Ghana Medical Journal <p><em>The Ghana Medical Journal</em> is a peer-reviewed, open access journal published by the Ghana Medical Association. It was established in 1962 It publishes quality manuscripts in in all aspects of health, health care and the medical sciences. The full text of published articles are available online at this website and at African Journals Online ( AJOL) and PubMed Central ( PMC).</p><p>The Ghana Medical Journal is indexed in Medline, African Journals Online (AJOL), African Index Medicus, Scopus, EBSCO</p><p>Other websites related to this journal: <a title="" href="" target="_blank"></a></p> Ghana Medical Association en-US Ghana Medical Journal 0016-9560 <p>Articles published in the Ghana Medical Journal may not be published elsewhere without the consent of the publishers. Request for consent for reproduction of material published in the Ghana Medical Journal should be addressed to the Editor-in-Chief. The publisher of this Journal reserves the right of copyright of all articles published in the Journal. It should also be understood by all authors that articles approved for publication in the journal are also deemed for publication online by the publisher.</p><p><span>Ghana Medical Journal is an Open Access journal and applies the Creative Commons Attribution (CC BY) license (Creative Commons Attribution License) 4.0 International. See details on the Creative Commons website ( to articles and other content published in the Journal.</span></p> Clinical, epidemiological characteristics and associated factors of hair greying in Lagos, Nigeria <p><strong>Objective</strong>: To document the epidemiological, clinical characteristics, believed triggers and associated behaviour in hair greying.<br><strong>Design</strong>: A community based cross-sectional descriptive study was conducted in February 2020 following ethical ap-proval and written informed consent from participants. All participants were clinically evaluated for hair greying, its pattern and location on the scalp. Socio-demographic data were documented. Data was entered and analyzed using the IBM statistics software version 22. Numerical and categorical variables are presented.<br><strong>Setting</strong>: The study was conducted at an urban market in Lagos, Nigeria.<br><strong>Participants</strong>: The study participants comprised 307 adult traders.<br><strong>Results</strong>: The mean age of the 307 participants studied was 42.7±12.8 years. The prevalence of hair greying was 47.6% (51% in males and 45.9% in females). The median (IQR) age of those with grey hair was 52 (44, 59) years. The prevalence of hair greying was 14.8% in those aged 30-34 years and 97.2% in those aged 60 years and above. The prevalence of premature greying was 17.7% and greying before friends and family members was reported at 19.9% and 13%, respectively. Grey hair was diffuse in 81.5%; localized to the frontal area of the scalp in 55.5%. Use of hair dye was noted in 15.8%.<br><strong>Conclusion</strong>: Hair greying is common in the study population. The age at onset is 30 years. Premature hair greying is uncommon in Nigeria. More epidemiological studies of hair greying especially of premature hair greying are needed.</p> Ehiaghe L Anaba Olusola Ayanlowo Olufolakemi M Cole-Adeife Erere Otrofanowei Ayesha O Akinkugbe Itohan R Oaku Ireneh Akwara Copyright (c) 2022-03-31 2022-03-31 56 1 1 4 10.4314/gmj.v56i1.1 Health-related quality of life and its demographic, clinical and psychosocial determinants among male patients with hypertension in a Ghanaian tertiary hospital <p><strong>Objectives</strong>: This study aimed to evaluate Health-related quality of life (HRQoL) among male patients with hyperten-sion and its associated demographic, clinical and psychosocial factors.<br><strong>Design</strong>: This was a facility-based cross-sectional study<br><strong>Setting</strong>: This study was carried out at the outpatient department in Korle-Bu Teaching Hospital<br><strong>Participants</strong>: Three hundred and fifty-eight hypertensive patients were recruited for this study<br><strong>Data collection</strong>: Information on socio-demographic characteristics, clinical features, insomnia, medication adherence, psychological distress, sexual dysfunction and HRQoL were obtained through patient-reported measures using struc-tured questionnaires and standardised instruments. Statistical analysis/Main outcome measure: The study assessed HRQoL among male hypertensive patients. One-way ANOVA was used to compare the average scores of the various domains of HRQL across the independent vari-ables. Multivariate linear regression models with robust standard errors were used to determine factors associated with quality of life.<br><strong>Results</strong>: Participants with poor perceived overall HRQoL was 14.0%. Comparatively, HRQoL (mean ± SD) was the least in the physical health domain (56.77±14.33) but the highest in the psychological domain (58.7 ± 16.0). Multi-variate linear regression showed that income level, educational level, insomnia, overall satisfaction, sexual desire and medication adherence were significant predictors of HRQoL. Average scores of HRQoL domains reduced with a higher level of sexual desire dysfunction.