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Introduction: The Coronavirus disease 2019 (COVID-19) has become a cause of significant morbidity and mortality in the world. There are currently 4 COVID-19 vaccines have been developed for mass vaccination to combat the disease. Some people, however, have expressed safety and efficacy concerns with regards to the vaccines. In Ghana, junior doctors, being frontline doctors, are likely to first encounter patients presenting with COVID-19. They may also have the highest direct exposure to the virus even though their outcomes after infection may be good. The study sought to determine the potential acceptance rate of COVID-19 vaccine among junior doctors, the factors that will influence their acceptance and whether they will recommend the vaccine to their patients. Methods: The study was an ethically approved anonymous cross-sectional survey to determine the willingness to accept the SARS-CoV-2 vaccine among junior doctors in Ghana. The survey was designed using Google forms posted to the various junior doctor’s social media group pages such as WhatsApp and Facebook with the study participants responding to 15 items. Results: Out of a total of 305 participants, females were 155 (50.8%). Of the respondents, 171/305 (56.1%) had cared for Covid-19 patients before, 51/305 (16.7%) had had Covid-19 infection previously and 204/305 (66.9%) will be willing to take the vaccine when available. Females were more likely to take the vaccine and those who were willing to accept the vaccine were more likely to recommend same to their family and others. Conclusion: This study has showed a more than average willingness to accept the COVID-19 vaccine. Female gender, living with the extended family and history of SARS-Cov-2 infection were positively associated with willingness to accept the COVID-19 vaccine. Doctors who were willing to accept the vaccine were also more likely to recommend their patients and family members to also accept the COVID-19 vaccine.

Introduction:A pregnant woman’s knowledge of her human immune deficiency virus (HIV) serostatus and that of her sexual partner and the disclosure of her serostatus to the partner puts her in a better position to make informed choices about her pregnancy, adopt strategies to prevent mother to child transmission (PMTCT) of HIV and reduce sexual transmission of HIV. Some pregnant women however opt out of antenatal HIV testing while others have challenges with partner disclosure. This study sought to assess the pregnant women’s knowledge of their HIV serostatus and that of their partners, and disclosure to partners about their serostatus. Methods:An ethically approved cross-sectional descriptive study was conducted at the antenatal clinic (ANC) of the Kumasi South Hospital, Ghana from the period 8thMarch to 5thApril, 2016. A structured questionnaire was administered to 407 ANC attendants who were randomly selected to participate in the study. Data entry was in Microsoft Excel and analyzed using R Core Team (2014). Results:The study showed that 80.1% (n = 326/407) of the participants knew their HIV serostatus. Of these, 18.1% (n = 59/326) knew prior to the current pregnancy and 81.9% (n = 267/326) were told during the current pregnancy. Among those who knew their HIV serostatus, the majority [83.1%; (n = 271/326)] had disclosed to their partners. Most of the participants [70.76%; (n = 288/407)] had no knowledge of their partners’ status. Conclusion:Every pregnant woman should know their HIV status, disclose it to their sexual partners and know the status of their sexual partners as this will PMTCT, reduce HIV transmission and acquisition among sero- discordant couples.

Coronavirus disease 2019 (COVID-19) is a pandemic caused by the severe acute respiratory coronavirus 2 (SARS Cov-2) which currently has caused over 76 million cases with over 1.6 million people dead worldwide. COVID-19 can manifest with several non-specific clinical presentations, posing a diagnostic challenge. Several studies have shown an increased COVID-19 severity in patients with Diabetes mellitus. However, some patients with COVID-19 severity may present with new-onset Diabetes mellitus or worsening blood glucose control in a known diabetic. There are various mechanisms by which the SARS Cov-2 causes hyperglycemia in infected patients. This can lead to hyperglycemia as a presentation of COVID-19 in the absence of specific signs and symptoms. We present three cases: two of them initially presented with acute onset hyperglycemia and were diagnosed with Diabetes mellitus but shortly developed clinical manifestations that led to the suspicion of COVID-19 and a positive COVID-19 RT-PCR test. The third was a diabetic with previously good glycaemic control which suddenly worsened for no reason and shortly after, also developed clinical manifestations that led to the suspicion of COVID-19 which was later confirmed. We recommend that patients with acute hyperglycemia state and/or worsening blood glucose control in patients with previously well controlled Diabetes mellitus should be evaluated for COVID-19 in order to reduce morbidity and mortality as hyperglycemia confers an increased disease severity&nbsp

