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Background: Most data on mortality and prognostic factors in patients with heart failure come from North America and Europe, with little information from other regions. Here, in the International Congestive Heart Failure (INTER-CHF) study, we aimed to measure mortality at 1 year in patients with heart failure in Africa, China, India, the Middle East, southeast Asia and South America; we also explored demographic, clinical, and socioeconomic variables associated with mortality. Methods: We enrolled consecutive patients with heart failure (3695 [66%] clinic outpatients, 2105 [34%] hospital in patients) from 108 centres in six geographical regions. We recorded baseline demographic and clinical characteristics and followed up patients at 6 months and 1 year from enrolment to record symptoms, medications, and outcomes. Time to death was studied with Cox proportional hazards models adjusted for demographic and clinical variables, medications, socioeconomic variables, and region. We used the explained risk statistic to calculate the relative contribution of each level of adjustment to the risk of death. Findings: We enrolled 5823 patients within 1 year (with 98% follow-up). Overall mortality was 16·5%: highest in Africa (34%) and India (23%), intermediate in southeast Asia (15%), and lowest in China (7%), South America (9%), and the Middle East (9%). Regional differences persisted after multivariable adjustment. Independent predictors of mortality included cardiac variables (New York Heart Association Functional Class III or IV, previous admission for heart failure, and valve disease) and non-cardiac variables (body-mass index, chronic kidney disease, and chronic obstructive pulmonary disease). 46% of mortality risk was explained by multivariable modelling with these variables; however, the remainder was unexplained. Interpretation: Marked regional differences in mortality in patients with heart failure persisted after multivariable adjustment for cardiac and non-cardiac factors. Therefore, variations in mortality between regions could be the result of health-care infrastructure, quality and access, or environmental and genetic factors. Further studies in large, global cohorts are needed. Funding: The study was supported by Novartis.

Optic nerve gliomas (ONG) are benign central nervous system tumours and the most common tumours of the optic nerve in children, often occurring before age 20. These tumours are slow-growing and can be treated with surgery and/or radiation therapy. Surgical resection is, however, associated with significant morbidity and loss of vision in the affected eye. The successful management of ONG requires a multidisciplinary, individualised approach aimed at preserving vision. This case report discusses an 11-year-old Ghanaian male diagnosed with left ONG in July 2023. He presented with blurred vision in the left eye, mild proptosis and poor vision, but no pain, headaches or neurological deficits. A contrast-enhanced magnetic resonance imaging of the orbit showed diffuse fusiform enlargement of the left optic nerve (35 × 12 × 11 mm). The successful management of ONG, in this case, using intensity-modulated radiotherapy demonstrates the potential of advanced radiotherapy techniques in preserving vision and achieving tumour control in pediatric patients, even in resource-limited settings. Continuous follow-up and a multidisciplinary approach are essential for managing the long-term outcomes and ensuring the best possible quality of life for these patients., Competing Interests: The authors declare that they have no conflicts of interest., (© the authors; licensee ecancermedicalscience.)

Pulmonary cryptococcosis is an uncommon invasive fungal infection of the lungs seen in immunocompromised individuals but increasingly reported among the immunocompetent. We report a rare case of pulmonary cryptococcosis in an immunocompetent host highlighting its unique clinical and radiological presentation.Clinical trial number: Not applicable., (© 2024. The Author(s).)

