Browsing by Author "Ekem, I."

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A 28-year-old Man from Ghana with a Chronic Ulcer on His Ankle: Leg Ulcers in Sickle Cell Disease
(Clinical Cases in Tropical Medicine, 2014) Sey, F.; Ekem, I.
A case–control study of prevalence of anemia among patients with type 2 diabetes
(2016-05-04) Antwi-Bafour, S.; Hammond, S.; Adjei, J.K.; Kyeremeh, R.; Martin-Odoom, A.; Ekem, I.
Abstract Background Anemia is defined as a reduction in the hemoglobin concentration of blood, which consequently reduces the oxygen-carrying capacity of red blood cells such that they are unable to meet the body’s physiological needs. Several reports have indicated that anemia mostly occurs in patients with diabetes with renal insufficiency while limited studies have reported the incidence of anemia in people with diabetes prior to evidence of renal impairment. Other studies have also identified anemia as a risk factor for the need for renal replacement therapy in diabetes. Understanding the pathogenesis of anemia associated with diabetes may lead to the development of interventions to optimize outcomes in these patients. The aim of this study was therefore to determine the prevalence of anemia among patients with type 2 diabetes. Methods A total of 100 (50 with type 2 diabetes and 50 controls) participants were recruited for our study. Participants’ blood samples were analyzed for fasting blood glucose, full blood count and renal function tests among others. The prevalence of anemia was then determined statistically. Results A high incidence of anemia was observed in the cases. Of the patients with diabetes, 84.8 % had a hemoglobin concentration that was significantly less (males 11.16±1.83 and females 10.41±1.49) than the controls (males 14.25±1.78 and females 12.53±1.14). Renal insufficiency determined by serum creatinine level of >1.5 mg/dL, estimated glomerular filtration rate <60 ml/minute/1.73 m2, and erythropoietin levels was also observed to be high in the cases (54.0 %; with mean creatinine concentration of 3.43±1.73 and erythropoietin 6.35±1.28 mIU/mL). A significantly increased fasting blood glucose, urea, sodium, potassium, and calcium ions were observed in the cases (7.99±1.30, 5.19±1.99, 140.90±6.98, 4.86±0.53 and 1.47±0.31 respectively) as compared to the controls (4.66±0.54, 3.56±2.11, 135.51±6.84, 4.40±0.58 and 1.28±0.26 respectively). Finally, a significant association between hemoglobin concentration and fasting blood glucose was also observed in the cases. Conclusions The findings suggest that a high incidence of anemia is likely to occur in patients with poorly controlled diabetes and in patients with diabetes and renal insufficiency.
Association of Endothelial Nitric Oxide Synthase (Enos) Gene Polymorphism with Complications of Hbss in Ghanaian Sickle Cell Disease Patients
(University of Ghana, 2014-07) Antwi-Boasiako, C.; Antwi, D. A.; Dzudzor, B.; Ekem, I.; University of Ghana, College of Health Sciences , School of Biomedical and Allied Health Sciences , Department of Physiology
Nitric oxide (NO) is a potent vasodilator synthesized by endothelial nitric oxide synthase (eNOS) enzyme of the vascular endothelial cells and plays a significant role in the regulation of vascular homeostasis by attenuating leukocyte adhesion to the endothelium. Nitric oxide levels are found to be low in Sickle cell disease (SCD) patients. The eNOS gene polymorphism has been implicated. Moreover, very scanty data with conflicting findings exist in theliterature on the association between eNOS gene polymorphism and SCD; there is no data on this association between SCD complications such as vaso-occlusive crisis (VOC), leg ulcers and Priapism in Ghana. Aim The aim of this study was to determine the association between eNOS gene polymorphism, endothelial dysfunction, angiogenesis and the complications of HbSS in Ghanaian SCD patients. Methodology This was a case control study involving 694 subjects, haematological analyses was done for all the subjects. In addition to haematological