The uptake of Continuing Professional Development (CPD) by Ghanaian radiographers

Continuing professional development (CPD) currently gains a priority within healthcare professions all over the globe. It is playing important roles in achieving improved quality care delivery. Healthcare practitioners are expected to continuously undertake CPD to maintain, enhance and improve quality of service delivery to meet the consumers’ expectations. CPD offers practitioners the opportunity to retain and enhance the basic knowledge and skills through their working life; thus enhancing competency within one’s professional range of practice.In Ghana, awareness of CPD participation has not been created among healthcare practitioners to enable them engage in effective CPD activities in order to improve their knowledge and skills.

Purpose

To examine the level of radiographers’ participation in CPD activities in Ghana.

Method

A 21-item questionnaire was constructed to collect data from 80 participants drawn from among radiographers currently practising in the radiology/X-ray departments of the ten regional hospitals in Ghana. The questionnaire comprised of 3 sections: demographics, CPD and education specific sections. Out of 80 questionnaires administered, 42 were completed and returned representing 52.5%. Out of the percentage, 74% were males and 26% females.The findings highlight that majority (44%) of the participants are currently within the age group of 31–40 years, while 2% is/are 60 or more years. The article also reveals that the radiographers have access to few peer review journals which serve as sources of information on contemporary issues in radiography and CPD learning activities. Again, a generally poor level of CPD awareness among the Ghanaian radiographers has been established. Lack of effective recording of learning and CPD activities have also been revealed.

Conclusion

The article concludes by recommending CPD policy guidelines; a regulatory body to register all healthcare professionals under one body to ensure effective CPD participation by the registrants; and CPD promotional education activities for Ghanaian healthcare practitioners. Evidence-based practice has also been recommended for Ghanaian healthcare professionals.     

Evaluation of Endoscopic Variceal Ligation (EVL) Versus Propanolol Plus Isosorbide Mononitrate/Nadolol (ISMN) in the Prevention of Variceal Rebleeding: Comparison of Cirrhotic and Noncirrhotic Patients

Both EVL and drug therapy are effective in the prevention of variceal rebleeding. Comparisons between the two modalities are few, and only in cirrhotics. This prospective randomized controlled trial compared EVL with drug therapy (propranolol + ISMN) in the prevention of rebleeds from esophageal varices in cirrhotic and noncirrhotic portal hypertension (NCPH) patients. One hundred thirty-seven variceal bleeders were randomized to EVL (Group I; n = 71) or drug therapy (Group II; n = 66). In Group I, EVL was done every 2 weeks till obliteration of varices. In Group II, propranolol (dose sufficient to reduce heart rate to 55 bpm/maximum tolerated dose) and ISMN (incremental dose up to 20 mg BD) were administered. Group I and II patients had comparable baseline characteristics, follow-up (12.4 vs. 11.1 months), cirrhotics and noncirrhotics [50(70.4%) and 21(29.6%) vs. 51(77.3%) and 15(22.7%)] and frequency of Child’s A (35 vs. 27), B (26 vs. 28), and C (9 vs. 11). The mean daily dose was 109 ± 46 mg propranolol and 34 ± 11 mg ISMN and was comparable in cirrhotic and NCPH patients. Upper GI bleeds occurred in 10 patients in Group I (5 from esophageal varices) and in 18 patients in Group II (15 from esophageal varices) (P = 0.06). The actuarial probability of rebleeding from esophageal varices at 24 months was 22% in Group I and 37% in Group II (P = 0.02). The probability of bleed was significantly higher in Child’s C compared to Child’s A/B cirrhotics (P = 0.02). On subgroup analysis, in NCPH patients, the actuarial probability of bleed at 24 months was significantly lower in Group I compared to Group II (25% vs 37%; P = 0.01). In cirrhotics, there was no difference in the probability of rebleeding between patients in Group I and those in Group II (P = 0.74). In Group II, 25.7% patients had adverse effects of drug therapy and 9% patients had to stop propranolol due to serious adverse effects, none required stopping ISMN. There were 10 deaths, 6 in Group I (bleed related, 1) and 4 in Group II (bleed related, 1); the actuarial probability of survival was comparable (P = 0.39). EVL and combination therapy are equally effective in the prevention of variceal rebleeding in cirrhotic patients. EVL is more effective than drug therapy in the prevention of rebleeds in patients with NCPH and, hence, recommended. However, in view of the small number of NCPH patients, further studies are needed before this can be stated conclusively.     

Recurrent aphthous stomatitis: a review

J Oral Pathol Med (2012) 41: 577-583 Recurrent aphthous stomatitis (RAS) is a common clinical condition producing painful ulcerations in oral cavity. The diagnosis of RAS is based on well-defined clinical characteristics but the precise etiology and pathogenesis of RAS remain unclear. The present article provides a detailed review of the current concepts and knowledge of the etiology, pathogenesis, and management of RAS.     