Introduction: Mucocoele of the appendix occurs in 0.2-0.7% of people in the world without any well-defined clinical symptoms. It occurs when there is an accumulation of mucous in the lumen of the appendix., Case Presentation: We present three cases: a 48-year-old male admitted to the emergency room with a one-day history of right iliac fossa pain. Abdominal examination was suggestive of acute appendicitis. The initial abdominal computerised tomography scan was reported as being unremarkable. At surgery, a firm tumour of the appendix was found, and a limited right hemicolectomy was done. Histopathology confirmed a mucocoele of the appendix with borderline mucinous histology.The second case is a 63-year-old man who presented with a one-year history of abdominal distension and weight loss. Previous abdominal ultrasound was suggestive of liver cirrhosis with significant ascitic fluid. Abdominal magnetic resonance imaging found an appendix mucocoele with infiltration of the omentum and scalloping of the liver surface suggestive of pseudomyxoma peritonei. A percutaneous biopsy of the omental mass confirmed metastatic mucinous adenocarcinoma of the appendix.The third case is a 68-year-old man who, during an annual medical check-up, had an incidental finding of a cystic right iliac fossa mass on ultrasound, confirmed on abdominopelvic computerised tomography scan to be an appendix mucocele. He had laparoscopic appendicectomy. The histopathological diagnosis confirmed a mucinous cystadenoma of the appendix., Conclusion: Preoperative diagnosis of appendiceal mucocoele is difficult and commonly discovered intraoperatively. The prognosis is good for the histologically benign type, but it is poor when malignant or peritoneal lesions are present., Funding: None declared., Competing Interests: Conflict of interest: None declared, (Copyright © The Author(s).)

Wilms tumor (WT) is the most common renal malignancy of childhood. The common metastatic sites are the lungs, liver, and lymph nodes, with brain and bone metastases occurring rarely. Metastatic disease can be present at initial diagnosis or may occur with relapse or disease progression. The majority of relapses in WT occur within the first two years post-treatment. Late relapses are rare. This article describes four cases of WT, each demonstrating an unusual site or timing of metastases. Case 1 presented primarily with jaw metastases, Case 2 presented with bone (vertebrae) and spinal metastases manifesting as paraplegia, at relapse one year after completion of treatment, Case 3 presented with isolated liver metastases four years after treatment completion, and Case 4 presented with brain metastases after six weeks of treatment abandonment. This case series demonstrates the varied pattern of metastases of WT and highlights the need for a high index of suspicion for WT among patients who present with unusual sites of tumor or for metastasis in those who present with neurologic symptoms during or after treatment., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Tagoe et al.)

Adult-onset asthma is extremely variable in its phenotypic presentation and has gained notoriety for the overall poorer treatment outcomes even on standard asthma therapy. Tracheal tumours are rare but when present, exhibit asthma-like phenomenon in adult patients posing great diagnostic challenges. We report two adult patients with tracheal adenoid cystic tumours who were initially treated for adult-onset asthma. Patient 1, a 45-year-old man was diagnosed and managed for adult-onset asthma over a 12 months period without satisfactory control of his symptoms. Following a late episode of hemoptysis, a chest Computed Tomography (CT) scan done revealed an occluding tracheal tumour. Patient 2 is a 28-year-old female who was diagnosed with adult-onset asthma for over 2 years with poor symptom control despite optimal asthma therapy. She developed cough-induced subcutaneous emphysema for which a chest CT scan revealed a tracheal mass. The patient had surgery with incomplete resection of tumour and adjuvant radiotherapy., Competing Interests: None declared., (© 2023 The Authors. Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.)

Objective: The study sought to determine clinical characteristics and histologic subtypes of a cohort of lung cancer patients in a tertiary facility., Design: Retrospective review of the medical records of histology-confirmed lung cancer cases at the respiratory clinic over a 3-year period., Setting: Respiratory Clinic, Korle-Bu Teaching Hospital, Accra, Ghana., Participants: All adult patients with histologically diagnosed lung cancer were enrolled., Main Outcome Measures: Lung cancer histological types., Results: The proportion of lung cancer cases was 12.4%. The majority were women (57.8%) and the mean age at diagnosis was 55.8±16.0 years. The patients were predominantly non-smokers (61%). Common symptoms were chronic cough and chest pain. More than two-thirds of the cases presented in clinical stages III and IV with the predominant histological subtype being adenocarcinoma in smokers and non-smokers. Genetic testing for epidermal growth factor receptor (EGFR) and Anaplastic Lymphoma kinase (ALK) mutations were largely absent., Conclusions: The majority of lung cancer patients presented late with advanced disease. Adenocarcinoma was the predominant histological subtype in a predominantly non-smoking population, with an increased prevalence among women less than 60 years. This should encourage testing for genetic mutations to improve patient survival., Funding: None declared., Competing Interests: Conflict of interest: None declared, (Copyright © The Author(s).)

