Browsing by Author "Dey, I.D."

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Apolipoprotein L1 risk genotypes in Ghanaian patients with systemic lupus erythematosus: a prospective cohort study
(BMJ, 2021) Blazer, A.; Dey, I.D.; Nwaukoni, J.; Reynolds, M.; Ankrah, F.; Algasas, H.; Ahmed, T.; Divers, J.
Two apolipoprotein L1 (APOL1) risk variants (RV) are enriched in sub-Saharan African populations due to conferred resistance to Trypanosoma brucei. These variants associate with adverse renal outcomes by multiple causes including SLE. Despite emerging reports that SLE is common in Ghana, where APOL1 variant allelic frequencies are high, the regional contribution to SLE outcomes has not been described. Accordingly, this prospective longitudinal cohort study tested the associations between APOL1 high-risk genotypes and kidney outcomes, organ damage accrual and death in 100 Ghanaian patients with SLE. Methods This was a prospective cohort study of 100 SLE outpatients who sought care at Korle bu Teaching Hospital in Accra, Ghana. Adult patients who met 4 American College of Rheumatology criteria for SLE were genotyped for APOL1 and followed longitudinally for SLE activity as measured by the Safety of Estrogens in Lupus National Assessment-Systemic Lupus Erythematosus Disease Activity Index (SELENASLEDAI) hybrid and organ injury as measured by the Systemic Lupus International Collaborating Clinics Damage Index (SDI) at baseline and every 6 months for 1 year. Outcomes of interest were kidney function, SDI and case fatality. Results Assuming a recessive inheritance, the APOL1 high-risk genotype (2RV) associated with end-stage renal disease (ESRD) at an OR of 14 (p=0.008). These patients accrued more SDI points particularly in renal and neurological domains. The SDI was 81.3% higher in 2RV patients compared with 0RV or 1RV patients despite no difference in SLE activity (p=0.01). After a 12-month period of observation, 3/12 (25%) of the 2RV patients died compared with 2/88 (2.3%) of the 0RV or 1RV carriers (OR=13.6, p=0.01). Deaths were due to end-stage kidney disease and heart failure. APOL1 RVs were heritable risk factors for morbidity and mortality in this Ghanaian SLE cohort. Despite no appreciable differences in SLE activity, APOL1 high-risk patients exhibited progressive renal disease, organ damage accrual and a 13-fold higher case fatality.
Building a rheumatology team for Africa: enhancing the roles of patients and non-specialists
(Rheumatology (Oxford, England), 2018-02) Etomi, O.; Fink, D.L.; Olaosebikan, H.; Dey, I.D.; Adelowo, O.O.
Sir, We are grateful to Genga et al. [1] for elegantly outlining the urgent need for improved rheumatology care in sub-Saharan Africa (SSA). The authors frame their discussion with the key observation that in many regions of SSA with ageing populations we have entered the era of non-communicable disease as the main driver of morbidity and mortality [2]. Rheumatic and musculoskeletal diseases (RMD) are the third most common cause of disability globally [3]. As Genga et al. observe, African specific risk factors, including the high frequency of manual occupations and increasingly western diets and behaviours, are poorly understood. Nigeria alone has a population of over 180 million people; West Africa has a population exceeding 320 million [4]. Comparable to the data from East Africa quoted by Genga et al. there are currently 26 consultant rheumatology physicians in West Africa. Outside of South Africa, the only fully accredited rheumatology training programme in SSA awarding its own certificate of specialization is based in Lagos, Nigeria. Trainees on rheumatology specialist programmes in Ghana and Kenya must currently complete their specialist training in South Africa or outside the continent owing to insufficient numbers to provide domestic senior supervision. The West African programme was established in 2000 by Professor Olufemi Adelowo. At this month’s American College of Rheumatology meeting (3–8 November 2017) Professors Adelowo and Oyoo presented data on behalf of the African League of Associations in Rheumatology reporting that the Nigerian programme has produced 12 consultant rheumatologists and 19 trainees with capacity for four trainees a year [5]. This programme provides a template for rheumatology training across the continent supported by the African League of Associations in Rheumatology and the International League Against Rheumatism [6]. We recently hosted the first rheumatology plenary session at the Nigerian Institute of Medical Research (NIMR) 4th International Scientific Conference (7–9 November 2017). It brought together rheumatology specialists and interested non-specialists from all over West Africa. Recently published data on behalf of Community Oriented Program for Control of Rheumatic Diseases suggest that musculoskeletal morbidity is high in Nigeria with 58% point prevalence of musculoskeletal symptoms in this population-based survey [7]. As alluded to by Genga et al., the conference discussed the major problem of delayed presentation of RMD to specialist care associated with increased morbidity and mortality from undiagnosed and inappropriately managed disease. Even in Lagos, where rheumatology provision is superior to other regions, the average time to specialist care from onset of symptoms exceeds 4 years [8]. Across West Africa presentations of SLE are often managed as infection given the perceived high prevalence of communicable disease: mortality is 48% in those admitted to hospital according to unpublished data (Dey et al. 2017). Specialist physicians cannot meet this adversity alone. Awareness of rheumatic conditions among both patients and non-specialist physicians is fundamental to improving care outcomes in SSA. Survey forms were given to 60 attendees of the NIMR conference at random with 53 respondents. Respondents were asked ‘What is the single most important barrier to improving the care of patients with musculoskeletal disease?’ Fifty-seven per cent reported either patient or non-specialist doctor awareness of RMD (see Fig. 1). Only 6% reported that availability or use of specialist treatments was the single most important barrier.
