Neuropathology Outreach in Ghana

Introduction/Objective

Ghana has a population of over 31 million people and approximately 15 neurosurgeons but is currently without a dedicated neuropathologist. Here we present a month of neuropathology outreach performed at the Komfo Anokye Teaching Hospital (KATH) in Kumasi and the Korle-Bu Teaching Hospital (KBTH) in Accra.

Methods/Case Report

In February of 2022, a second-year neuropathology fellow and a board-certified neuropathologist traveled to Ghana to give 40 approximately 1.5 hour neuropathology didactic and interactive teaching sessions. A two-week format of outreach was developed for each site in Ghana and consisted of didactic lectures and interactive sessions covering the WHO 2021 brain tumor classification system, neuroautopsy, neuroinfectious disease, neurodegenerative disease, neuromuscular disease, forensic neuropathology, neurodevelopment, and unknown case conferences. Meanwhile, a pathology trainee worked remotely to organize 12 one-hour virtual general pathology lectures and develop continuing outreach. A survey of 16 questions including 12 multiple choice questions and four short answer questions was used to assess each component and the overall satisfaction of the outreach.

Results (if a Case Study enter NA)

Eight brains were examined at four neuroautopsy conferences and ten case consultations were performed upon request. Survey results showed no statistical differences amongst the 20 sessions. Comments were positive and included one respondent planning to redesign their PhD research to focus on neurodegenerative disease in Ghana and several others commenting on the utility of molecular updates. Suggestions for improvement included quizzes, including more morphology and IHC in lectures, sending digital slides before future visits, teaching spinal cord removal, and the need for continuing outreach in neuropathology, dermatopathology, cytopathology and gynecologic pathology.

Conclusion

This experience provides a useful and well-appreciated approach to delivering international neuropathology outreach. Opportunities in neuropathology on an international level range from educational to clinical practice and research.

Trends in extrapulmonary TB cases at three teaching hospitals in Ghana, 2008-2017

SETTING

Three teaching hospitals in Ghana.

OBJECTIVE

To elucidate trends in demographics, clinical characteristics and treatment outcomes in extrapulmonary TB (EPTB) patients.

DESIGN

This was a retrospective study involving the review and comparison of EPTB and pulmonary TB (PTB) data from 1 January 2008 to 31 December 2017 in TB registers and treatment cards.

RESULTS

Of 15,392 TB cases, 4607 (30%) were EPTB, including 4477/4607 (97%) new cases. There were 2,679/4607 (58%) males and the age range was 0.3 to 96 years. Pleural TB (1021/4607, 22%) was the most common. Treatment success rates for EPTB and PTB were respectively 72% and 84%. HIV positivity was high among patients with disseminated/miliary TB (429/779, 55%) and TB meningitis (242/526, 46%). To note, disseminated/miliary TB (χ2 = 33.53, P < 0.0001) increased, whereas TB meningitis (χ2 = 19.43, P < 0.0001) decreased over the 10-year period. Mortality among EPTB patients was associated with increasing age (⩾25 years), disseminated/miliary TB, TB meningitis and HIV positivity.

CONCLUSIONS

There is male preponderance for both EPTB and PTB in Ghana. Increasing age, disseminated/ miliary TB, TB meningitis and HIV are risk factors for mortality among EPTB patients. This emphasises the need for public education on the risk factors for EPTB and preventive strategies.

P1847IMPROVING SHARED DECISION MAKING FOR END-STAGE RENAL DISEASE PATIENTS IN THE NETHERLANDS

Background and Aims

Annually, more than 2.000 end-stage renal disease (ESRD) patients in the Netherlands receive education regarding renal replacement therapies (RRT). The choice for RRT has major impact on a patient’s life. Ideally, this choice is made during a process of Shared Decision Making (SDM), since this improves satisfaction of patients and quality of care. Since 2017, three decision aids for SDM are available in the Netherlands: the 3 Good Questions, Option Grids and Dutch Kidney Guide (www.nierwijzer.nl). However, it is unknown whether these decision aids are sufficiently implemented in daily practice. Therefore, we evaluated SDM and developed an SDM workshop to train centres how to implement these decision aids.