Background: Invasive aspergillosis (IA) among haematological malignancy patients is rarely diagnosed or studied in many African countries. Aspergillus galactomannan (GM) enzyme immunoassay (EIA) utilized in aiding diagnosis is not readily accessible in Ghana. Previous studies have evaluated the IMMY sōna Aspergillus GM lateral flow assay (LFA) and suggested it as a potential alternative to the GM EIA., Objectives: We aimed to use the LFA in international (EORTC/ MSGERC) definitions to obtain preliminary data on IA among patients with haematological malignancies in Ghana with a focus on the prevalence and antifungal prophylaxis., Methods: We conducted a pilot study among patients with haematological malignancies at the Korle-Bu Teaching Hospital, Ghana using the LFA, culture and computed tomography scan to screen for and classify IA cases according to international definitions., Results: A total of 56 adult patients were recruited including acute leukaemia 14 (25.0%), chronic leukaemia 38 (67.9%), and lymphoma 4 (7.1%). Nine (16.1%) patients had a history of severe neutropenic episodes. All patients were on at least one chemotherapy drug. Three (5.4%) patients met the criteria for IA, comprising two probable IA in acute myeloid leukaemia and one possible IA in non-Hodgkin's lymphoma and constitutes one of five (20%) patients with ongoing severe neutropenia. The LFA was diagnostic in two IA patients. The IA cases were among 49 (87.5%) patients who did not receive antifungal prophylaxis., Conclusion: Proactive diagnostic approaches to IA and effective antifungal prophylaxis may be significant in the management of haematological malignancy patients with severe neutropenia in Ghana., Competing Interests: The Authors declare that no competing interest exists., (Copyright © 2023 by West African Journal of Medicine.)

Chronic pulmonary aspergillosis (CPA) often occurs in patients that have been previously treated for pulmonary tuberculosis (PTB). A limited number of studies have looked at the development of CPA at different times following the completion of a PTB treatment course. This prospective longitudinal study aimed to determine the incidence of CPA at two timepoints, at the end of the PTB treatment (T 1 ) and six months post-treatment (T 2 ). Patients with confirmed PTB from a previous study who were placed on anti-TB medication were followed up and screened for CPA at T 1 and T 2 by assessing their symptoms, evaluating their quality of life, and screening them for Aspergillus infection by performing antibody testing and cultures. CPA was defined by the Global Action for Fungal Infections (GAFFI) diagnostic algorithm. Forty-one patients were enrolled, of whom thirty-three patients (80%) and twenty-eight patients (68%) were resurveyed at T 1 and T 2, respectively. The rate of new CPA was 3.3% (1/33) and 7.4% (2/27) at T 1 and T 2 , respectively, with an overall incidence of 10.7% (3/28) among the patients at both T 1 and T 2 . A positive Aspergillus -specific antibody test was an indicator for CPA in all three patients. Aspergillus -specific antibody screening during and after the end of an anti-TB treatment regimen may be important for early detection of CPA in high-PTB-burden settings.

Anorectal mucosal melanoma (AMM) is a rare, aggressive malignancy. The symptoms of AMM mimic common benign conditions in the anus, such as haemorrhoids; hence diagnosis is often made late, a third of patients having metastasis at first presentation. Surgical resection remains the standard of treatment, and adjuvant therapy is varied, including immunotherapy, brachytherapy, and chemotherapy. The prognosis is poor, with a 5-year survival of 20%. A 65year old woman presented with a five-year history of symptoms suggestive of haemorrhoids and was diagnosed with a malignant anorectal mucosal melanoma after symptoms worsened and further investigation was performed. She underwent surgical resection and is currently receiving adjuvant therapy. The prognosis of AMM, the lack of consensus on the treatment regimen to dat e, and the need for a high index of suspicion for early diagnosis are discussed ., Funding: None declared., Competing Interests: Conflict of interest: None declared, (Copyright © The Author(s).)