Comparison of neurocognitive changes among newly diagnosed tuberculosis patients with and without dysglycaemia
(BMC Psychiatry, 2020-04-03) Yorke, E.; Boima, V.; Dey, I.D.; Ganu, D.; Nkornu, N.; Acquaye, K.S.; Mate-Kole, C.C.
Background: Diabetes often occurs together with tuberculosis (TB) and both may affect each other negatively. Diabetes may be associated with neurocognitive dysfunctioning in affected patients and may negatively impact treatment adherence and outcomes. This study compared the neurocognitive status between newly diagnosed smear positive tuberculosis patients with dysglycaemia and those with normoglycaemia. Methods: The current study was a cross-sectional study involving one hundred and forty-six (146) newly diagnosed smear positive TB patients. Oral glucose tolerance test (OGTT) was performed and the results were categorized as either normoglycaemia, impaired glucose tolerance (IGT), impaired fasting glucose (IFG) or diabetes. Neurocognitive functioning among study participants was assessed at the time of TB diagnosis using Cognitive Failure Questionnaire (CFQ), Montreal Cognitive Assessment tool (MoCA), California Verbal Learning Test (CVLT), Brief Symptom Inventory (BSI) and the Spitzer Quality of Life Index (QLI). Results: The mean age of the participants (n = 146) was 38.7 years with 78.8% being males and 21.2% females. Using the fasting blood glucose test, the prevalence of impaired fasting glucose and diabetes were 5.5 and 3.4% respectively, both representing a total of 13 out of the 146 participants; whilst the prevalence of impaired glucose tolerance and diabetes using 2-h post-glucose values were 28.8 and 11.6% respectively, both representing a total of 59 out of the 146 participants. There were no significant differences in the mean scores on the neurocognitive measures between the dysglaycaemia and normoglycamic groups using fasting plasma glucose (FPG). However, there were significant differences in the mean scores between the dysglycaemia and normal groups using 2-h postprandial (2HPP) glucose values on Phobic Anxiety (Normal, Mean = 0.38 ± 0.603; dysglycaemia, Mean = 0.23 ± 0.356; p = 0.045), and Montreal Cognitive Assessment (MoCA) scores (17.26 ± 5.981 vs. 15.04 ± 5.834, p = 0.037). Conclusion: Newly diagnosed smear positive patients with dysglycaemia were associated with significantly lower mean cognitive scores and scores on phobic anxiety than those with normoglyacaemia. The latter finding must be further explored.
Depression and quality of life in patients on long term hemodialysis at a nationalhospital in Ghana: a cross-sectional study
(Ghana medical journal, 2018-03) Ganu, V.J.; Boima, V.; Adjei, D.N.; Yendork, J.S.; Dey, I.D.; Yorke, E.; Mate-Kole, C.C.; Mate-Kole, M.O.
The study examined quality of life and prevalence of depressive symptoms in patients on long term hemodialysis. Further, it explored the impact of socio-demographic characteristics on depression and quality of life. Design Study design was cross-sectional. Setting Study was conducted in the two renal dialysis units of the Korle-Bu Teaching hospital in Accra, Ghana. Participants and study tools One hundred and six participants on haemodialysis were recruited for the study. The Patient Health Questionnaire and the World Health Organization Quality of Life instrument were used to assess depression and quality of life. Results Forty five percent of participants screened positive for symptoms of depression. Approximately 19% obtained low scores on overall quality of life. There were significant negative correlations between the following: Depression and overall QoL, Depression and duration of dialysis treatment and Depression and income level. There was positive correlation between overall QoL and duration of dialysis, treatment and income. Conclusion Depressive symptoms were common amongst patients on long term hemodialysis. Haemodialysis patients who obtained low scores on quality of life measures were more likely to screen positive for depressive symptoms. Screening for depressive symptoms among these patients is critical as early treatment may improve their general wellbeing.
Outcome of pregnancy in patients with systemic lupus erythematosis at Korle-bu Teaching Hospital
(Ghana Medical Journal, 2016-06) Dey, I.D.; Coleman, J.; Kwarko, H.; Mate-Kole, M.
Objective: To study maternal and fetal outcomes in Ghanaian women with systemic lupus erythematosus (SLE). Methods: Retrospective study of pregnancies in women with SLE in a single centre in Ghana. Results: The mean age was 30.1 years and all were nulliparous. Two out of the seven pregnancies were in disease remission at the time of booking. Nephritis without renal impairment was present in 7 pregnancies (6 women). One woman developed intrapartum eclampsia. Two women had secondary antiphospholipid syndrome (APS). Two suffered early fetal losses and one late fetal loss at 32 weeks. All three who lost their fetus had uncontrolled hypertension. Six had mild flares mainly joint pains during pregnancy. There was no maternal mortality. The median gestational age at delivery was 38 weeks (range, 16 to 40 weeks) and the mean birth weight was 3017 g; the median Apgar scores were 8 and 9 at 1 and 5 minutes of life, respectively. There were no cases of intrauterine growth restriction (IUGR). There were no cases of congenital heart block or neonatal lupus. Conclusion: Good pregnancy outcomes are possible in women with SLE even in resource poor settings. . All pregnancies should still be considered high risk and be managed jointly between the obstetricians, the perinatologists and the rheumatologists, in particular, those with renal involvement and hypertension. Long term follow up of a larger cohort is needed.
Transient Impact of Dysglycemia on Sputum Conversion among Smear-Positive Tuberculosis Patients in a Tertiary Care Facility in Ghana
(SAGE, 2021) Yorke, E.; Boima, V.; Dey, I.D.; Amissah-Arthur, M.; Ganu, V.; Amaning-Kwarteng, E.; Tetteh, J.; Mate-Kole, C.C.
BACKGROUND: Apart from increasing the risk of tuberculosis (TB), diabetes may be associated with more severe disease and lower rates of sputum conversion among TB patients. METHODS: We conducted a baseline cross-sectional study with a longitudinal follow-up of newly diagnosed smear-positive TB patients for 6 months. Sputum conversion rates between those with dysglycemia and those without were compared at 2 months (end of the intensive phase) and 6 months (end of the treatment). Descriptive statistics and logistic regression were computed to assess factors associated with dys glycemia as well as sputum conversion. RESULTS: A significantly higher proportion of normoglycemic patients had negative sputum compared with those with dysglycemia (83% vs 67%, P-value < .05) at 2 months but not at 6 months (87% vs 77%, P-value > .05). After controlling for age group and adjusting for other covariates, patients with dysglycemia were 66% less likely to convert sputum than those with normoglycemia. Females were at least 7 times more likely than males and those with high waist-to-hip ratio (WHR) of 88% were less likely compared with those with low WHR for sputum conversion at 2 months, respectively. At 6 months, females (compared with males) and those with high WHR (compared with those with normal WHR) were at over 9 times increased odds and 89% less likely for sputum conversion, respectively. CONCLUSION: A significantly lower proportion of smear-positive TB patients with dysglycemia converted to smear negative after 2 months of treatment but not at the end of the treatment, thus suggesting a transient impact of dysglycemia on sputum conversion.
We must harness technology to deliver the musculoskeletal disease epidemiology that is urgently needed across sub-Saharan Africa
(Clinical Rheumatology, 2018-05) Fink, D.L.; Oladele, D.; Etomi, O.; Olaosebikan, H.; Dey, I.D.; Adelowo, O.O.
Dear Editor,I write in reference to the timely article authored byCourage et al. [1]. They publish the first population-levelstudy of musculoskeletal (MSK) disease in sub-SaharanAfrica using a methodology developed by the CommunityOriented Program for the Control of Rheumatic Diseases(COPCORD). The quality of the data and the spirit ofCOPCORD are admirable. COPCORD has sought to studythe scope of MSK disease in developing countries in a finan-cially viable way by community survey.Over 360 million people live in West Africa; by 2050,Nigeria alone is projected to have a larger population thanthe USA [2]. Globally, MSK diseases are the second mostcommon cause of years lost to disability [3]. An epidemic ofnon-communicable disease (NCD) has emerged from an eraof improved communicable disease control: the burden ofMSK disease will only continue to increase as the populationof sub-Saharan Africa (SSA) ages. It is clear from the study byCourage et al. that the burden of MSK morbidity is significant[1]. Despite these stark facts, there are currently 12 consultantrheumatologists in Nigeria and population-level MSK diseasedata is scarce across SSA [4