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Couto B, Di Luca DG, Antwi J, Bhakta P, Fox S, Tartaglia MC, Kovacs GG, Lang AE. Ethnic background and distribution of clinical phenotypes in patients with probable progressive supranuclear palsy. Parkinsonism Relat Disord 2024; 123:106955. [PMID: 38677215 DOI: 10.1016/j.parkreldis.2024.106955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/02/2024] [Accepted: 04/02/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Progressive Supranuclear Palsy (PSP) is a sporadic neurodegenerative disease without a clear geographic prevalence. Cohorts studied in the UK and India showed no higher prevalence of atypical parkinsonism in South Asian patients. We describe the ethnic and racial background of PSP patients in the Greater Toronto Area (GTA), Canada. METHODS A prospective observational study of patients with clinically probable PSP evaluated at the dedicated Rossy PSP program. Demographic and clinical data were collected at baseline including PSP phenotype. Results were compared with the latest demographic information from the greater Toronto area. RESULTS Of the 197 patients screened, 135 had probable PSP and resided within the GTA. The mean age at visit was 71.1 years, disease duration 4.4 years, and disease severity moderate. Compared to our catchment area, there was a higher proportion of patients with a South Asian origin and a lower proportion of patients from East and Southeastern Asia and Africa. A secondary analysis using population census data limited to individuals greater than 65 confirmed the significantly higher representation of South Asians in our clinic but found no differences for other racial and ethnic origins. CONCLUSION Evaluation of this Toronto cohort found a greater than expected proportion of affected individuals with South Asian ethnic and racial origin. Despite limitations, our results suggest the possibility of a racial and ethnic predisposition to PSP. Further studies are needed to confirm and to address potential associated risk factors, and genome-environmental interactions.
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Affiliation(s)
- Blas Couto
- Edmond J. Safra Program in Parkinson's Disease, Rossy Program for PSP Research and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, ON, Canada; Instituto de Neurociencia Cognitiva y Traslacional (INCyT), INECO-CONICET-Favaloro, Buenos Aires, Argentina.
| | - Daniel G Di Luca
- Edmond J. Safra Program in Parkinson's Disease, Rossy Program for PSP Research and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, ON, Canada; Department of Neurology, Washington University in St. Louis, MO, USA.
| | - Jeffrey Antwi
- Edmond J. Safra Program in Parkinson's Disease, Rossy Program for PSP Research and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, ON, Canada.
| | - Puja Bhakta
- Edmond J. Safra Program in Parkinson's Disease, Rossy Program for PSP Research and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, ON, Canada.
| | - Susan Fox
- Edmond J. Safra Program in Parkinson's Disease, Rossy Program for PSP Research and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, ON, Canada; Department of Medicine, Division of Neurology, University Health Network and the University of Toronto, Toronto, Ontario, Canada.
| | - Maria Carmela Tartaglia
- Memory Clinic, Toronto Western Hospital, Toronto, ON, Canada; Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Division of Neurology, University Health Network and the University of Toronto, Toronto, Ontario, Canada.
| | - Gabor G Kovacs
- Edmond J. Safra Program in Parkinson's Disease, Rossy Program for PSP Research and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, ON, Canada; Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology and Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Laboratory Medicine Program & Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Division of Neurology, University Health Network and the University of Toronto, Toronto, Ontario, Canada.
| | - Anthony E Lang
- Edmond J. Safra Program in Parkinson's Disease, Rossy Program for PSP Research and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, ON, Canada; Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Division of Neurology, University Health Network and the University of Toronto, Toronto, Ontario, Canada.
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Karikari AK, Amedjake D, Antwi J, Agyei-Baffour P, Mock C, Edusei AK, Donkor P. The knowledge level of nurses managing critically-ill and injured patients in Ashanti Region of Ghana. Afr J Emerg Med 2023; 13:306-310. [PMID: 38021351 PMCID: PMC10663742 DOI: 10.1016/j.afjem.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 10/05/2023] [Indexed: 12/01/2023] Open
Abstract
Background Shortages in the right cadres of human resources to manage health emergencies remain an acute problem especially in low- and middle-income countries. Efforts to address this challenge are dependent on the knowledge and competency of emergency nurses. We sought to determine the knowledge level of nurses in emergency management in the Ashanti Region of Ghana. Methods We used a cross-sectional, quantitative approach to evaluate knowledge about emergency care among 408 nurses working in wards and emergency units in 11 randomly selected district hospitals (6 public and 5 faith-based). Participants were purposively selected and examined on knowledge level using a structured questionnaire. The inclusion criteria were different cadres of nurses who had spent at least 6 months in the selected hospitals. Results Four hundred and eight nurses participated. Most were general nurses (73.1 %) or mid-wives (14.4 %), with few specialised in emergency nursing (3.9 %) or critical care nursing (1.6 %). Mean percentage correct on an objective 20 question test on emergency care was 59.8 %. Few (35.6 %) nurses felt that they had adequate knowledge to manage emergencies. Around half (52.5 %) had received training in managing critically ill and injured patients through continuing professional development and 46.6 % felt prepared to work at emergency units. But few (34.7 %) reported having adequate logistics to manage emergencies and fewer (32.2 %) had time off to access training opportunities. Predictors of reporting adequate knowledge to manage emergencies included: having received training in managing critically ill and injured patients (p<.002), feeling prepared to work at emergency units (p<.001), and having adequate logistics to manage emergencies (p<.001). Conclusion Most nurses did not feel that they had adequate knowledge to manage emergencies. This study has identified increased availability of continuing professional development on emergency care for nurses as a priority in Ghana.