analysis, vascular cell adhesion molecule-1 (VCAM-1), intercellular adhesion molecule-1 (ICAM-1), E-selectin, Angiopoietin-1 (Ang-1), angiopoietin-2 (Ang-2), Vascular endothelial growth factor (VEGF), NO and genotyping were determined for 213 subjects which included 153 SCD patients with 135 HbSS (46 steady state, 57 VOC, 21 leg ulcers, 11 priapism) and 18 HbSC patients in VOC and 60 age -matched healthy controls (HbAA) who were voluntary blood donors recruited from the Center for Clinical Genetics and Accra Area Blood Centre respectively all at the Korle-Bu Teaching Hospital, Accra. Genotypic analysis of two functionally significant eNOS variants (T786C) polymorphism in the promoter region and the variable number of tandem repeats (VNTR) in intron 4 were carried out with a polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) assay. Plasma concentrations of VCAM-1, ICAM-1, and E-selectin were measured using commercial enzyme immunoassay kits (GenWay, Califonia, USA). Ang-1, Ang-2, and VEGFwere measured by enzyme-linked immunosorbent assay (ELISA) (R&D Systems, UK) and NO using Griess reagent system by ELISA method (Promega, Madison, USA). Results The results showed that there were significantly lower plasma NO levels in the SCD complications as compared to SCD asymptomatic patients and control groups (P<0.001). The results showed that SCD patients had significantlyhigher frequencies of mutant alleles of the eNOS gene polymorphisms (p<0.001). Furthermore, there was a significantly strong positive association between both TCandCC genotypes (OR, 10.33; 95% CI, 1.24-86.06) and (OR, 10.38; 95%CI, 1.781-60.47) respectively of the T786C polymorphism of the eNOS gene in SCD patientswith leg ulcer. Ang-1, Ang-2 and VEGF levels were significantly elevated in SCD patients as compared with controls (P<0.001) and were much higher in patients with complications. Ang-2/Ang-1 ratio was high in SCD patients and still higherin SCD complications. The VCAM-1, ICAM-1, and E-selectin were significantly higher in SCD patients and much higher in those with complications.
Childhood acute lymphoblastic leukaemia (ALL) in Ghanaians and Germans--a comparative study.
(West African Journal of Medicine, 2000) Ekem, I.
The records of 20 ALL patients aged 12 years and below seen at Korle-Bu Teaching Hospital(KBTH) between December 1982 and May 1990 were examined as well as that of their counterparts in Hamburg University Children's Hospital(HHOG) matched by age, sex and as closely as possible date of presentation. Data on clinical and laboratory findings, treatment and outcomes were taken and analysed using binomial proportions and paired samples T-tests. It was found that KBTH patients presented with lower haemoglobin levels, bigger organ enlargements, received less intensive treatment and defaulted more often than HHOG patients. White blood cell(WBC) counts were statistically the same. Achievability of remission was 75% and 100% for KBTH and HHOG patients respectively. Average follow up was 6 months for KBTH patients and 69 months for HHOG. 60% of KBTH patients had defaulted at the time of the study. 75% of HHOG patients were alive at the time of study with the longest follow up being 114 months. It is concluded that in spite of the bigger organ enlargement for the KBTH patients, WBC count which is the single most important prognostic factor was the same for both groups, and with less intensive therapy, achievability of remission for KBTH was 75%--reasonably good. More work need to be done in Africa on prognostic features and treatment.
Global geographic differences in healthcare utilization for sickle cell disease pain crises in the CASiRe cohort
(Blood Cells, Molecules and Diseases, 2021) Strunk, C.; Tartaglione, I.; Piccone, C.M.; Colombatti, R.; Andemariam, B.; Manwani, D.; Smith, A.; Haile, H.; Kim, E.; Wilson, S.; Asare, E.V.; Rivers, A.; Farooq, F.; Urbonya, R.; Boruchov, D.; Boatemaa, G.D.; Perrotta, S.; Ekem, I.; Sainati, L.; Rao, S.; Zempsky, W.; Sey, F.; Antwi-Boasiako, C.; Segbefia, C.; Inusa, B.; Campbell, A.D.