<br><strong>Conclusion</strong>: HRQoL among male hypertensive patients was negatively affected by insomnia, sexual desire dysfunc-tion, educational level and adherence to antihypertensive medications but positively affected by income level. Clinical practice and policy processes should be directed at these factors to improve HRQoL.</p> Vincent Boima Alberta K. Yeboah Irene A. Kretchy Augustina Koduah Kofi Agyabeng Ernest Yorke Copyright (c) 2022-03-31 2022-03-31 56 1 5 14 10.4314/gmj.v56i1.2 Coping strategies of Nigerian medical students during the COVID-19 pandemic <p><strong>Objective</strong>: This study assessed the coping strategies of Nigerian medical students during the COVID-19 pandemic.<br><strong>Design</strong>: We conducted an online descriptive cross-sectional study among medical and dental students attending three of the largest Colleges of Medicine in the Southwestern zone of Nigeria.<br><strong>Settings</strong>: Our study involved students across the pre-clinical and clinical levels of the three Colleges of Medicine.<br><strong>Participants</strong>: We selected the respondents through a purposive sampling technique and disseminated questionnaires applied using an online survey platform (Google forms A total of 1010 par-ticipants out of 2404 eligible students completed the questionnaires accurately, giving a response rate of 42%.<br><strong>Methods</strong>: The Brief-COPE questionnaire assessed the participants' coping strategies (approach and avoidant) during the COVID-19 pandemic. We conducted a bivariate analysis using the chi-square test and multiple regression analysis (p&lt; 0.05) to determine the predictors of avoidant coping strategies.<br><strong>Results</strong>: Respondents mean age was 21.8±2.9 years, results were presented as Odds Ratios(OR) at 95% confidence intervals(CI). About 95% of respondents employed an approach coping strategy, while the minority(5%) adopted an avoidant coping strategy. Females were three times more likely to employ an avoidant coping strategy (OR=3.32 (95% CI 1.67-6.21) compared to male students.<br><strong>Conclusion</strong>: This study reveals that the majority of the respondents employed an approach coping strategy towards the COVID-19 pandemic. Females were more likely to employ an avoidant coping strategy. We recommend gender-specific programs to help medical students cope with the COVID-19 pandemic.</p> OyinOluwa G. Adaramola Oluwaseun M. Idowu Oluwanisola I. Toriola Daniella M. Olu-Festus Toluwanimi E. Oyebanji Christabel I. Uche-Orji Oluseun P. Ogunnubi Oluwakemi O. Odukoya Copyright (c) 2022-03-31 2022-03-31 56 1 15 22 10.4314/gmj.v56i1.3 Factors associated with seizure severity among children with epilepsy in Northern Nigeria <p><strong>Objective</strong>: To describe how seizure severity in children with epilepsy may be affected by certain socio-demographic and clinical variables<br><strong>Design</strong>: A cross-sectional study<br><strong>Setting</strong>: At the Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria<br><strong>Participants</strong>: Sixty children and adolescents who were being followed up for seizure disorder at the child neurology clinic<br><strong>Intervention</strong>: Information on socio-demographic characteristics was obtained with a questionnaire, details of neuro-logical co-morbidities were extracted from the participants’ records, and seizure severity was assessed with the Na-tional Hospital Seizure Severity Score 3 tool.<br><strong>Main Outcome Measure</strong>: Chi-square test was used to establish the relationship between categorical variables, while the Independent t-test was used in describing the differences between means. Simple linear regression was calculated to assess the predictability of seizure severity.<br><strong>Result</strong>: The median age was ten years (IQR = 6-13 years), with a male dominance (1.5:1). The Seizure Severity Score (SSS) ranged between 3 and 24 units, with a mean of 12.22 ± 4.29 units. The only characteristic that had a significant association with SSS on bivariate analysis was the “presence of co-morbidities” (p=0.019). A simple linear regression revealed that the presence of a neurological co-morbidity predicted an increase in the SSS by 2.67 units. [R2 = 0.091, F (1, 58)= 5.837, p = 0.019. ꞵ = 2.67, t= 2.42, p= 0.019.]<br><strong>Conclusion</strong>: This study shows that neurological co-morbidities predict worsening seizure severity. This knowledge may influence prognostication and the charting of a treatment trajectory.</p> Idris A. Adedeji Adamu S. Adamu Faruk M. Bashir Faruk M. Bashir Copyright (c) 2022-03-31 2022-03-31 56 1 23 27 10.4314/gmj.v56i1.4 Computed tomography patterns of intracranial infarcts in a Ghanaian tertiary facility <p><strong>Objective</strong>: To determine the Computed Tomography (CT) patterns of intracranial infarcts<br><strong>Design</strong>: A retrospective cross-sectional study.<br><strong>Setting</strong>: The CT scan unit of the Radiology Department, Cape Coast Teaching Hospital (CCTH), from February 2017 to February 2021<br><strong>Participants</strong>: One thousand, one hundred and twenty-five patients with non-contrast head CT scan diagnosis of is-chaemic strokes, consecutively selected over the study period without any exclusions<br><strong>Main outcome measures</strong>: Patterns of non-contrast head CT scan of ischaemic strokes.