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Affiliation(s)
- AK Karikari
- Komfo Anokye Teaching Hospital, Post Office Box 1934, Kumasi, Ghana
| | - D Amedjake
- Nursing and Midwifery Training College, Korlebu, Accra, Ghana
| | - J Antwi
- Directorate of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - P Agyei-Baffour
- Department of Health Policy, Management & Economics, School of Public Health, College of Health Sciences, KNUST, Kumasi, Ghana
| | - C Mock
- University of Washington, Seattle, USA
| | - AK Edusei
- Department of Health Promotion and Disability Studies, School of Public Health, College of Health Sciences, KNUST, Kumasi, Ghana
| | - P Donkor
- Department of Surgery, Komfo Anokye Teaching Hospital, Ghana
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AlWazan BA, Garcia-Cordero I, Couto B, Monteiro ML, Tsang MY, Antwi J, Sasitharan J, Bhakta P, Kovacs GG, Fox S, Tang-Wai DF, Lang AE, Tartaglia MC. Investigating differences in young- and late-onset progressive supranuclear palsy. J Neurol 2023; 270:6103-6112. [PMID: 37670149 DOI: 10.1007/s00415-023-11976-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/25/2023] [Accepted: 08/25/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND The impact of age of onset on the presentation of progressive supranuclear palsy phenotypes is not well studied. We hypothesized that there is difference in presentation and phenotype between young- and late-onset PSP. OBJECTIVES Our aim was to compare phenotypes and rate of change in disability between young-onset PSP (YOPSP) and late-onset PSP (LOPSP). METHODS Retrospective data of patients seen in the Rossy PSP Centre from March 2014 to April 2022 with clinical diagnosis of PSP as per the MDS 2017 diagnostic criteria were examined. We used cut-off age of 65 years to categorize the patients into YOPSP and LOPSP. We compared the prevalence of phenotypes, presenting symptoms, and MDS core criteria between the two groups. The severity of disease between the two groups was measured using PSP-RS. RESULTS We found 107 patients with clinical diagnosis of PSP as per MDS criteria, a third were defined as YOPSP. PSP speech/language (SL) phenotype was more prevalent in YOPSP (18% vs 0%, p < 0.001). Aphasia was significantly higher in YOPSP (16% vs 1.4%, p = 0.03). The speech and language dysfunction (C1) core criteria were more prevalent in YOPSP (33.3% vs 12.2%, p = 0.05). Longitudinal analysis of PSP-RS showed worsening of bulbar total score at 6 months in YOPSP (t (38) = 2.87; p = 0.05). CONCLUSION Our study revealed that YOPSP are more likely to present with a speech and language variant. Our results highlight that age of onset may predict PSP phenotypes, which holds both clinical and prognostic importance.
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Affiliation(s)
- Batoul A AlWazan
- Memory Clinic, Toronto Western Hospital, Toronto, ON, Canada.
- Geriatric Unit, Department of Medicine, Mubarak Al Kabeer- Hospital, Jabriya, Kuwait.
