Browsing by Author "Adu-Aryee, N.A."
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Item Antibiotic use in a tertiary healthcare facility in Ghana: a point prevalence survey(Antimicrobial Resistance and Infection Control, 2018-01) Labi, A.K.; Obeng-Nkrumah, N.; Nartey, E.T.; Bjerrum, S.; Adu-Aryee, N.A.; Ofori-Adjei, Y.A.; Yawson, A.E.; Newman, M.J.Background The global rise and spread of antibiotic resistance is limiting the usefulness of antibiotics in the prevention and treatment of infectious diseases. The use of antibiotic stewardship programs guided by local data on prescribing practices is a useful strategy to control and reduce antibiotic resistance. Our objective in this study was to determine the prevalence and indications for use of antibiotics at the Korle-Bu Teaching Hospital Accra, Ghana. Methods An antibiotic point prevalence survey was conducted among inpatients of the Korle-Bu Teaching Hospital between February and March 2016. Folders and treatment charts of patients on admission at participating departments were reviewed for antibiotics administered or scheduled to be administered on the day of the survey. Data on indication for use were also collected. Prevalence of antibiotic use was determined by dividing the number of inpatients on antibiotics at the time of survey by the total number of patients on admission. Results Of the 677 inpatients surveyed, 348 (51.4%, 95% CI, 47.6–55.2) were on treatment with antibiotics. Prevalence was highest among Paediatric surgery where 20/22 patients (90.9%, 95% CI, 70.8–98.9) were administered antibiotics and lowest among Obstetrics patients with 77/214 (36%, 95% CI, 29.5–42.8). The indications for antibiotic use were 245/611 (40.1%) for community-acquired infections, 205/611 (33.6%) for surgical prophylaxis, 129/611 (21.1%) for healthcare associated infections and 33/611 (5.4%) for medical prophylaxis. The top five antibiotics prescribed in the hospital were metronidazole 107 (17.5%), amoxicillin-clavulinic acid 82 (13.4%), ceftriaxone 17(12.1%), cefuroxime 61 (10.0%), and cloxacillin 52 (8.5%) respectively. Prevalence of meropenem and vancomycin use was 12(2%) and 1 (.2%) respectively. The majority of patients 181 (52%) were being treated with two antibiotics. Conclusion This study indicated a high prevalence of antibiotic use among inpatients at the Korle-Bu Teaching Hospital. Metronidazole was the most commonly used antibiotic; mainly for surgical prophylaxis. There is the need to further explore factors contributing to the high prevalence of antibiotic use and develop strategies for appropriate antibiotic use in the hospital.Item Circulating cell-free DNA integrity as a diagnostic and prognostic marker for breast and prostate cancers(Cancer Genetics, 2019-04) Arko-Boham, B.; Aryee, N.A.; Blay, R.M.; Owusu, E.D.A.; Tagoe, E.A.; Doris Shackie, E.S.; Debrah, A.B.; Adu-Aryee, N.A.Background Cancer incidence and its related mortality is rising and is currently the second leading cause of death globally. In Africa, breast and prostate cancer in females and males, respectively, are the worst globally. However, biomarkers for their early detection and prognosis are not well developed. This study sought to investigate circulating cell-free DNA (ccfDNA) integrity and its potential utility as diagnostic and/or prognostic biomarker. Circulating cell-free DNA (ccfDNA) is degraded DNA fragments released into the blood plasma. In healthy individuals, the source of ccfDNA is solely apoptosis, producing evenly sized shorter DNA fragments. In cancer patients, however, necrosis produces uneven longer cell-free DNA fragments in addition to the shorter fragments originating from apoptosis. DNA integrity, expressed as the ratio of longer fragments to total DNA, may be clinically useful for the detection of breast and prostate cancer progression. Methods Sixty-four (64) females, consisting of 32 breast cancer patients and 32 controls, and 61 males (31 prostate cancer patients and 30 controls) were included in the study. Each participant donated 5 ml peripheral blood from which sera were separated. Real-time qPCR was performed on the sera to quantify ALU 115 and 247 levels, and DNA integrity (ALU247/ALU115) determined. Results & Conclusion ALU species 115 and 247 levels in serum were elevated in breast and prostate cancer patients compared to their counterpart healthy controls. DNA integrity was higher in prostate cancer patients than in the control, but in breast cancer patients was lower compared to their controls. In prostate but not in breast cancers, DNA integrity increased with disease severity and higher staging.Item MALIGNANT GASTRIC NEOPLASMS; HOPE FOR THE FUTURE(2013-12-09) Adu-Aryee, N.A.Gastric cancers are known to have poor prognosis worldwide except for Japan and Korea. There is a changing trend in the distribution of tumours with a relative increase in the proportion of proximal tumours in the western world. This has not been found to be true in Ghana. The addition of various forms of adjuvant treatment has improved the prognosis of treatment worldwide and these are being introduced into oncologic practice in Ghana with good prospects. Opportunities exist for researching into prognostic features of this devastating tumourItem Malignant gastric neoplasms; hope for the future(Current Challenges with their Evolving Solutions in Surgical Practice in West Africa: A Reader, 2013) Adu-Aryee, N.A.In lieu of an abstract, here is a brief excerpt of the content: •81• Chapter 8 Malignant Gastric Neoplasms; Hope for the Future N.A. Adu-Aryee Introduction Gastric cancers are a diverse group of cancers which are known to have a poor prognosis worldwide except in Japan and Korea.1 The predominant cancer type worldwide is the adenocarcinoma arising from mucosa and forms 90 percent of all gastric neoplasms. The two main variants are the diffuse and intestinal types with different presentations and prognosis.2 Lesions also arise from lymphoid tissues which are not native to the stomach but are present because of chronic irritation. The main irritant which is also shared with the adenocarcinoma sub-group is the relatively newly found organism Helicobacter pylori (H pylori).3 In lymphoid neoplasms the lesions are known as Mucosa Associated Lymphoid Tissue (MALT) Lymphomas.4 The muscle layer also contributes its share of malignancy through the interstitial cells of Cajal which are the intrinsic pacemaker cells of the stomach. The resulting tumours formerly thought to be leiomyosarcomas (arising from smooth muscle) are now referred to as stromal tumours hence the term Gastro-Intestinal Stromal Tumours, or GISTs.5 Prognosis for adenocarcinomas of the stomach have been considered as poor except in Japan where the disease is considered a public health problem and so early detection and radical surgery for early lesions give survival rates of over 90 percent.6 This has not been duplicated in other places leading to research into supplementary forms of treatment, some of which have shown statistically significant improvements in survival rates. These modalities include peri-operative chemotherapy7 and postoperative chemoradiation8 and •82• Chapter 8 in some cases targeted therapies against Human Epidermal Receptor II where this is over-expressed.9 The presence of H pylori in the aetiology of MALT lymphomas also lends itself to a therapeutic option of organism eradication in treatment of this condition as part of the armamentarium.10 The GISTs are the group which have been in the forefront of research, targeted treatments for tyrosine kinase inhibitors showing the way.11 There are also a tiny subset of neuroendocrine tumours which are apparently quite chemosensitive. This review will focus on the experience with adenocarcinomas within the Korle Bu Teaching Hospital(KBTH). Adenocarcinomas of the stomach Known to be quite aggressive, these lesions have been known to be detected only when symptomatic and advanced in nature except for countries with early detection or screening policies. The worldwide incidence is not known but in Europe 159,900 cases were reported in 2006 with 118,200 deaths recorded.12 In the USA, 38,780 upper gastrointestinal tumours are projected to occur in 2012, of which 25,610 patients are expected to die.13 Operating theatre records for KBTH in Accra suggest that in 2010, seven patients had partial gastrectomies with three having palliative bypasses for obstruction. In 2011, there were eight gastric resections with three bypasses. These figures suggest that most of the cases are still fairly advanced (Figure 8.1) making curative surgery next to impossible. •83• Malignant Gastric Neoplasms; Hope for the Future Figure 8.1: Advanced gastric cancer observed at gastroscopy Mortality rates for gastric cancers have been known to be high and dependent on stage of occurrence or presentation of the lesions. The incidence worldwide is generally thought to be declining. This has been attributed to changes in food storage patterns and the use of frozen foods rather than salted or pickled foods. Improvements in water supply have also been cited. In Ghana Darko et al.1996 found a significant incidence of H Pylori in gastric pathology including tumours.14 Unpublished data by Archampong, T. (personal communication) in Accra also correlate this finding. Other factors like ingestion of well-done red meat, drinking green tea and familial disease patterns have been cited. The worrying trend however is a relative increase in the number of proximal as opposed to distal tumours in the Western world or in •84• Chapter 8 low-risk areas.15 The implications of having more proximal tumours which seem to behave like distal oesophageal tumours is a relatively poorer prognosis with more extensive surgical procedures and more physiologic stress on the patient. This increase in proximal tumours has been linked to increasing obesity in the general populace together with an increase in the incidence of reflux oesophagitis.15,16 The true reason for these changes in epidemiology is not known. Unpublished endoscopy suite figures for the KBTH for 2010 and 2011 give total endoscopic cancer rates of 47...Item Massive persistent lower gastrointestinal haemorrbage secondary to typhoid fever(Ghana Medical Journal, 2001-09) Adu-Aryee, N.A.; Aduful, H.K.; Edwin, F.We report a case of massive lower gastrointestinal bleeding secondary to typhoid fever. The diagnosis was essentially clinical. The patient was managed surgically. This involved segmentation of the ileum with soft bowel clamps, enterotomy and underrunning of an identified arterial bleeding site. The patient made an uneventful recovery.Item Position and susceptibility to inflammation of vermiform appendix in Accra, Ghana(East African Medical Journal, 2006) Clegg-Lamptey, J.N.; Armah, H.; Naaeder, S.B.; Adu-Aryee, N.A.OBJECTIVES: To determine the normal (non-inflamed) position of the vermiform appendix in Ghana and carry out a pilot study to test the hypothesis "The retrocaecal appendix is less prone to inflammation". DESIGN: Retrospective autopsy study. SETTING: The pathology department and the department of surgery theatres of the Korle Bu Teaching hospital in Accra, Ghana SUBJECTS: Consecutive autopsies and inflamed appendices at appendicectomy. Deaths occurring from untreated appendicitis were excluded from the autopsy study. Conversely non-inflamed appendices and appendices from interval appendicectomy were excluded from the appendicitis study. RESULTS: There were 1358 autopsies and 323 inflamed appendices. In the autopsy study the retrocaecal position was the most common (914 [67.3%]). Other positions were pelvic (294 [21.6%]), preileal (66 [4.9%]), postileal (51 [3.8%]) and paracaecal (33 [2.4%]). These positions were similar in males and females. The positions of 323 inflamed appendices were: retrocaecal (183 [56.7%]), pelvic (66 [20.4%]), preileal (20 [6.2%]), postileal (15 [4.6%]) and paracaecal (39 [12.1%]). Comparing the nonretrocaecal to the retrocaecal position by chi square, the non-retrocaecal position was more prone to inflammation (p<0.001). CONCLUSION: The position of the normal appendix in Ghana differs from Western literature. The retrocaecal position appears less prone to inflammation in Ghanaians.Item Profile of breast diseases at a self-referral clinic in Ghana(West African Journal of Medicine, 2009-03) Clegg-Lamptey, J.N.A.; Aduful, H.K.; Yarney, J.; Adu-Aryee, N.A.; Vanderpuye, V.; Kyereh, M.; Nkansah, A.; Edwin, A.BACKGROUND: Breast cancer is a common malignancy in Ghana, and many patients are referred with advanced disease and long duration of symptoms. OBJECTIVE: To determine the spectrum of breast disease diagnosed through patient self-referral in Ghana. METHODS: Abreast clinic, where patients could walk in without referral, was started in the Korle Bu Teaching Hospital in 2001. A team of surgeons, radiation oncologists, oncology nurses, a clinical psychologist and a clinical pharmacist sat in conference once a week to see and discuss self-referred patients. RESULTS: Seven hundred and forty eight patients, mean age 38.6 (range 8-85) years, were seen during a four-year period. There were 741 females and seven males. The main complaints were pain 450(50.2%), lump 257(28.7%) and nipple discharge 62(8.3%). Fifty (5.6%) came for check-up; 139(18.6%) had more than one complaint. The mean (S.D.) duration of symptoms was; for nipple discharge 14.1(10.5) months, lump 11.9(7.7) months, and pain 113(8.9) months. The main diagnoses were: Normal breasts 192(27.7%), mastalgia 135(18.1%), fibroadenosis 114(15.2%), fibroadenomas 84(11.2%), breast cancer 58(7.8%), suspected breast cancer 25(3.3%), galactorrhea 9(1.2%), mastitis 8(1.1 %), musculoskeletal pain 8(1.1%), duct ectasia 8(1.1%), mondor's disease 7(0.94%) and recurrent breast cancer 6(0.8%). In patients with breast cancer, 42(66%) had advanced disease, 6(9.4%) had recurrent disease and 4(6.3%) had metastatic disease. CONCLUSION: The number of self-referrals, detected breast cancers and duration of symptoms justify the need for self-referral clinics in Ghana.Item A retrospective analysis of breast cancer subtype based on ER/PR and HER2 status in Ghanaian patients at the Korle Bu Teaching Hospital, Ghana(BMC Clinical Pathology, 2015-07) Seshie, B.; Adu-Aryee, N.A.; Dedey, F.; Calys-Tagoe, B.; Clegg-Lamptey, J.-N.Background Breast cancer is a heterogeneous disease composed of multiple subgroups with different molecular alterations, cellular composition, clinical behaviour, and response to treatment. This study evaluates the occurrence of the various subtypes and their clinical and pathological behaviour in the Ghanaian breast cancer population at the Korle Bu Teaching Hospital (KBTH). Methods Retrospective review of case notes of patients who had completed treatment for breast cancer at the KBTH within the last 5 years was conducted between April 2011 and March 2012. Subtypes were determined by immunohistochemistry classification based on expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER-2). Result A total of 165 cases contributed to this study. The mean age at diagnosis was 52.5 ± 12.1 years. Tumour size ranged from 0.8 cm to 15 cm with a mean of 4.9 ± 2.8 cm and median of 4 cm. Tumour grade was Grade I 8.3 %, Grade II 60.8 % and Grade III 30.8 %. ER, PR and HER2/neu receptor positivity was 32.1, 25.6 and 25.5 % respectively. Almost half (49.4 %) of the study population had triple negative tumours. Luminal A, luminal B and non-luminal HER2 were 25.6, 12.2, and 12.8 % respectively. No statistically significant association was seen between subtype and tumour size, tumour grade, lymph node status and age at diagnosis. Conclusion Triple negative tumour is the most occurring subtype in the Ghanaian breast cancer population treated at the Korle Bu Teaching Hospital. Lack of association seen between subtypes and their clinical and pathological behaviour could be due to small sample size.Item Upper Gastrointestinal Endoscopy at the Korle Bu Teaching Hospital, Accra, Ghana(2007-03) Aduful, H.K.; Naaeder, S.B.; Darko, R.; Baako, B.N.; Clegg-Lamptey, J.N.A.; Nkrumah, K.N.; Adu-Aryee, N.A.; Kyere, M.Objectives To study the indications for endoscopy, the endoscopic diagnosis and other lessons learnt. Methods A retrospective and prospective audit of all upper gastrointestinal endoscopies performed in the Endoscopy Unit of the Korle-Bu Teaching Hospital from January 1995 to December 2002 was performed. Results A total of 6977 patients, 3777 males and 3200 females with age range 1 year 8 months to 93 years were endoscoped. The mean age of males was 43.5 ± 0.5 and females 43.7 ± 0.6 years. Epigastric pain (42.5%), dyspepsia (32.8%) and haematemesis and melaena (14.2%) were the commonest reasons for endoscopy. Chronic duodenal ulcer (19.6%), acute gastritis (12.7%), duodenitis (10.2%), oesophagitis (7.5%) were the commonest diagnoses. Normal endoscopy was reported in 41.1% patients, and was higher in the younger age group compared to the older (R = 0.973, P<0.001). Nine hundred and ninety (14.2%) patients were endoscoped for haematemesis and melaena of which chronic duodenal ulcer (32.1%), gastritis/gastric erosions (12.8%), oesophageal varices (9.8%), carcinoma of the stomach (6.4%), and duodenitis (4.2%), were the commonest causes. No lesion was found in 20.6% of these patients. Urease test was positive in 75% of all biopsy specimen and 85% in chronic duodenal ulcer, gastritis and duodenitis. Conclusion The normal endoscopy rate is high and needs to be reduced in order to help prolong the lives of the endoscopes. Chronic duodenal ulcer is usually associated with H. pylori infection and is the commonest cause of upper gastrointestinal bleeding.