Background: Sickle cell disease (SCD) is characterized by frequent, unpredictable pain episodes and other vasoocclusive crises (VOCs) leading to significant healthcare utilization. VOC frequency is often an endpoint in clinical trials investigating novel therapies for this devastating disease. Procedure: The Consortium for the Advancement of Sickle Cell Research (CASiRe) is an international collaboration investigating clinical severity in SCD using a validated questionnaire and medical chart review standardized across four countries (United States, United Kingdom, Italy and Ghana). Results: This study, focused on pain crisis incidence and healthcare utilization, included 868 patients, equally represented according to age and gender. HgbSS was the most common genotype. Patients from Ghana used the Emergency Room/Day Hospital for pain more frequently (annualized mean 2.01) than patients from other regions (annualized mean 1.56 U.S.; 1.09 U.K.; 0.02 Italy), while U.K. patients were hospitalized for pain more often (annualized mean: U.K. 2.98) than patients in other regions (annualized mean 1.98 U.S.; 1.18 Ghana; Italy 0.54). Italy's hospitalization rate for pain (annualized mean: 0.57) was nearly 20 times greater than its emergency room/day hospital only visits for pain (annualized mean: 0.03). When categorized by genotype and age, similar results were seen.
Haematological Aspects of Tropical Diseases
(Postgraduate Haematology, Sixth edition, 2010-11) Bates, I.; Ekem, I.
Rapid increases in worldwide travel mean that haematologists need to keep up to date with tropical diseases that can cause haematological abnormalities. This chapter covers tropical diseases associated with organisms in the blood or bone marrow (e.g. malaria, filariasis, sleeping sickness, Chagas disease, leishmaniasis) and diseases which alter the blood count or coagulation systems. This chapter not only describes the haematological abnormalities associated with these conditions but also provides an overview of disease epidemiology, clinical presentation, diagnosis and the haematological complications of treatment.
Hematological parameters in Ghanaian sickle cell disease patients
(Journal of Blood Medicine, 2018-10) Antwi-Boasiako, C.; Ekem, I.; Abdul-Rahman, M.; Sey, F.; Doku, A.; Dzudzor, B.; Dankwah, G.B.; Otu, K.H.; Ahenkorah, J.; Aryee, R.
Background: Effective treatment and management of sickle cell disease (SCD) has been a challenge in Africa over the years. Hematological parameters are very useful profiles in the effective management of the disease. However, there is scarcity of studies on the hematological parameters of SCD in Ghana. This study aimed at determining hematological parameters among SCD patients with vaso-occlusion, those in the steady state as well as healthy controls at a teaching hospital in Ghana. Methodology: This was a cross-sectional study involving a total of 628 subjects, including 148 HbAA controls, 208 HbSS patients in steady state, 82 HbSC patients in steady state, 156 HbSS patients in vaso-occlusive crises (VOC), and 34 HbSC patients in VOC. Venous blood sample was collected from all study participants. A full blood count was done within 2 hours of collection, and hemoglobin (Hb) concentration, packed cell volume, red blood cell (RBC) concentration, mean corpuscular Hb, mean cell volume, mean corpuscular Hb concentration, and white blood cells (WBC) and platelet (PLT) counts were recorded. Results: WBC and PLT counts were significantly higher in both female and male patients with SCD, compared with their healthy counterparts (P<0.05). The level of WBC was, however, significantly higher in patients with HbSS VOC among the SCD patients (P<0.001). Levels of Hb, RBC, and hematocrit were significantly higher in the controls (P<0.001). There was no significant difference in mean cell Hb among male patients with SCD (P=0.274) and female patients with SCD (P=0.5410). Conclusion: The SCD patients had lower Hb and RBC than the controls; however, higher PLT and WBC are noted in various status of SCD, possibly reflecting spleen effect in these patients. Further studies are needed to confirm these findings.
Hypersegmented neutrophils and reversible hyperpigmentation in vitamin B(12) deficiency in Ghana.
(BMJ Case Report, 2009) Ekem, I.
The present report concerns three cases of vitamin B(12) deficiency in Ghana. One case presented in the expected textbook manner with neurological signs, anaemia and a low serum vitamin B(12) level, whereas another presented with anaemia and hyperpigmentation, but a high serum vitamin B(12) level. Both responded well to treatment with vitamin B(12). It is suggested from the literature that the high serum vitamin B(12) may have been the result of high intrinsic factor antibodies. The third patient presented with haemolytic anaemia with depression, and was managed as such initially. She responded well, with a normalisation of haemoglobin levels. Persisting vague neurological symptoms lead to a check of serum vitamin B(12), which was found to be low. Her symptoms cleared with vitamin B(12) treatment. The need for a pragmatic approach in diagnosing vitamin B(12) deficiency is stressed.
Multicentric Castleman’s Disease In A Ghanaian Adult
(Ghana medical journal, 2013-06) Dei-Adomakoh, Y.A.; Segbefia, C.; Ekem, I.; Taylor, A.
Castleman's disease is a rare cause of lymphoid hyperplasia that may result in localized symptoms or an aggressive, multisystem disorder that can mimic other diseases like lymphoma or tuberculosis. We describe a case of a 55-year-old Ghanaian male who was successfully diagnosed and managed for multicentric Castleman's disease with combination chemotherapy.
Multicentric Castleman's disease in a Ghanaian adult.
(Ghana medical journal, 2013-06) Dei-Adomakoh, Y.A.; Segbefia, C.; Ekem, I.; Taylor, A.
Castleman's disease is a rare cause of lymphoid hyperplasia that may result in localized symptoms or an aggressive, multisystem disorder that can mimic other diseases like lymphoma or tuberculosis. We describe a case of a 55-year-old Ghanaian male who was successfully diagnosed and managed for multicentric Castleman's disease with combination chemotherapy.
Neuropsychological functioning of adult sickle cell disease patients in Ghana
(Changing Trends in Mental Health Care and Research in Ghana, 2014) Ampomah, M.; Mate-Kole, C.C; Ofori-Atta, A; Anum, A; Ohene, S.; Ekem, I.; Acquaye, J.K; Ankra-Badu, G.A; Sey, F.; Sefa-Dedeh, A
Ocular manifestations of sickle cell disease at the Korle-bu Hospital, Accra, Ghana
(2010) Ophthalmol, E.J.; Osafo-Kwaako, A.; Kimani, K.; Ilako, D.; Akafo, S.; Ekem, I.; Rodrigues, O.; Enweronu-Laryea, C.C.; Nentwich, M.M.
Purpose. To determine the magnitude and pattern of ocular manifestations in sickle cell disease at Korle-bu Hospital, Accra, Ghana. Methods. Hospital-based cross-sectional study including all patients with sickle cell disease reporting for routine follow-up at the Sickle Cell Clinic at Korle-bu Hospital, Accra, Ghana. Results. A total of 201 patients with sickle cell disease (67 male and 134 female) were enrolled, comprising 114 subjects with genotype HbSS, aged 6-58 years, mean 19.26 (SD 11.70), and 87 with genotype HbSC, aged 6-65 years, mean 31.4 (SD 16.76). Visual impairment was found in 5.6% of eyes examined. Causes were cataract, proliferative sickle retinopathy (PSR), optic atrophy, phthisis bulbi, and central retinal artery occlusion. Common anterior segment signs of sickle cell disease, which were more common in HbSC patients, were tortuous corkscrew conjunctival vessels, iris atrophy, and cataract. Eyes with iris atrophy or depigmentation were 1.8 times more at risk of PSR than eyes without. Overall, PSR was found in 12.9% of subjects examined (3.5% of HbSS, 25.3% of HbSC; 15.9% of males and 11.2% of females). The prevalence of proliferative sickle retinopathy increased with age and increased systemic severity of sickle cell disease; sex did not have an influence. Conclusions. There is a high prevalence of ocular morbidity in sickle cell disease patients at Korle-bu Hospital. Prevalence increased with age, systemic severity of sickle cell disease, and HbSC genotype.
Ocular manifestations of sickle cell disease at the Korle-Bu hospital, Accra, Ghana.
(European Journal of Ophthalmology, 2011) Osafo-Kwaako, A.; Kimani, K.; Ilako, D.; Akafo, S.; Ekem, I.; Rodrigues, O.; Enweronu-Laryea, C.; Nentwich, M.M.
PURPOSE: To determine the magnitude and pattern of ocular manifestations in sickle cell disease at Korle-bu Hospital, Accra, Ghana. METHODS:Hospital-based cross-sectional study including all patients with sickle cell disease reporting for routine follow-up at the Sickle Cell Clinic at Korle-bu Hospital, Accra, Ghana. RESULTS: A total of 201 patients with sickle cell disease (67 male and 134 female) were enrolled, comprising 114 subjects with genotype HbSS, aged 6-58 years, mean 19.26 (SD 11.70), and 87 with genotype HbSC, aged 6-65 years, mean 31.4 (SD 16.76). Visual impairment was found in 5.6% of eyes examined. Causes were cataract, proliferative sickle retinopathy (PSR), optic atrophy, phthisis bulbi, and central retinal artery occlusion. Common anterior segment signs of sickle cell disease, which were more common in HbSC patients, were tortuous corkscrew conjunctival vessels, iris atrophy, and cataract. Eyes with iris atrophy or depigmentation were 1.8 times more at risk of PSR than eyes without. Overall, PSR was found in 12.9% of subjects examined (3.5% of HbSS, 25.3% of HbSC; 15.9% of males and 11.2% of females). The prevalence of proliferative sickle retinopathy increased with age and increased systemic severity of sickle cell disease; sex did not have an influence. CONCLUSIONS: There is a high prevalence of ocular morbidity in sickle cell disease patients at Korle-bu Hospital. Prevalence increased with age, systemic severity of sickle cell disease, and HbSC genotype.