| | - Indira Garcia-Cordero
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
| | - Blas Couto
- Institute of Cognitive and Translational Neuroscience (INCyT), INECO-CONICET-Favaloro University Hospital, Buenos Aires, Argentina
| | - Marta Lamartine Monteiro
- Memory Clinic, Toronto Western Hospital, Toronto, ON, Canada
- Neurology Department, CHU Tivoli, La Louvière, Belgium
| | - Michelle Y Tsang
- Division of Neurology, Department of Medicine, University Health Network and the University of Toronto, 399 Bathurst St. WW 5-449, Toronto, ON, M5T 2S8, Canada
| | - Jeffrey Antwi
- Edmond J. Safra Program in Parkinson's Disease, Rossy Progressive Supranuclear Palsy Centre and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, ON, Canada
| | - Jonathan Sasitharan
- Edmond J. Safra Program in Parkinson's Disease, Rossy Progressive Supranuclear Palsy Centre and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, ON, Canada
| | - Puja Bhakta
- Edmond J. Safra Program in Parkinson's Disease, Rossy Progressive Supranuclear Palsy Centre and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, ON, Canada
| | - Gabor G Kovacs
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
- Division of Neurology, Department of Medicine, University Health Network and the University of Toronto, 399 Bathurst St. WW 5-449, Toronto, ON, M5T 2S8, Canada
- Edmond J. Safra Program in Parkinson's Disease, Rossy Progressive Supranuclear Palsy Centre and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Krembil Brain Institute, University Health Network, Toronto, ON, Canada
- Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
| | - Susan Fox
- Division of Neurology, Department of Medicine, University Health Network and the University of Toronto, 399 Bathurst St. WW 5-449, Toronto, ON, M5T 2S8, Canada
- Edmond J. Safra Program in Parkinson's Disease, Rossy Progressive Supranuclear Palsy Centre and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, ON, Canada
| | - David F Tang-Wai
- Division of Neurology, Department of Medicine, University Health Network and the University of Toronto, 399 Bathurst St. WW 5-449, Toronto, ON, M5T 2S8, Canada
- Krembil Brain Institute, University Health Network, Toronto, ON, Canada
- Toronto Dementia Research Alliance, Toronto, ON, Canada
- Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Anthony E Lang
- Edmond J. Safra Program in Parkinson's Disease, Rossy Progressive Supranuclear Palsy Centre and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, ON, Canada
| | - Maria Carmela Tartaglia
- Division of Neurology, Department of Medicine, University Health Network and the University of Toronto, 399 Bathurst St. WW 5-449, Toronto, ON, M5T 2S8, Canada.
- Edmond J. Safra Program in Parkinson's Disease, Rossy Progressive Supranuclear Palsy Centre and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, ON, Canada.
- Neurology Department, CHU Tivoli, La Louvière, Belgium.
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Couto B, Fox S, Tartaglia MC, Rogaeva E, Antwi J, Bhakta P, Kovacs GG, Lang AE. The Rossy Progressive Supranuclear Palsy Centre: Creation and Initial Experience. Can J Neurol Sci 2023; 50:845-852. [PMID: 36600512 DOI: 10.1017/cjn.2022.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To describe the development and initial experience of a clinical research program in progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS) in Canada: The Rossy PSP Centre, to share the data acquisition tools adopted, and to report preliminary results. METHODS Extensive demographic and longitudinal clinical information is collected every 6 months using standardized forms. Biofluids are collected for biobanking and genetic analysis, and many patients are enrolled in neuroimaging research protocols. Brain donation is an important component of the program, and standardized processing protocols have been established, including very short death to autopsy times in patients undergoing medical assistance in dying. RESULTS Between Oct 2019 and Dec 2021, 132 patients were screened, 91 fulfilling criteria for PSP and 19 for CBS; age 71 years; 41% female; duration 5 years, age-of-onset 66 years. The most common symptoms at onset were postural instability and falls (45%), cognitive-behavioral changes (22%), and Parkinsonism (9%). The predominant clinical phenotype was Richardson syndrome (82%). Levodopa and amantadine resulted in partial and short-lasting benefit. CONCLUSIONS The Rossy PSP Centre has been established to advance clinical and basic research in PSP and related tauopathies. The extent of the clinical data collected permits deep phenotyping of patients and allows for future clinical and basic research. Preliminary results showed expected distribution of phenotypes, demographics, and response to symptomatic treatments in our cohort. Longitudinal data will provide insight into the early diagnosis and management of PSP. Future steps include enrollment of patients in earlier stages, development of biomarkers, and fast-tracking well-characterized patients into clinical trials.