Objectives: To review the Computed Tomography( CT )features of pediatric oncological patients with abdominal and pelvic tumours and correlate these findings with their histopathological diagnosis., Design: This was a retrospective cross-sectional facility-based study., Setting: This study was conducted in the Pediatric Oncology Unit and Radiology Department of the Korle Bu Teaching Hospital., Participants: Fifty-six pediatric oncology patients with contrast-enhanced abdominal and pelvic CT scans., Data Collection: The abdominal and pelvic CT scans findings, patient biodata, and histopathology reports of oncology patients over four years were reviewed., Statistical Analysis: Simple descriptive statistics using frequency distribution, percentages, means, and standard deviation were used to describe the various variables and presented tables., Results: The four commonest tumours were nephroblastoma, neuroblastoma, lymphoma, and hepatoblastoma. The mean age at diagnosis was 4.8 years, with a slightly higher male predominance. The majority of the tumours were extremely large at presentation. Overall, the CT - histopathology concordance was 79.2%., Conclusion: Abdominal and pelvic CT scans play an important role in the diagnostic workup of pediatric malignancies by ensuring early and accurate diagnosis of these tumours., Funding: None declared., Competing Interests: Conflict of interest: None declared, (Copyright © The Author(s).)

Chronic pulmonary aspergillosis (CPA) may mimic pulmonary tuberculosis (PTB). The two diseases are clinically indistinguishable and may result in CPA misdiagnosed as PTB or vice versa. Although PTB is largely recognised as a differential diagnosis of CPA and often ruled out prior to CPA diagnosis, the reverse is uncommon. The aim of this study was to determine the proportion of CPA cases among patients being assessed for PTB. A cross-sectional survey was conducted among consecutive patients referred for GeneXpert Mycobacterium tuberculosis test for the diagnosis of PTB at the Korle-Bu Teaching Hospital, Accra, Ghana. Patients' demographics, clinical and socioeconomic details were obtained using a structured questionnaire. Blood was collected for Aspergillus and HIV serology, and sputum samples obtained for Aspergillus culture. Chest radiograph was obtained, and computed tomography scan was also done for patients with positive Aspergillus serology or cavitation. CPA was defined using an algorithm developed by the Global Action for Fungal Infections (GAFFI) international expert panel. A total of 154 patients were included in the analysis, of whom 134 (87%) did not have a prior PTB diagnosis. There were 41 (26.6%) GeneXpert positive cases. CPA prevalence was 9.7% overall, but 50% in patients with a prior history of PTB and 3.7% in those without previous PTB. Although CPA is rarely considered as a differential diagnosis of PTB in Ghana, our findings show that CPA may affect half of patients being assessed for PTB relapse. Efforts to diagnose CPA should be prioritised in this patient group., (© The Author(s) 2022. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology.)

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., (© 2021 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

We report a case of a young Ghanaian male who developed Bleomycin Induced Pneumonitis (BIP) after being treated for Hodgkin's Lymphoma. Pulmonary toxicity is the most feared complication of bleomycin therapy despite its effectiveness in achieving cure in patients with Hodgkin's lymphoma and germ cell tumors. BIP has a significant mortality rate if detected late and a high index of suspicion is required in all patients on bleomycin-based therapies with sudden onset of respiratory symptoms., Competing Interests: Conflict of interest: None declared, (Copyright © The Author(s).)

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., Funding: None declared., Competing Interests: Conflict of interest: None declared, (Copyright © The Author(s).)

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 declared., Competing Interests: Conflict of interest: None declared

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.