The Orthodontic Management of an Adult with Sickle Cell Disease
(Ghana medical journal, 2015-09) Amoah, K.G.; Newman-Nartey, M.; Ekem, I.
Sickle cell disease (SCD) is a hereditary blood disorder characterized by abnormally shaped red cells. SCD frequently exhibits multisystemic manifestations including oral and craniofacial disorders. Craniofacial features such as maxillary protrusion and more forward growth of the mandible with significantly retruded maxillary and mandibular incisors are common. When a patient with Sickle Cell Disease (SCD) needs orthodontic treatment, it is important for the practitioner involved to know about the disease and the respective treatment because of the importance of complete blood supply after application of intraoral and extraoral forces. This article describes a sickle cell HbSS patient with orthodontic problems and how she was successfully managed at the University of Ghana Dental School. (PDF) The Orthodontic Management of an Adult with Sickle Cell Disease. Available from: https://www.researchgate.net/publication/284762212_The_Orthodontic_Management_of_an_Adult_with_Sickle_Cell_Disease [accessed Sep 14 2018].
A preliminary study of the suitability of archival bone marrow and peripheral blood smears for diagnosis of CML using fish
(Advances in Hematology, 2014-09) Charwudzi, A.; Olayemi, E.E.; Ekem, I.; Olopade, O.; Coyle, M.; Benneh, A.A.; Allotey, E.A.
Background. FISH is a molecular cytogenetic technique enabling rapid detection of genetic abnormalities. Facilities that can run fresh/wet samples for molecular diagnosis and monitoring of neoplastic disorders are not readily available in Ghana and other neighbouring countries. This study aims to demonstrate that interphase FISH can successfully be applied to archival methanol-fixed bone marrow and peripheral blood smear slides transported to a more equipped facility for molecular diagnosis of CML. Methods. Interphase FISH was performed on 22 archival methanol-fixed marrow (BM) and 3 peripheral blood (PB) smear slides obtained at diagnosis. The BM smears included 20 CML and 2 CMML cases diagnosed by morphology; the 3 PB smears were from 3 of the CML patients at the time of diagnosis. Six cases had known BCR-ABL fusion results at diagnosis by RQ-PCR. Full blood count reports at diagnosis were also retrieved. Result. 19 (95%) of the CML marrow smears demonstrated the BCR-ABL translocation. There was a significant correlation between the BCR-ABL transcript detected at diagnosis by RQ-PCR and that retrospectively detected by FISH from the aged BM smears at diagnosis (r = 0.870; P = 0.035). Conclusion. Archival methanol-fixed marrow and peripheral blood smears can be used to detect the BCR-ABL transcript for CML diagnosis. © 2014 Alice Charwudzi et al.
Sickle Cell Disease: Reappraisal of the Role of Foetal Haemoglobin Levels in the Frequency of Vaso-Occlusive Crisis
(Ghana Medical Journal, 2015-06) Antwi-Boasiako, C.; Frimpong, E.; Ababio, G.K.; Dzudzor, B.; Ekem, I.; Gyan, B.; Sodzi-Tettey, N.A.; Antwi, D.A.