Effect of diquat on the antioxidant system and cell growth in human neuroblastoma cells

Oxidative stress elicits an adaptive antioxidant response, which varies with tissue type. Diquat, a potent redox cycler that generates reactive oxygen species, has been used to study oxidative stress; however, its effect on the antioxidant system has not been characterized in neuronal cells. Accordingly, we measured antioxidant parameters and cell growth in human neuroblastoma SH-SY5Y cells cultured for 48 h in medium containing 5, 10, or 25 microM diquat dibromide or phosphate-buffered saline. Viable cells were assayed for glutathione (GSH) and activities of catalase (CAT), superoxide dismutase (SOD), glutathione reductase (GR), glutathione peroxidase (GPX), and glucose-6-phosphate dehydrogenase (GPDH). Mitochondrial function was evaluated by glutamate dehydrogenase (GDH) activity and MTT reduction. Diquat caused a marked concentration-related decrease in viable cell count ( by 26, 51, and 87% at 5, 10, and 25 microM diquat). Cell viability was only affected at 10 and 25 microM diquat and did not fully account for the decreased viable cell count. Concentration-related increases also occurred with GSH levels and a majority of antioxidant enzymes activities; however, the mode and magnitude varied with parameter. Increases in GSH, CAT, SOD, and GR were maximal at 25 microM diquat (to 3-, 6-, 2-, and 1.5-fold control values, respectively). GPDH activity was maximal at 10 microM diquat and then decreased to 86% of control activity at 25 microM diquat. GPX activity showed a concentration-related decrease (to 35% of control). Activity of the mitochondrial enzyme GDH increased 3-fold at 25 microM diquat, along with a lesser increase in MTT reduction. We conclude that diquat reduces cell growth in neuroblastoma cells and induces an adaptive antioxidant response, which are concentration dependent and occur at sublethal concentrations. At higher concentrations, diquat alters mitochondrial function and becomes increasingly toxic.     

The effect of altered hemoglobin-oxygen affinity on oxygen transport by hemoglobin solution

Oxygen dynamics were evaluated in eight baboons following total exchange transfusion with either stripped (SFH) or pyridoxylated (SFH-P) stroma-free hemoglobin solution. Oxygen consumption and circulatory dynamics were maintained with both hemoglobin solutions. The oxygen extraction ratio increased in each group from 0.15 to 0.47, with no change in cardiac output or arteriovenous oxygen content difference. The major finding was the significantly higher mixed venous PO₂ (Pv?O₂) values observed with pyridoxylated hemoglobin at hematocrits below 20. At hematocrits of 5%, the SFH-P animals had a Pv?O₂ of 31.3 Torr, while the group receiving SFH had a Pv?O₂ of 13.8 Torr. The data suggest that SFH-P is more likely to minimize tissue hypoxia than SFH. Finally, the physiology of oxygen transport with hemoglobin solution appears to be different from that of erythrocytic hemoglobin.     

Rhino-orbital-cerebral mucormycosis: An epidemiological study from a tertiary care referral center in Western India

Purpose:Rhino-orbital-cerebral mucormycosis (ROCM) is a rare opportunistic fungal infection with a fulminant course and an often fatal outcome. It can occur in immune-compromised patients such as those having uncontrolled diabetes, on long-term corticosteroid or immunosuppressive therapy, with COVID-19 infection, renal failure, AIDS, malignancy, or organ transplant. The aim of our study was to study the epidemiology of mucormycosis in COVID-19 patients and identify its risk factors.Methods:Ours was an epidemiological study wherein we gathered the demographic, clinical, histopathological, and radiological data of 458 patients of mucormycosis who presented to us between August 2020 and May 2021. Mucormycosis was defined through clinical and radiological findings or positive culture reports.Results:Out of all, 20.74% of patients did not have any past or concurrent history of COVID-19. The most common symptom of mucormycosis was orbital/facial pain (38.64%) and the most common sign was periocular/facial edema (50.74%). Mucormycosis involving the nose and sinuses (94.54%) was most common followed by rhino-orbital (45.41%) and brain involvement (10.04%). The most common risk factor for mucormycosis was diabetes [81.92%], followed by corticosteroid use [79.69%] and supplemental oxygen [48.90%]. Most of the patients received similar treatment with IV amphotericin B [88.64%] and local debridement [80.74%]Conclusion:With the third wave of COVID-19 still lurking, a fatal fungal infection should be kept in mind in COVID-19 active as well as recovered patients, especially those who have co-morbid medical conditions such as uncontrolled diabetes and who are treated with large doses of corticosteroids.     

A standalone approach to utilize telomere length measurement as a surveillance tool in oral leukoplakia

Oral squamous cell carcinoma (OSCC) is often preceded by a white patch on a surface of the mouth, called oral leukoplakia (OL). As accelerated telomere length (TL) shortening in dividing epithelial cells may lead to oncogenic transformation, telomere length measurement could serve as a predictive biomarker in OL. However, due to high variability and lack of a universal reference, there has been a limited translational application. Here, we describe an approach of evaluating TL using paired peripheral blood mononuclear cells (PBMC) as an internal reference and demonstrate its translational relevance. Oral brush biopsy and paired venous blood were collected from 50 male OL patients and 44 male healthy controls (HC). Relative TL was measured by quantitative PCR. TL of each OL or healthy sample was normalized to the paired PBMC sample (TL ratio). In OL patients, the mean TL ratio was significantly smaller not only in the patch but also in distal normal oral tissue, relative to healthy controls without a high‐risk oral habit. Dysplasia was frequently associated with a subgroup that showed a normal TL ratio at the patch but significantly smaller TL ratio at a paired normal distal site. Our data suggest that evaluation of TL attrition using a paired PBMC sample eliminates the requirement of external reference DNA, makes data universally comparable and provides a useful marker to define high‐risk OL groups for follow‐up programs. Larger studies will further validate the approach and its broader application in other premalignant conditions.