.
BACKGROUND:Buruli ulcer, a neglected tropical disease, is common in West Africa and imposes a significant burden on health systems. Examining epidemiological data is important to guide health systems planning to facilitate control activities in endemic countries. OBJECTIVES:We aimed to provide a comprehensive description of the clinical epidemiology of a large cohort of polymerase chain reaction-confirmed cases of Buruli ulcer in districts in the middle belt of Ghana over an 18-year period. METHODS:We retrospectively analysed demographic and clinical data for affected individuals. Data were collected using World Health Organization standard case-based forms and managed in Microsoft Excel. Descriptive analysis was performed using SPSS and Stata statistical software. RESULTS:In total, 956 individuals with a median (interquartile range) age of 18 (10-35) years were included; 40% (385/956) of patients with Buruli ulcer were under 15 years. Clinical lesions included ulcers (61.5%), nodules (15.6%), plaques (14%) and osteomyelitis (1.4%). Regarding lesion severity, 38.6% were category I, 32.3% category II and 22.6% category III. Most lesions (51.7%) were located on the lower limbs. There was notable variability in the number of recorded cases across the years, with 2014 witnessing the highest and 2010 the lowest numbers. The Ahafo Ano North district reported the highest number of cases. CONCLUSIONS:Despite a general decline in case numbers, Ghana continues to be an endemic area for Buruli ulcer. Our findings support the need for policies emphasizing active surveillance for early case detection using integrated approaches. Further investigation into the changing epidemiology of Buruli ulcer is warranted.
Pancreaticopleural fistula (PPF) is an uncommon complication of pancreatitis that typically presents with respiratory symptoms rather than classic epigastric pain. PPF often occurs in settings of alcoholic pancreatitis with pancreatic pseudocyst rupture or ductal disruption, leading to abnormal pancreas-pleural communication. A 50-year-old woman with alcohol and tobacco use disorders presented with progressive dyspnea. She was found to have a left pleural effusion and acute pancreatitis. She experienced recurrent admissions for persistent pleural effusions despite appropriate chest tube drainage. Pleural fluid revealed markedly elevated lipase, and serial imaging identified a pseudocyst and PPF. A disconnected pancreatic duct was endoscopically stented. Her course included management with surgical decortication, talc pleurodesis, and multiple chest tubes, as well as complications of an enlarging pancreatic pseudocyst, splenic vein thrombosis, and pleural empyema. She was declined as a surgical candidate for pancreatectomy due to high operative risk. A multidisciplinary team recommended conservative management with parenteral nutrition and fistula suppression with octreotide. This case underscores the importance of early suspicion for PPF in patients with pancreatitis and recurrent pleural effusions, emphasizing the role of pleural enzyme testing, targeted imaging, and coordinated multispecialty management to reduce diagnostic delays and guide timely intervention.
Soft tissue reconstruction of the lower extremity presents unique challenges due to functional, structural, and esthetic demands. Locoregional flaps remain a valuable option for limb salvage, particularly in patients unsuitable for free tissue transfer or in centers without microsurgical capabilities. Advances in imaging and perforator flap planning have improved success rates and broadened indications for locoregional flaps. These flaps offer reliable outcomes comparable to free flaps, with potential benefits in operative time, hospital stay, and cost. Patient-reported outcomes and new assessment tools are increasingly informing flap selection and surgical planning for optimal functional recovery.
Abstract Background: Gynecological cancers and their treatments can compromise fertility, with profound psychosocial consequences for women of reproductive age. Yet, the lived experiences of women with cancer related infertility remain underexplored in low resource settings, including Ghana. This study examined the impact of gynecological cancers on fertility among reproductive aged women receiving care at Ho Teaching Hospital, Ghana. Methods: A qualitative descriptive design was used. Fourteen women aged 15 to 49 years with gynecological cancers who had completed or were undergoing treatment were purposively recruited until saturation. Semi structured interviews (30 to 45 minutes) were conducted face to face or by telephone in English, Twi, or Ewe, audio recorded, transcribed verbatim, and analyzed using thematic analysis. Strategies to enhance rigor included independent coding, member checking, reflexivity, and peer debriefing. Results: Five themes and eighteen subthemes emerged. Participants described infertility as a threat to womanhood and future life plans, expressed as a sense of incompleteness, fear of rejection, denial, and shattered aspirations. Social consequences included stigma and impaired intimate relationships. Treatment related burdens, menstrual changes, pain, fatigue, and anxiety compounded distress. Economic hardship and educational disruption were common. Women also demonstrated resilience through adherence to treatment, dietary and lifestyle modifications, faith based coping, and family support. Conclusion: Gynecological cancer related infertility is a multidimensional survivorship burden. Integrating fertility counseling, psychosocial support, symptom management, and financial/social protection into cancer care is critical in Ghanaian settings. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The author(s) received no specific funding for this work. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The researchers sought ethical review and clearance from the Research Ethics Committee of the University of Health and Allied Sciences before commencing data collection (Approval No. UR199/1125). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors
