Browsing by Author "Crabbe, S."
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Item A case series describing causes of death in pregnant women with sickle cell disease in a low‐resource setting(American Journal of Hematology, 2018-07) Asare, E.V.; Olayemi, E.; Boafor, T.; Dei-Adomakoh, Y.; Mensah, E.; Osei-Bonsu, Y.; Crabbe, S.; Musah, L.; Hayfron-Benjamin, C.; Covert-Greene, B.et.al.Sickle cell disease (SCD) is most prevalent in sub‐Saharan Africa with 15,000 newborns per year in Ghana.1, 2 Pregnant women with SCD have increased risks of both SCD‐specific and pregnancy‐related complications, compared to pregnant women without SCD.3 In a recent meta‐analysis, our team reported that SCD in pregnancy increases the risk of maternal death by over 20‐fold compared to pregnant women without SCD, in low‐ and middle‐income countries.4 In sub‐Saharan Africa, maternal death rate of SCD is 7%‐12%,3, 5, 6 without clearly identifiable etiologies. Following our before and after study that demonstrated a 89% relative risk reduction in maternal death in women with SCD with our combined SCD‐obstetric team care model,7 we undertook a medical records and autopsy review of all SCD maternal deaths over a seven‐year period from 2010 to 2016, at the Korle‐Bu Teaching hospital (KBTH), in Accra, Ghana. Ethical approval was obtained from the institutional review boards of the College of Health Sciences, University of Ghana and Vanderbilt University Medical Centre. At the KBTH, about 11 000 deliveries occurred annually including 200 women with SCD, and about two‐thirds are HbSC. We conducted a combined retrospective (January 2010 to April 2015) and prospective case series (May 2015 to December 2016) of all maternal deaths in women with SCD at KBTH. All deaths that occurred prior to arrival at the hospital, and those without documented evidence of hemoglobin phenotype, were excluded. Our research team, including obstetricians, hematologists, a pediatrician, anesthesiologists and nurses, adjudicated all cases of SCD maternal deaths to reach a consensus on the cause of death. Pathologists performed autopsies. In this series, we defined maternal death, direct and indirect obstetric cause of death according to WHO ICD‐10 classification (WHO 2012).8 The maternal mortality records, patients' admission and discharge files, and death certificates of all SCD‐related maternal deaths within the study period were retrieved and reviewed by the team. Data were summarized as simple descriptive statistics. The Mann‐Whitney U‐test and Fisher exact test were used to evaluate differences between pregnant women with HbSS versus HbSC. A P‐value of < .05 was considered statistically significant. SPSS version 24 (IBM Corp, USA) was used for analysis.Item Impact of blood perilipin A levels on obesity and metabolic health(. BMC Research Notes, 2022) Ofori, E.K.; Letsu, B.S.; Amponsah, S.K.; Ahenkorah, J.; Crabbe, S.; Kwao‑Zigah, G.; Oppong, S.Y.; Diaba‑Nuhoho, P.; Amanquah, S.D.Objective: Perilipin A is a common protein that coats lipid surfaces preventing them from being exposed to oxida‑ tive damage. Researchers have found little consistency in the relationship between perilipin A levels in the blood and body fat. This study was a cross-sectional observational that looked at circulating perilipin A levels and how they relate to metabolic health. Results: The participants in this study were 86 individuals with a mean age of 45.5±1.2 years. Multiple clinical and metabolic indicators (age, weight, BMI, total body fat mass, triglyceride, and HOMA-IR) were shown to be inversely associated with perilipin A levels (rho=− 0.32, − 0.37, − 0.40, − 0.45, − 0.33 and − 0.29; p<0.05 respectively). Obese persons were almost six times more likely than non-obese individuals to have lower perilipin A levels (odds ratio=6.22, CI=2.35–11.50, p<0.001). Our fndings underscore the important role of perilipin A proteins in metabolic health. KeywordItem Implementation of multidisciplinary care reduces maternal mortality in women with sickle cell disease living in low-resource setting(Social Science Journal, 2017-05) Asare, E.V.; Olayemi, E.; Boafor, T.; Dei-Adomakoh, Y.; Mensah, E.; Ghansah, H.; Osei-Bonsu, Y.; Crabbe, S.; Musah, L.; Hayfron-Benjamin, C.; Covert, B.; Kassim, A.A.; James, A.Sickle cell disease (SCD) is associated with adverse pregnancy outcome. In women with SCD living in low-resource settings, pregnancy is associated with significantly increased maternal and perinatal mortality rates. We tested the hypothesis that implementing a multidisciplinary obstetric and hematology care team in a low-resource setting would significantly reduce maternal and perinatal mortality rates. We conducted a before-and-after study, at the Korle-Bu Teaching Hospital in Accra, Ghana, to evaluate the effect of a multidisciplinary obstetric-hematology care team for women with SCD in a combined SCD-Obstetric Clinic. The pre-intervention period was assessed through a retrospective chart review to identify every death and the post-intervention period was assessed prospectively. Interventions consisted of joint obstetrician and hematologist outpatient and acute inpatient reviews, close maternal and fetal surveillance, and simple protocols for management of acute chest syndrome and acute pain episodes. Primary outcomes included maternal and perinatal mortality rates before and after the study period. A total of 158 and 90 pregnant women with SCD were evaluated in the pre- and post- intervention periods, respectively. The maternal mortality rate decreased from 10 791 per 100 000 live births at pre-intervention to 1176 per 100 000 at postintervention, representing a risk reduction of 89.1% (P50.007). Perinatal mortality decreased from 60.8 per 1000 total births at pre-intervention to 23.0 per 1000 at post-intervention, representing a risk reduction of 62.2% (P50.20). A multidisciplinary obstetric and hematology team approach can dramatically reduce maternal and perinatal mortality in a low-resource setting.© 2017 Wiley Periodicals, Inc.