ray attenuation coefficient in CT organ volume measurements using voxel count method. The method involve using the principle of linear attenuation coefficient which describes the fraction of a beam of x-rays or gamma rays that is absorbed or scattered per unit thickness of the absorber to enable tissue differentiation and hence the used of volume elements method, where the body is literally divided into 3-dimensional rectangular boxes with known size and thickness. This value basically accounts for the number of atoms within a specified distance of a material and the probability of a photon being scattered or absorbed from the nucleus or an electron of one of these atoms. A graph of linear attenuation coefficients versus radiation energy are used to separate between various body tissues. At a specific energy the difference in attenuation between two tissues is greatest at a specific radiographic contrast in an image. Hence, this variation enable a separation and subsequent measurements of varied tissues. Therefore, it is extremely useful to determine various linear attenuation coefficients of tissues to enable various variations to be determine for clinical application.

Although the use of CT in medical diagnosis delivers radiation doses to patients that are higher than those from other radiological procedures, lack of proper optimized protocols could be an additional source of increased dose in developing countries. The aims of this study is to determine the variations of doses to patients undergoing CT scan using four different CT scanners with different CT scanning protocols for the purposes of optimizations and to compare with other available international standard and guidelines. The method involve the use of patients scanning protocol and image data to estimate patient body regional doses with four common CT examinations. These were obtained from four CT units/hospitals in Ghana. A large variation of mean body regional doses among different CT scanners were observed for similar CT examinations. These variations largely originated from different CT scanning protocols used, with different CT scanner type. The measured CTDIVOL with GE Lightspeed VCT 64 scanner for head, hest, abdomen and pelvis were 7.7mGy, 12.5 mGy, 14.4 mGy, and 12.9 mGy, respectively. Similarly, Philip 16 scanner recorded 6.6mGy, 13.1mGy, 14.8mGy, and 14.5mGy respectively. Furthermore, Siemen Emotion 16 scanner recorded 5.9mGy, 14.2mGy, 16.8mGy and 12.0mGy respectively. While, Toshiba Aquilion one scanner had CTDIVOL value which varies as 7.2mGy, 13.4mGy, 15.2mGy and 13.5mGy respectively. In conclusion the values were mostly lower than the values of CTDI and DLP as reported in literature for EC, IAEA, ICRP, ACR and AAPM Guidelines.

The study is based on measurements of renal dimensions to determine standard reference renal volume model and renal volumetric ellipsoid coefficient. Two methods, Voxel count method and rotational renal ellipsoid equation were the two measuring tools used with an integrated MVL application software platform. The procedure involve measurement of linear dimensions together with using the snake technique to draw the region of interest (ROI) for the volumetric measurements. These were done to obtain: renal length, lateral diameter, A-P diameter and the total number of voxels to estimates the renal volume. These parameters were used to calculate renal volume using the rotational renal ellipsoid equation as well as using the Minitab statistical software to model renal volume equation. The reference standard renal volume was also determined using water displacement with the Archimedes' principle. The average renal shape index and its dispersion (i.e. covariance matrix) was approximately 1±0.02. The male average measured values for right and left kidneys were as follows: renal length, 103.35cm and 105.13cm, lateral diameter, 60.79 and 60.40 and A-P diameter, 44.12 and 44.95 and renal volume; 146.74cm3 and 151.76cm3 respectively. Furthermore, the female average measured values for right and left kidneys were as follows: renal length, 101.43 and 102.98, lateral diameter, 59.20 and 59.02 and A-P diameter, 43.09 and 44.82, renal volume 142.04cm3 and 148.29cm3 respectively. The average estimated renal volumetric ellipsoid coefficient (VeC) was 0.53. However, various variations for both male and female, with their corresponding right and left kidneys were, 0.5283, 0.5297, 0.5280 and 0.5304 respectively. The reference renal dimensions including the standard renal volume and renal volumetric ellipsoid coefficient are recommended for clinical application in Ghana.

The study is based on estimate of CTDI and DLP values for patients' dose optimization procedures. Technical parameters were obtained for three groups of randomly selected patients undergoing abdominal CT examinations of 320 patients of age 20-80 years. The measured values were obtained on image data and the standard reference values of various machines were obtained from service manual as part of QC/QA and the recommended values from ICRP publication 103. The mean CTDI and DLP parameters were; 6.33mGy and 936.25mGy respectively. Furthermore, the mean recorded values of CTDIVOL values were well within ICRP recommendation when the protocol was completed in one scan. On the other hand, in the case of multiscan the total CTDIVol was higher than the ICRP recommendations. While the mean DLP values were higher than the recommended value of 780 mGy-cm by ICRP publication 103. Finally, approximately 37% of the total varied CTDI and DLP values were higher than the recommended dose by ICRP publication 103.

Introduction: The availability and utilization of MRI units across sub-Saharan Africa countries remain poor and its distribution is largely unknown. A cross-sectional survey was conducted to determine the distribution and utilization of MRI facilities across the West African sub-region. Methods: An interview and online search survey was conducted from September 2015 to September 2016, to determine the MRI facilities (Government/Public and Private) available in the West African sub-region. In Nigeria and Ghana, face-to-face interviews were conducted while for other West African countries, telephone interviews with radiologists and other health professionals as well as a Google online search were conducted to ascertain the distribution of the MRI facilities in the region. The number of MRI units in West Africa per million population was calculated and compared with other parts of the world from available published data. Results: Eighty-four MRI units serve a combined population of 372,551,411 in the West African sub-region at the time of this report. Nigeria accounted for more than two-thirds (58 (69%)) of the available units. Of these, 45 (77.6%) of the units were low-field strength systems. Ghana's 14 MRI units were fairly equally distributed between the private (57%) and the public sectors (43%). Ghana with 0.48 units/million population had the highest number of MRI units/ million population followed by Nigeria with 0.30 units/million population. Conclusion: Though there is an increase in the number of available MRI units in the West African sub region in the last decade, the numbers remain appallingly small for the population. Infrastructural and maintenance limitations constitute a major impediment to the use of high filed systems in the region. There may be need for greater cooperation between public and private enterprises for future improvement of MRI utilization in the region. Keywords: MRI, West Africa, survey, utilization, partnership

Background: Neurological limb deficit due to non-traumatic myelopathy is a disabling and distressing neurological condition. In recent time Magnetic Resonance Imaging (MRI) has proven to be the ultimate imaging modality for evaluating pathologies of the spinal cord.Objective: To describe the Magnetic Resonance Imaging (MRI) features of patients with Non-Traumatic Spinal Cord Injury evaluated at the Korle Bu Teaching Hospital.Methods: A descriptive cross-sectional study was carried out at the Korle Bu Teaching Hospital (KBTH), Accra, Ghana. Results: Out of a total of 141 MRI’s evaluated 60.3% were males and 39.7% female. The majority of the respondents 85.1% had paraparesis/paraplegia,13.5% had quadriparesis/quadriplegia, 1.4% had weakness in one upper limb and both lower limbs. The commonest MRI features of NTSCI recorded was due to degenerative disease of the spine 75.9%, spinal metastases 5.7%, Pott's/pyogenic spondylitis 3.5%, demyelinating disease 2.8% and primary spinal tumours 2.8%.Conclusion: The commonest MRI findings in the study population were due to degenerative disease of the spine, followed by spinal metastases and infective spondylitis. Funding: Not declaredKeywords: paraparesis, paraplegia, tetraparesis, tetraplegia, Magnetic Resonance Imaging

Introduction : an estimated 4 million cholera cases are recorded worldwide with 3.5% CFR annually. Ghana recorded 28,975 cholera cases with CFR of 0.8% in 2014. Atebubu-Amanten District was also affected in this outbreak. However, the data had not been analyzed to determine its magnitude and distribution. We analyzed the outbreak data to describe the trend, distribution and people most affected to provide information for targeted interventions to prevent and or manage future cholera outbreaks in Atebubu-Amanten. Methods : we conducted a secondary data analysis from the line list and case-based forms compiled during the 2014 cholera outbreak. We reviewed sanitation reports during the outbreak from the District Health Directorate (DHD). Data was analyzed using MS Excel 2010. We performed univariate data analysis to determine means, distribution of cases by age, sex, community of occurrence and fatality rate. Results : the outbreak started from 22/08/2014 to 04/11/2014 representing epidemiological weeks 32 to 51. A total of 269 cases were recorded with a CFR of 3.3%. The Mean age of cases was 28.0 years. The highest number of cases (56) and deaths (4) were recorded in epidemiological weeks 41 and 36 respectively. Most of these cases were within age group 20-29 years 76(28.3%) or from Zongo No. 2 community 69(25.3%) in the Atebubu sub-district. Conclusion : the 2014 cholera outbreak in Ghana, also affected Atebubu-Amanten District. The observed CFR was high. Poor sanitation and poor drinking water sources were probably responsible for the high number of cases in Zongo No. 2 community of Atebubu-Amanten district. We recommended that the DHD and the District Assembly should intensify education on personal hygiene and provide suitable sanitation and potable water for the communities in Atebubu-Amanten District.