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Affiliation(s)
- Blas Couto
- Edmond J. Safra Program in Parkinson's Disease, Rossy Progressive Supranuclear Palsy Centre and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Susan Fox
- Edmond J. Safra Program in Parkinson's Disease, Rossy Progressive Supranuclear Palsy Centre and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Maria Carmela Tartaglia
- Edmond J. Safra Program in Parkinson's Disease, Rossy Progressive Supranuclear Palsy Centre and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University Health Network and the University of Toronto, Toronto, Ontario, Canada
- Memory Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, Ontario, Canada
| | - Ekaterina Rogaeva
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, Ontario, Canada
| | - Jeffrey Antwi
- Edmond J. Safra Program in Parkinson's Disease, Rossy Progressive Supranuclear Palsy Centre and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Puja Bhakta
- Edmond J. Safra Program in Parkinson's Disease, Rossy Progressive Supranuclear Palsy Centre and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Gabor G Kovacs
- Edmond J. Safra Program in Parkinson's Disease, Rossy Progressive Supranuclear Palsy Centre and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University Health Network and the University of Toronto, Toronto, Ontario, Canada
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Laboratory Medicine Program & Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
| | - Anthony E Lang
- Edmond J. Safra Program in Parkinson's Disease, Rossy Progressive Supranuclear Palsy Centre and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University Health Network and the University of Toronto, Toronto, Ontario, Canada
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, Ontario, Canada
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Quaglietta PR, Ramjist JK, Antwi J, Kissoondoyal A, Lapidus-Krol E, Baertschiger RM. Unanticipated consequences of COVID-19 pandemic policies on pediatric acute appendicitis surgery. J Pediatr Surg 2023; 58:931-938. [PMID: 36775681 PMCID: PMC9851992 DOI: 10.1016/j.jpedsurg.2023.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 01/03/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND Global pandemics may limit access to specialized care, delaying diagnosis and treatment of common acute surgical diseases. We analyzed the impact of the novel coronavirus disease 2019 (COVID-19) pandemic on acute appendicitis at an urban tertiary care center. We hypothesize that pandemics are associated with delayed presentation and worsened clinical sequelae, specifically, higher incidences of perforation in children. METHODS We retrospectively assessed patients admitted to our institution with acute appendicitis in pre-pandemic control (February 2018-June 2019) and COVID-19 (February 2020-June 2021) cohorts. Primary outcomes included complicated appendicitis rates (perforation/abscess/bowel obstruction), COVID-19 status, complications and travel distance to our institution. 1107 patients met inclusion criteria: 491 (44.4%) during the control period and 616 (55.6%) in the COVID-19 cohort. Statistical analysis involved t-tests, contingency tables and logistic regression modelling for key variables. RESULTS A larger proportion of complicated appendicitis occurred during COVID-19 compared to controls (28.3% vs 38.8%, p < 0.001). Symptom duration at presentation and length of stay were not significantly different. Duration of antibiotic treatment, surgery length, readmission rate and travel distances were significantly higher during COVID-19. The pre-pandemic cohort had a significantly younger age distribution. CONCLUSION Pediatric appendicitis was significantly impacted during COVID-19, demonstrated by increased rates of complicated appendicitis, surgery duration and antibiotic duration. This may be an unintended secondary consequence of patients avoiding healthcare facilities for non-pandemic related illnesses or lockdown policies. Government policies directing all provincial pediatric appendicitis cases to pediatric institutions increased travel distances for our patients and had unanticipated consequences and resource requirements on tertiary healthcare. LEVEL OF EVIDENCE Level III for "Treatment Studies".
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Affiliation(s)
- Paula R Quaglietta
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada; Institute of Medial Science, University of Toronto, Toronto, ON, M5S 1A8, Canada; Department of Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada
| | - Joshua K Ramjist
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada
| | - Jeffrey Antwi
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada
| | - Ashby Kissoondoyal
- Department of Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada
| | - Eveline Lapidus-Krol
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada
| | - Reto M Baertschiger
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada; Institute of Medial Science, University of Toronto, Toronto, ON, M5S 1A8, Canada; Department of Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada.
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Gyedu A, Stewart B, Wadie R, Antwi J, Donkor P, Mock C. Population-based rates of hernia surgery in Ghana. Hernia 2019; 24:617-623. [PMID: 31429025 DOI: 10.1007/s10029-019-02027-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 08/04/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE To estimate the population-based annual rate of hernia surgery in Ghana, so as to better define the met and unmet need and to identify opportunities to decrease the unmet need. METHODS Data on operations performed from June 2014 to May 2015 were obtained from representative samples of 48 of 124 district (first-level) hospitals, 9 of 11 regional (referral) hospitals, and 3 of 5 tertiary hospitals, and scaled-up to nationwide estimates. Rates of hernia surgery were compared to previously published annual incidence of symptomatic hernia in Ghana (210/100,000 population) and to published annual rates of hernia surgery in high-income countries (120-275/100,000). RESULTS Estimated 17,418 [95% uncertainty interval (UI) 8154-26,683] hernia operations were performed nationally. The annual rate of hernia operations was 65 operations/100,000 population (95% UI 30.2-99.0). The rate was considerably less than the annual incidence of new symptomatic hernia or rates of hernia surgery in high-income countries. Hernia operations represented 7.5% of all operations. Most hernia operations (74%) were performed at district hospitals. Most district hospitals (54%) did not have fully trained surgeons, but nonetheless performed 38% of district-level hernia operations. CONCLUSIONS The rate of hernia operations fell short of estimated need. Most hernia repairs were performed at district hospitals, many without fully trained surgeons. Future global surgery benchmarking needs to address both overall surgical rates as well as rates for specific highly important operations. Countries can strengthen their planning for surgical care by defining their total, met, and unmet need for hernia surgery.