<br><strong>Results</strong>: About 50.6% of the study participants were females with an average age of 62.59±13.91 years. Males were affected with ischaemic strokes earlier than females (p&lt;0.001). The risk factors considered were, hyperlipidaemia (59.5%), hypertension (49.0%), Type 2 diabetes mellitus (DM-2) (39.6%) and smoking (3.0%). The three commonest ischaemic stroke CT scan features were wedge-shaped hypodensity extending to the edge of the brain (62.8%), sulcal flattening/effacement (57.6%) and loss of grey-white matter differentiation (51.0%), which were all significantly as-sociated with hypertension. Small deep brain hypodensities, the rarest feature (2.2%), had no significant association with any of the risk factors considered in the study.<br><strong>Conclusion</strong>: Apart from the loss of grey-white matter differentiation, there was no significant association between the other CT scan features and sex. Generally, most of the risk factors and the CT scan features were significantly associated with increasing age.</p> Emmanuel K. M. Edzie Klenam Dzefi-Tettey Philip N. Gorleku Edmund K. Brakohiapa Peter Appiah-Thompson Kwasi Agyen-Mensah Michael K. Amedi Frank Quarshie Evans Boadi Joshua M. Kpobi Richard A. Edzie Abdul R. Asemah Copyright (c) 2022-03-31 2022-03-31 56 1 28 37 10.4314/gmj.v56i1.5 Delayed diagnosis of polycythaemia vera in an adult female with non-cirrhotic portal hypertension <p>Polycythaemia vera (PV) is a rare myeloproliferative neoplasm characterized primarily by erythrocytosis and an in-creased risk of thrombosis. We report a case of PV in a 60-year-old female with diabetes mellitus (DM) and a past history of recurrent abdominal pain and documented oesophageal varices who was followed up for 2 years as a case of non-cirrhotic portal hypertension of unknown cause. PV was only diagnosed after persistent complaints of vaso-motor symptoms and better scrutiny of full blood count results.</p> Kenneth Tachi Victor Ekem Yvonne Dei-Adomakoh Copyright (c) 2022-03-31 2022-03-31 56 1 38 41 10.4314/gmj.v56i1.6 Follicular thyroid carcinoma with internal jugular vein tumour thrombus <p>Tumour thrombus is the presence of tumour cells in great vessels. The reported incidence of tumour thrombus in thyroid carcinoma is about 0.2-3.8%. Being asymptomatic, detection of tumour thrombosis clinically is difficult. We present the report of internal jugular vein (IJV) tumour thrombosis in a known follicular thyroid carcinoma patient, detected with multimodality imaging. Grayscale ultrasound scan of the neck showed a well-defined, bi-lobed (2.4 x 1.5) cm, intraluminal solid lesion with homogeneous echotexture within the distal left IJV close to its confluence with the ipsilateral subclavian vein. The lesion showed significant internal vascularity on colour Doppler assessment. The sonographic findings confirmed further imaging with computed tomography (CT) and radioisotope scans. We con-clude that patients with thyroid cancer should be evaluated for tumour thrombosis both clinically and with imaging, particularly with ultrasound and CT/MRI or nuclear medicine, as it has prognostic implications.</p> Raphael N. Mayeden Klenam Dzefi-Tettey Benard O. Botwe Copyright (c) 2022-03-31 2022-03-31 56 1 42 45 10.4314/gmj.v56i1.7 Mucinous adenocarcinoma of a tailgut cyst <p>A tailgut cyst is a rare congenital lesion that develops from a residual posterior remnant of the intestine and presents as a mass in the presacral space. They are generally asymptomatic or have atypical symptoms, are usually benign but may rarely become malignant. We report a case of a 37-year-old female who initially presented to the Surgical De-partment of Korle Bu Teaching Hospital, Accra, Ghana with a malignant tailgut cyst after having repeated surgical procedures for recurrent perianal infective pathologies but still had persistence of symptoms. The lesion was initially excised and found to be a dermoid cyst histologically. The mass recurred after a year and had a re-excision; the lesion was diagnosed histologically as mucinous adenocarcinoma. This report emphasizes the different forms of presentation of a patient with a tailgut cyst and the possibility of malignant transformation, as well as the presentation of this tailgut cyst which can be diagnosed using radiological investigations and histological findings.</p> Philemon K. Kumassah Antoinette A. A. Bediako-Bowan Nelson Agboadoh Yaw B. Mensah Jonathan C.B. Dakubo Copyright (c) 2022-03-31 2022-03-31 56 1 46 50 10.4314/gmj.v56i1.8 The challenges and complications of re-implantation of the penis following amputation <p>Amputation of the penis is a rare and devastating injury. The etiologies vary from accidental, self-inflicted to attacks due to sexual jealousy and revenge. In the present era of microvascular surgery, replantation is the standard care. However, replantation of the penis comes with its own set of difficulties and complications. Knowledge of the anatomy and prior knowledge of the possible complications makes the surgeon aware of the course of events after a replantation. It helps in devising strategies to overcome these challenges methodically. We present a case of penile replant with the complications that we encountered, and the measures are taken to counter them on our way to a successful outcome.</p> Moumita De Rakesh Dawar Copyright (c) 2022-03-31 2022-03-31 56 1 49 52 10.4314/gmj.v56i1.9