Background: As the second leading cause of death and the leading cause of adult-onset disability, stroke is a major public health concern particularly pertinent in Sub-Saharan Africa (SSA), where nearly 80% of all global stroke mortalities occur, and stroke burden is projected to increase in the coming decades. However, traditional and emerging risk factors for stroke in SSA have not been well characterized, thus limiting efforts at curbing its devastating toll. The Stroke Investigative Research and Education Network (SIREN) project is aimed at comprehensively evaluating the key environmental and genomic risk factors for stroke (and its subtypes) in SSA while simultaneously building capacities in phenomics, biobanking, genomics, biostatistics, and bioinformatics for brain research. Methods: SIREN is a transnational, multicentre, hospital and community-based study involving 3,000 cases and 3,000 controls recruited from 8 sites in Ghana and Nigeria. Cases will be hospital-based patients with first stroke within 10 days of onset in whom neurovascular imaging will be performed. Etiological and topographical stroke subtypes will be documented for all cases. Controls will be hospital- and community-based participants, matched to cases on the basis of gender, ethnicity, and age (±5 years). Information will be collected on known and proposed emerging risk factors for stroke. Study Significance: SIREN is the largest study of stroke in Africa to date. It is anticipated that it will shed light on the phenotypic characteristics and risk factors of stroke and ultimately provide evidence base for strategic interventions to curtail the burgeoning burden of stroke on the sub-continent.

The occurrence of chromosomal aberrations resulting in congenital transposition of internal organs is rare. Isolated congenital stomach and spleen (multiple) transposition with partial pyloric stenosis, where the rest of the internal organs remain in their normal positions, to the best of our knowledge has not been reported before. Attention to, knowledge and records of this case should be considered vital for understanding future symptoms and occurrences and also for prevention of surgical mistakes.

Background : Cardiothoracic ratio is a simple and cheap tool in the estimation of heart size. It is a useful index of cardiac size evaluation, and a value of 50% is generally considered to indicate the upper limit of normal. Study Objective : This study is to ascertain the normal mean value in cardiothoracic ratio of Ghanaians using chest radiography to serve as baseline for screening for cardiomegaly. Methodology : Standard postero-anterior radiographs of the -clients/patients were used in the study. The cardiothoracic ratio (CTR) was obtained by dividing the transverse cardiac diameter [sum of the horizontal distances from the right and left lateral-most margins of the heart to the midline (spinous processes of the vertebral bodies)] by the maximum internal thoracic diameter. Systematic sampling with appropriate inclusion and exclusion criteria were used to obtain a sample size of 1989. Results : The mean transverse cardiac diameter and cardiothoracic ratio increased with age. The transverse thoracic diameter increased with age until the sixth decade when it reduced with age. The mean CTR increased gradually with age with females having greater values than males. The mean CTR of the study population were 0.459, 0.467 and 0.452 for the general population, females and males respectively. Conclusion : This study has been able to establish 0.459 as the mean CTR values for Ghanaians. It has also shown the relationship between age and clients /patient’s cardiothoracic ratio which compares favourably with findings of a similar study in Nigeria, a neighbouring country in the West African sub region with similar ethnic and social structure. Keywords : Radiography, Indigenous Ghanaian, cardiomegaly, cardiothoracic ratio, Screening