Background: Foetal haemoglobin has been implicated in the modulation of sickle cell crisis. Its level is generally inversely proportional to the severity of sickle cell disease (SCD) for a given sickle cell phenotypes. The main aim of therapy for vaso-occlusive crisis (VOC), which is the hallmark of SCD, is to reduce the chances of sickling through the prevention of polymerization of HbS. One way of preventing this polymerization is by increasing foetal haemoglobin levels. Objectives: To determine the relationship between HbF levels and the frequency of crisis in SCD patients in Ghana. Method: A longitudinal retrospective survey covering a period of 30 months was carried out on adult SCD patients at the Sickle Cell Clinic of the Korle-Bu Teaching Hospital. Results: Eighty-three adults aged 15 to 65 years made up of 40 males and 43 femalea were studied. Analysis of variance (ANOVA) gave significant results in Hb and HbF levels. Higher HbF levels were positively related to less frequent crisis and were significantly high in SCD patients than in controls. HbF effects on the clinical manifestations on SCD were variable. Conclusion: Threshold values of HbF play a role in reducing the frequency of vaso-occlusive crisis in SCD patients and this finding contributes to the body of available literature on SCD severity. However our work does not give the apparent threshold level of helpful HBF Level in SCD.
Sickle Cell Disease: Reappraisal of the Role of Foetal Haemoglobin Levels in the Frequency of Vaso-Occlusive Crisis
(Ghana Medical Journal, 2015-06) Antwi-Boasiako, C.; Frimpong, E.; Ababio, G.K.; Dzudzor, B.; Ekem, I.; Gyan, B.; Sodzi-Tettey, N.A.; Antwi, D.A.
Foetal haemoglobin has been implicated in the modulation of sickle cell crisis. Its level is generally inversely proportional to the severity of sickle cell disease (SCD) for a given sickle cell phenotypes. The main aim of therapy for vaso-occlusive crisis (VOC), which is the hallmark of SCD, is to reduce the chances of sickling through the prevention of polymerization of HbS. One way of preventing this polymerization is by increasing foetal haemoglobin levels. To determine the relationship between HbF levels and the frequency of crisis in SCD patients in Ghana. A longitudinal retrospective survey covering a period of 30 months was carried out on adult SCD patients at the Sickle Cell Clinic of the Korle-Bu Teaching Hospital. Eighty-three adults aged 15 to 65 years made up of 40 males and 43 femalea were studied. Analysis of variance (ANOVA) gave significant results in Hb and HbF levels. Higher HbF levels were positively related to less frequent crisis and were significantly high in SCD patients than in controls. HbF effects on the clinical manifestations on SCD were variable. Threshold values of HbF play a role in reducing the frequency of vaso-occlusive crisis in SCD patients and this finding contributes to the body of available literature on SCD severity. However our work does not give the apparent threshold level of helpful HBF Level in SCD. (PDF) Sickle Cell Disease: Reappraisal of the Role of Foetal Haemoglobin Levels in the Frequency of Vaso-Occlusive Crisis. Available from: https://www.researchgate.net/publication/281160890_Sickle_Cell_Disease_Reappraisal_of_the_Role_of_Foetal_Haemoglobin_Levels_in_the_Frequency_of_Vaso-Occlusive_Crisis [accessed Sep 18 2018].
Steroid-induced dysglycaemia in patients with haematological disorders a ten-year review in a tertiary hospital in Ghana
(Ghana medical journal, 2019-06-02) Dei-Adomakoh, Y.A.; Akpalu, J.; Yawson, A.E.; Ekem, I.; Reynolds, M.; Atiase, Y.
Background: Glucocorticoids (steroids) play a key role in the management of multiple medical conditions including haematological disorders. This study looked at the prevalence of steroid induced dysglycaemia in patients with haematological disorders receiving steroids as part of their treatment with the view of modifying its use and selection of patients where necessary. Methods: A retrospective review of haematology patients on treatment regimens including steroids. Information extracted included, demographic characteristics, clinical information such as age, gender, haematological disorder, type of steroid, daily and cumulative dose of steroid, duration of therapy, family history of diabetes and alcohol use. Results: The case records of 351 haematology patients were reviewed. However, eight patients with dysglycaemia before therapy were excluded. The median age of patients was 51.0 ± 26.0(IQR: Interquartile Range) years, with an age range of 13 to 87 years, and a female: male ratio of 1.2: 1 (p= 0.778). The prevalence of Steroid-Induced Dysglycaemia (SID) was 3.79% with a mean diagnosis interval of 8.8 + 2.1 months. Overall, 245 (71.4%) patients were on continuous steroids. Among the 13 patients who developed SID, 11 (84.6%) were on continuous steroids. In the majority of the patients (97.1%) there was no family history of diabetes in a first degree relative. Significant differences were found between patients with normoglycaemia and those with dysglycaemia with respect to age (p=0.049) and duration of steroid therapy (p=0.024). Conclusion: The prevalence of steroid-induced dysglycaemia is relatively low among Ghanaian patients with haematological disorders on steroid based chemotherapy.
A study of the geographic distribution and associated risk factors of leg ulcers within an international cohort of sickle cell disease patients: the CASiRe group analysis
(Annals of Hematology, 2020-05-06) Antwi-Boasiako, C.; Andemariam, B.; Colombatti, R.; Asare, E.V.; Strunk, C.; Piccone, C.M.; Manwani, D.; Boruchov, D.; Farooq, F.; Urbonya, R.; Wilson, S.; Boatemaa, G.D.; Perrotta, S.; Sainati, L.; Rivers, A.; Rao, S.; Zempsky, W.; Ekem, I.; Sey, F.; Segbefia, C.; Inusa, B.; Tartaglione, I.; Campbell, A.D.
Vasculopathy is a hallmark of sickle cell disease ultimately resulting in chronic end organ damage. Leg ulcer is one of its sequelae, occurring in ~ 5–10% of adult sickle cell patients. The majority of leg ulcer publications to date have emanated from single center cohort studies. As such, there are limited studies on the geographic distribution of leg ulcers and associated risk factors worldwide. The Consortium for the Advancement of Sickle Cell Research (CASiRe) was formed to improve the understanding of the different phenotypes of sickle cell disease patients living in different geographic locations around the world (USA, UK, Italy, Ghana). This cross-sectional cohort sub-study of 659 sickle cell patients aimed to determine the geographic distribution and risk factors associated with leg ulcers. The prevalence of leg ulcers was 10.3% and was associated with older age, SS genotype, male gender, and Ghanaian origin. In fact, the highest prevalence (18.6%) was observed in Ghana. Albuminuria, proteinuria, increased markers of hemolysis (lower hemoglobin, higher total bilirubin), lower oxygen saturation, and lower body mass index were also associated with leg ulceration. Overall, our study identified a predominance of leg ulcers within male hemoglobin SS patients living in sub-Saharan Africa with renal dysfunction and increased hemolysis.
UK-based real-time lymphoproliferative disorder diagnostic service to improve the management of patients in Ghana
(Indian Journal Dermatol 2(3): 143-149, 2009) Ekem, I.; Parkins, E.; Roger, G.; Owen, G.; Bedu-Addo, G.; Ohene Opare, S.; Adomakoh, Y.; Bates, I.
The objective of the study was to evaluate the feasibility of a UK-based real-time service to improve the diagnosis and management of lymphoproliferative disorders (LPDs) in Ghana. Adult patients reporting to hospital with a suspected LPD, during a 1 year period, were prospectively enrolled. Bone marrow and/or lymph node biopsies were posted to the Haematology Malignancy Diagnostic Service (HMDS), Leeds, UK and underwent morphological analysis and immunophenotyping. Results were returned by e-mail. The initial diagnoses made in Ghana were compared with the final HMDS diagnoses to assess the contribution of the HMDS diagnosis to management decisions. The study was conducted at the two teaching hospitals in Ghana-Komfo Anokye, Kumasi and Korle Bu, Accra. Participants comprised 150 adult patients (>/=12 years old), 79 women, median age 46 years. Bone marrow and lymph node biopsy samples from all adults presenting with features suggestive of a LPD, at the two teaching hospitals in Ghana, over 1 year were posted to a UK LPD diagnostic centre, where immunophenotyping was performed by immunohistochemistry. Molecular analysis was performed where indicated. Diagnostic classifications were made according to international criteria. Final diagnosis was compared to the initial Ghanaian diagnosis to evaluate discrepancies; implications for alterations in treatment decisions were evaluated. Median time between taking samples and receiving e-mail results in Ghana was 15 days. Concordance between initial and final diagnoses was 32% (48 of 150). The HMDS diagnosis would have changed management in 31% (46 of 150) of patients. It is feasible to provide a UK-based service for LPD diagnosis in Africa using postal services and e-mail. This study confirmed findings from wealthy countries that a specialised haematopathology service can improve LPD diagnosis. This model of Ghana-UK collaboration provides a platform on which to build local capacity to operate an international quality diagnostic service for LPDs.