Method

Twelve centres in the Netherlands were randomly selected and invited to participate. In these centres, the degree of SDM experienced by patients, who recently received RRT information, was measured using the SDM-Q-9 and collaboRATE questionnaires. Furthermore, SDM awareness and use of the decision aids by health care professionals was explored. Finally, we provided a 2-hour workshop for professionals with information regarding SDM and the three decision aids.

Results

In the twelve participating centres (two academic, ten non-academic), 176 patients completed the questionnaires; 73% found the general impression of the received information (very) good, 84% found the total number of consults good, and 86% found the received amount of information good.

On a scale from 0 – 100, with a higher score indicating better SDM, the mean SDM-Q-9 score was 75±22 and the collaboRATE score 86±14. Overall, no significant difference between centres in the SDM-Q-9 and collaboRATE scores was found.

When centres with the worst SDM-Q-9 score (&lt; 70) were compared to centres with the best score (&gt; 77), a difference was noticed in the use of kidney-specific decision aids, i.e. Option Grids and Dutch Kidney Guide, and the eGFR level at which the information was given. Only 50% of the worst scoring centres used the decision aids compared to 100% of the best scoring centres. The majority of the worst scoring centres started at an eGFR between 20 and 30 ml/min/1.73 m2, while the best scoring centres all started at an eGFR between 15 and 20 ml/min/1.73 m2. In addition, best scoring centres provided information about all treatment modalities, including nocturnal haemodialysis and conservative treatment (100% of the best vs. 50% of the worst scoring centres), and more often provided information at home (67% of the best vs. 25% of the worst scoring centres).

A total of 117 health care professionals (27% physicians, 8% physician assistants, 38% nurses, 14% social workers, 13% other) completed the questionnaire; 81% found the general impression of the education process (very) good, 80% found the total number of consults good, and 56% found the amount of provided information good, while 28% found the amount too much.

Fifty-six percent of the professionals believed SDM was applied, however only 28% used the 3 Good Questions and 31 – 33% the Option Grids. The Dutch Kidney Guide was used by 51%.

Subsequently, ten of the twelve centres participated in the SDM workshop which was appreciated with a 7.5±0.4 on a scale from 0 – 10.

Conclusion

Although patients and health care professionals are fairly satisfied with the RRT information and degree of SDM, the use of SDM decision aids by health care professionals is limited. An SDM workshop introducing the decision aids was developed to train centres how to implement them. When optimizing SDM for ESRD patients in the Netherlands, attention should be paid to providing information about all treatment options, including nocturnal haemodialysis and conservative treatment, and providing information at home, to patients with an eGFR between 15 and 20 ml/min/1.73 m2.

This project was funded by Stichting Kwaliteitsgelden Medisch Specialisten (SKMS) and health insurers CZ, Menzis and Stichting Achmea Gezondheidszorg.

No evidence of transmission from an acute case of hepatitis A in a foodhandler: follow-up of almost 1,000 potentially exposed individuals, London, United Kingdom, April 2012

Identification of acute hepatitis A virus (HAV) infection in a foodhandler in a London hotel led to a large incident response. We identified three potentially exposed groups: hotel staff who had regularly consumed food prepared by the case and shared toilet facilities with the case, patients who shared the same hospital ward as the case and hotel guests who consumed food prepared by the case. We arranged post-exposure HAV vaccination for all 83 potentially exposed hotel staff and all 17 patients. We emailed 887 guests advising them to seek medical care if symptomatic, but did not advise vaccination as it was too late to be effective for most guests. Through the International Health Regulations national focal points and the European Union Early warning and response system (EWRS), we communicated the details of the incident to public health agencies and potential risk of HAV transmission to international guests. Potentially exposed hotel staff and guests were asked to complete an online or telephone-administered questionnaire 50 days following possible exposure, to identify any secondary cases. Survey response was low, with 155 responses from guests and 33 from hotel staff. We identified no secondary cases of HAV infection through follow-up.

Lead: ongoing public and occupational health issues in vulnerable populations: a case study

BACKGROUND

Lead has been recognized increasingly as a public health risk, although with the introduction of wide-ranging occupational and public health measures, levels of blood lead in the general population of the UK and other developed nations have been in decline in recent years. Nonetheless, cases of lead poisoning still occur.

METHODS

We report on a large cluster of exposed lead workers and their families, including several children. The focus of the occupational and public health investigations was to identify the different groups at risk and the pathways by which potential exposures were taking place.

RESULTS

Lead in the workplace was found to account for the raised blood lead levels amongst the workers with exposure occurring as a result of insufficient demarcation between 'clean' and 'dirty' areas, and from contamination of personal belongings with lead. Furthermore, there was evidence of para-occupational exposure of family members.

CONCLUSIONS

The successful control of lead in this case required multidisciplinary working. Efforts included extensive workplace controls, along with the education and care of workers and their families, though complicated by lack of familiarity with the UK health service amongst the affected groups, language barriers, underlying low levels of literacy and high mobility.

Investigations and control measures following a non-travel-associated case of toxigenic Cornyebacterium diphtheriae, London, United Kingdom, December 2009-January 2010

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Investigations and control measures following a non-travel-associated case of toxigenic Cornyebacterium diphtheriae, London, United Kingdom, December 2009-January 2010

This article reports the investigation and control measures undertaken following the identification of a toxigenic strain of Cornyebacterium diphtheriae var gravis, designated ribotype Minsk , in a partially vaccinated teenager born in the United Kingdom with no recent history of travel or known contact with a case of diphtheria or a carrier. This case highlights the need for ongoing work to improve vaccine uptake rates to ensure children receive all scheduled vaccinations.

Granulocytic sarcoma of the testis

Granulocytic sarcoma is a rare tumor composed of neoplastic blood cells, typically occurring during the course of, or before the onset of, acute nonlymphoblastic leukemia. We present a case of a 37-year-old man with acute testicular pain who was found to have a testicular mass diagnosed as granulocytic sarcoma (GS). Because GS virtually always progresses to leukemia, he underwent postoperative radiotherapy and chemotherapy. He was free of disease 6 months after treatment. This case highlights a rare hematologic cancer that urologists and pathologists should be aware of because it can present as a testicular mass.

[Mediagenic psychoses]

Disturbances of psychotic intensity resulting from external trauma at times of crisis and tension have been described in the literature, particularly in combat reactions, including the Saddam syndrome. Acute psychoses as reactions to mystical-religious fervor have also been described. We describe 2 clusters of patients admitted with an acute, delusional, psychotic picture against the background of the Vanunu treason trial and later the strong messianic expectations aroused among the followers of the Rebbe of Lubavitch. Both of these events received extensive coverage in the Israeli press and electronic telecommunication media. The emergence of the mental disturbances and the content of the psychoses were linked to the particularly strident and dramatic media coverage of these 2 events. The impact of the reports of wide-spread messianic fantasies in the contemporary news bulletins on those with preexisting premorbid sensitivity was sufficient to trigger the psychoses. The delusional content was topical, and not that of the traditional psychotic delusions such as that of being Napoleon. This emphasizes that not only an authentic major external trauma such as a war is capable of triggering psychosis, but also emotionladen, stressful news items, frequently repeated in the media (such as reports of espionage or messianic fervor), may have similar effects.

The effect of exposure to positive space charge on aversive responses to noxious stimuli in rats

Exposure of rats to positive atmospheric ions for four days or longer results in an increase in aversive response times (tail flick and hot-plate). While these effects are similar to those produced after opiate administration, they could not be inhibited by naloxone treatment. Prompt reversal of the positive ion analgesic effect, however was brought about by treatment with parachlorophenylalanine which lowers brain serotonin levels. The data suggest that the action of positive ions on the pain inhibitory system is dependent upon an intact serotonin pathway and that the effects on this system are mediated via central rather than peripheral neural mechanisms.