Background and Purpose— The Questionnaire for Verifying Stroke-Free Status (QVSFS), a method for verifying stroke-free status in participants of clinical, epidemiological, and genetic studies, has not been validated in low-income settings where populations have limited knowledge of stroke symptoms. We aimed to validate QVSFS in 3 languages, Yoruba, Hausa and Akan, for ascertainment of stroke-free status of control subjects enrolled in an on-going stroke epidemiological study in West Africa. Methods— Data were collected using a cross-sectional study design where 384 participants were consecutively recruited from neurology and general medicine clinics of 5 tertiary referral hospitals in Nigeria and Ghana. Ascertainment of stroke status was by neurologists using structured neurological examination, review of case records, and neuroimaging (gold standard). Relative performance of QVSFS without and with pictures of stroke symptoms (pictograms) was assessed using sensitivity, specificity, positive predictive value, and negative predictive value. Results— The overall median age of the study participants was 54 years and 48.4% were males. Of 165 stroke cases identified by gold standard, 98% were determined to have had stroke, whereas of 219 without stroke 87% were determined to be stroke-free by QVSFS. Negative predictive value of the QVSFS across the 3 languages was 0.97 (range, 0.93–1.00), sensitivity, specificity, and positive predictive value were 0.98, 0.82, and 0.80, respectively. Agreement between the questionnaire with and without the pictogram was excellent/strong with Cohen k=0.92. Conclusions— QVSFS is a valid tool for verifying stroke-free status across culturally diverse populations in West Africa.

Thoracic kidney is a rare type of renal ectopia. Patients with thoracic kidneys are usually asymptomatic and the condition is usually discovered incidentally during radiological evaluation for other conditions or during thoracic surgery. An intravenous urography done for a thirty-eight year old man referred on account of a seemingly small right kidney on an abdominal ultrasound scan, showed a normal right kidney and a left thoracic kidney. Thoracic kidney is a rare but an important cause of a thoracic ‘mass’ or ‘elevated hemi diaphragm’. It should be considered in the evaluation of such patients to prevent unnecessary surgical interventions and image guided biopsies.

Background : For many years, double contrast barium enema has been an effective way to evaluate the large bowel. With the development of the colonoscope, the role of barium enema has been questioned. However it is still useful in investigating patients with colorectal symptoms especially in the developing world where colonoscopy is widely unavailable and fraught with challenges in completely evaluating the colon. Objective : This study aimed at reviewing double contrast barium enema investigations in our centre. Methods : This was a retrospective study on patients who underwent double contrast barium enema at the Korle Bu Teaching Hospital from May 2003 to April 2007 on account of symptoms referable to the large bowel. Results : A total of 362 investigation reports were studied, of which 205 were for males and 154 for females, the mean age of the patients was 55.3 years (S.D 15.3years). Majority of the investigations, 228 (61.96%), were normal. Diverticular disease diagnosed in 88 (23.91%) cases was the commonest finding, followed by neoplasm 27 (7.34%) cases and Ulcerative colitis 6 (1.63%) cases, non-specific narrowing of the bowel in 4 (1.09%) and in 5 (1.36%) cases their investigations were inconclusive due to poor bowel preparation. Rectal bleeding was the most frequent symptom prompting barium enema studies. Conclusion : Double contrast barium enema study of the large bowel is an important evaluation of patients with colorectal symptoms.

Background: Intussusception is a common abdominal emergency in children which necessitates prompt diagnosis and management. Nonsurgical methods of managing this condition are rapidly gaining popularity with fluoroscopic-guided pneumatic reduction being one of such methods that has been used with great success in many countries. We present our initial experience with fluoroscopic-guided pneumatic reduction of intussusception at Korle Bu Teaching Hospital which is also the fi rst time the technique has been used in Ghana. Materials and Methods: A total of 18 children were enrolled in the study between August 2007 and February 2008 at Korle Bu Teaching Hospital, Accra, Ghana. Patients were given air enema under fluoroscopic-guidance using locally assembled equipment. The intraluminal pressure was monitored with a pressure gauge and was not permitted to go above 120 mmHg. A total of three attempts of 3 min each were allowed. Results: There were 12 males and 6 females. The average age of the patients was 8.3 months (SD= 3 months). Twelve (67%) of the cases were reduced successfully while 6 (33%) failed to reduce. A majority of those that did not reduced had symptoms for at least 2 days. Bowel perforation occurred in three (16.7%) cases. Conclusion: Pneumatic reduction of intussusception is a cost-effective and rapid method of management of intussusception. It however has limitations like high reported rate of bowel perforation and limited ability to identify lead points. The benefi ts however seem to outweigh these challenges, such as fluoroscopicguided pneumatic reduction has a very high success rate. Fluoroscopic guided pneumatic reduction should be considered as one of the primary modes of reduction in Ghana and other neighbouring countries that are yet to practice it.Key words: Air enema, bowel perforation, intussusception, pneumatic reduction