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Affiliation(s)
- A Gyedu
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Private Mail Bag, University Post Office, Kumasi, Ghana.
| | - B Stewart
- Department of Surgery, University of Washington, Seattle, WA, USA.,Department of Interdisciplinary Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - R Wadie
- School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - J Antwi
- Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - P Donkor
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Private Mail Bag, University Post Office, Kumasi, Ghana
| | - C Mock
- Department of Surgery, University of Washington, Seattle, WA, USA.,Harborview Injury Prevention and Research Center, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA
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Jegathesan T, Bhutani VK, Campbell D, Shah V, Twiss J, Rasiah S, Baleswaran S, Antwi J, Prajapati D, Jhaveri A, Ehsan S, Visvanathaiyer G, Sgro M. 141 Total bilirubin rate of rise of in moderate preterm neonates: impact of gestational age. Paediatr Child Health 2019. [DOI: 10.1093/pch/pxz066.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
As compared to term neonates, those < 35 weeks gestation (wks GA) are at greater risk for both acute and chronic bilirubin encephalopathy (ABE, CBE). Among these with postnatal total bilirubin rate of rise, (TB ROR) at age 0 to 72 hours has been observed because of either loss placental elimination system or increased postnatal production due to hemolysis. The ranges are known to vary > 8.5 umol/L/h in neonates with Rh disease to >3.4 umol/L/h at the 95th percentile track of the hour-specific nomogram. TB ROR in healthy term neonates is <3.4 umol/L/h.
Objectives
To determine the GA ranges on TB ROR to explore predictive TB ROR in preterm neonates who are more vulnerable with each <35 wks GA.
Design/Methods
A multi-site observational study to quantify TB ROR in preterm infants between 28 to 35 weeks. 1804 infants born between January 2013- March 2018 at 28–35 wks GA from three canadian perinatal centres were included and those with Rh disease were excluded. Analysis included infants >27 weeks with at least one TB prior to the initiation of treatment for severe hyperbilirubinemia treatment. Feeding patterns, birth history and maternal health conditions were documented.
Results
The TB ROR were compared by two prematurity GA groups (28–31 weeks and 32–35 weeks) then per individual gestational age in four time periods in hours, 0–24, 24–48, 48–96, and 96 -120 in 1049 preterm infants using 3065 TB samples. Infants <28 weeks GA were excluded since they represented a more diverse population. TB ROR by prematurity groups over all was higher in 32–35 weeks group at 0–12 hours (3.85 umol/L/h) and 25–36 hours (2.81umol/L/h) and decreased at 49–72 hours (0.24umol/L/h) time period as compared to the less mature group.
Conclusion
Though TB ROR were of similar patterns between prematurity groups (28–31 weeks and 32–35 weeks) it was at higher rate of rise between 13–36 hours and decreasing from 36–72 hours, with a plateau after 72 hours of age. There was a significant difference in the magnitude of TB ROR between prematurity groups at 0–24 hours. Additional research into the clinical care impact on the TB ROR should be conducted to study impact of production and elimination.
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Affiliation(s)
- Thivia Jegathesan
- Department of Pediatrics, St.Michael’s Hospital
- Institute of Medical Sciences, Faculty of Medicine, University of Toronto
| | - Vinod K Bhutani
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University, School of Medicine
| | - Douglas Campbell
- Department of Pediatrics, Li Ka Shing Knowledge Institute, St.Michael’s Hospital
- Allan Waters Family Simulation Centre, St.Michael’s Hospital
- Department of Pediatrics, University of Toronto
| | - Vibhuti Shah
- Department of Pediatrics, Sinai Health Systems
- Department of Pediatrics, Division of Neonatology, University of Toronto
| | | | | | | | | | | | - Aadi Jhaveri
- Department of Pediatrics, Hamilton Health Sciences Centre, McMaster University
| | | | | | - Michael Sgro
- Institute of Medical Sciences, Faculty of Medicine, University of Toronto
- Department of Pediatrics, University of Toronto
- Department of Pediatrics, Li Ka Shing Knowledge Institute, St.Michael’s Hospital
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