Introduction:emergency hysterectomy (EH) remains a life-saving procedure in cases of life-threatening obstetric hemorrhage and other gynaecological emergencies.We aim to determine the indications, surgical outcomes and challenges of EH in our tertiary centre. Methods:an ethically approved retrospective descriptive cross-sectional study on all EHs performed at a tertiary hospital during the period of 1stJanuary 2018 to 31stDecember 2019 was conducted. Medical records of eligible patients were retrieved, reviewed and analysed using frequencies and percentages and then summarized in tables. Results:there were 146 EHs over the two year period. The age of participants ranged from 19 to 59 years, with a mean of 34.3 years (SD = 6.06). SD: standard deviation.The main indication for EH was primary postpartum haemorrhage (PPH):73.28% (n = 110/146). The other indications were uterine perforation with necrosis: 8.9% (n = 13/146), secondary postpartum haemorrhage: 4.8% (n = 7/146), choriocarcinoma and pelvic abscess: 2.74% (n = 4/146) each and broad ligament haematoma: 2.06% (n = 3/146). There were 3.42% (n = 5/146) which were classified as ‘others **’: two cases of ovarian cyst torsion; one case of placental site tumour; one case of incomplete septic abortion; one case of bulky multinodular fibroid uterus with severe unremitting lower abdominal pain.The most common indication for the subgroup of hysterectomy due to PPH was uterine atony 54.20% (n = 60/110), followed by ruptured uterus20.56% (n = 23/110) and then, morbidly adherent placenta 14.95% (n = 16/110). Placenta accreta constituted 62.5% (n = 10/16) of the morbidly adherent placenta.There were 91.78% (n=134/146) total abdominal hysterectomies and 8.22% (n = 12/146) subtotalhysterectomies. About eighty percent 79.45% (n = 116/146) of the surgeries required general anaesthesia, 15.07% (n = 22/146) required regional anaesthesia whilst 5.48% (n = 8/146) were started as regional anaesthesia but were converted to general anaesthesia.There were no associated intraoperative complications in 96.60% (141/146) of the cases. The most frequent intraoperative complications included bowel injury 2.04% (3/146), bladder injury 0.68% (1/146) and maternal death 0.68% (1/146).Twoof the three bowel injuries required bowel resection and anastomosis. Most of the surgeries 89.73% (n = 131/146) were performed by skilled doctors above the level of a Specialist. Major challenges faced include delayed referral of patients to the tertiary centre for prompt management and lack of quick access to blood products. Conclusion:emergency hysterectomy is performed in women who are relatively young with primary postpartum haemorrhage as the commonest indication but there are other non-obstetric indications for this emergency surgery. Though a challenging procedure, it is safe in the hands of a skilled surgical team.

Crusted scabies is a rare and highly contagious form of Sarcoptes scabiei var hominis infestation whose incidence may increase in the near future due to increasing use of immunosuppressive therapies and a general lack of awareness about the condition. It is misdiagnosed as psoriasis, irritant dermatitis or eczema. Delays in diagnosis lead to widespread transmission amongst contacts leading to potential community outbreak. Crusted scabies is extremely difficult to treat and there are growing concerns of possible resistance to current treatment. This case report describes a 44-year-old Ghanaian woman with human immunodeficiency virus (HIV) infection and diagnosed with skin scrapings. Treatment was initiated but the patient died from HIV related complications. Crusted scabies, though rare, should be an issue of global concern due to the potential for widespread dissemination. Adequate resources need to be channeled into scabies eradication as well as education of health personnel to promptly identify and treat cases.

Patient: Female, 35-year-old Final Diagnosis: Cesarean section ectopic pregnancy Symptoms: Amenorrhea Medication:— Clinical Procedure: Exploratory laparotomy • MRI • ultrasonography Specialty: Obstetrics and Gynecology Objective: Management of emergency care 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.