Browsing by Author "Neequaye, J."
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Item African Burkitt lymphoma: Age-specific risk and correlations with malaria biomarkers(American Journal of Tropical Medicine and Hygiene, 2011-03) Emmanuel, B.; Kawira, E.; Ogwang, M.D.; Wabinga, H.; Magatti, J.; Nkrumah, F.; Neequaye, J.; Bhatia, K.; Brubaker, G.; Biggar, R.J.; Mbulaiteye, S.M.African Burkitt lymphoma is an aggressive B-cell, non-Hodgkin lymphoma linked to Plasmodium falciparum malaria. Malaria biomarkers related to onset of African Burkitt lymphoma are unknown. We correlated agespecific patterns of 2,602 cases of African Burkitt lymphoma (60% male, mean ± SD age = 7.1 ± 2.9 years) from Uganda, Ghana, and Tanzania with malaria biomarkers published from these countries. Age-specific patterns of this disease and mean multiplicity of P. falciparum malaria parasites, defined as the average number of distinct genotypes per positive blood sample based on the merozoite surface protein-2 assessed by polymerase chain reaction, were correlated and both peaked between 5 and 9 years. This pattern, which was strong and consistent across regions, contrasted parasite prevalence, which peaked at 2 years and decreased slightly, and geometric mean parasite density, which peaked between 2 and 3 years and decreased sharply. Our findings suggest that concurrent infection with multiple malaria genotypes may be related to onset of African Burkitt lymphoma. Copyright © 2011 by The American Society of Tropical Medicine and Hygiene.Item Antibodies reactive to Plasmodium falciparum serine repeat antigen in children with Burkitt lymphoma from Ghana(International Journal of Cancer, 2012-04) Guech-Ongey, M.; Yagi, M.; Palacpac, N.M.Q.; Emmanuel, B.; Talisuna, A.O.; Bhatia, K.; Stefan, D.C.; Biggar, R.J.; Nkrumah, F.; Neequaye, J.; Tougan, T.; Horii, T.; Mbulaiteye, S.M.The role of protective immunity to Plasmodium falciparum (Pf) malaria in Burkitt lymphoma (BL) is unknown. We investigated the association between BL and antibodies reactive to SE36 antigen, a recombinant protein based on P. falciparum serine repeat antigen 5 gene, targeted by protective malaria immune responses. Cases were children (0-14 years) enrolled at the Korle-Bu Teaching Hospital, Accra, Ghana, during 1965-1994 with BL confirmed by histology or cytology (92% of cases). Controls were apparently healthy children enrolled contemporaneous to the cases from the nearest neighbor house to the case house and were age,- sex-frequency-matched to the cases. Anti-SE36 IgG antibodies were measured using enzyme-linked absorbent immunoassays (ELISAs). SE36 titers were estimated by extrapolating ELISA optical density readings to a standard fitting curve. Anti-SE36 titers were log-transformed for analysis. Odds ratios (ORs) and two-sided 95% confidence intervals (95% CIs) were estimated using unconditional logistic regression. The mean log endpoint dilution titers were 0.63 logs lower in cases than in controls (8.26 [SD 1.68] vs. 8.89 [SD 1.75], Student's t-test, p = 0.019). Lower titers were observed in cases than controls aged 0-4 years (p = 0.05) and in those aged 5-14 years (p = 0.06). Low and medium tertiles of anti-SE36 IgG antibodies were associated with increased OR for BL ([OR 1.67, 95% CI 1.21-2.31] and [OR 1.33, 95% CI 0.96-1.86], respectively, p trend = 0.002) in analyses adjusting for age, sex, calendar period and test plate. Our findings suggest that compared to similarly aged children enrolled from the same community, children with BL in Ghana have lower antibodies to SE36 antigen. © 2011 UICC.Item Cerebrospinal fluid markers in African Burkett’s lymphoma with central nervous system involvement(Journal of the National Cancer Institute, 1982) Wallen, W.C.; Biggar, R.J.; Levine, P.H.; Neequaye, J.; Nkrumah, F.K.Several cerebrospinal fluid markers were found to be elevated in Burkitt's lymphoma patients with central nervous system (CNS) involvement. Antibody levels to the virus capsid antigen of the Epstein-Barr virus and to the brain cell antigens myelin and cerebroside were elevated during active CNS disease. Immune complexes were present in levels above 100 micrograms/ml in most patients with CNS involvement but tended to be low or negative in patients without CNS disease. Oligoclonal IgG bands were present in 12 of 13 patients with CNS disease and in only 3 of 26 patients with no clinical evidence of disease. None of these markers were present in 6 other tumor patients without CNS disease. The presence of these markers in 12 of 13 patients in whom CNS disease was involved suggests that these markers may be useful in determining the status of the tumor with regard to involvement of the CNS.Item Changes in presenting tumour site of Burkitt's lymphoma in Ghana, West Africa, 1965-1978.(British Journal of Cancer, 1981) Biggar, R.J.; Nkrumah, F.K.; Neequaye, J.; Levine, P.H.Between 1965 and 1978, 430 cases of Burkitt's lymphoma were evaluated at the Burkitt Tumour Project, Accra, Ghana. During this period a change in the presenting features occurred, in which abdominal disease increased and facial disease decreased. This change was especially apparent in males, in whom the proportion of cases with abdominal disease more than doubled (chi 2 time trend = 25.99, P = 0.00000017) We speculate that the change may be related to possible changes in BL incidence.Item Comparison of chloroquine with artesunate in the treatment of cerebral malaria in Ghanaian children(Journal of Tropical Pediatrics, 2001-06) Goka, B.Q.; Adabayeri, V.; Ofori-Adjei, E.; Quarshie, B.; Asare-Odei, G.; Akanmori, B.D.; Kurtzhals, J.; Ofori-Adjei, D.; Neequaye, J.Despite previously reported chloroquine-resistant forms of P. falciparum in Ghana, chloroquine remains the drug of choice in severe malaria. Artemisinin derivatives have been shown to be effective against chloroquine-resistant strains in other endemic areas. This open randomized study was conducted to compare the efficacy of chloroquine and artesunate in the treatment of childhood cerebral malaria. Out of 82 subjects that fulfilled the inclusion criteria, 36 were randomized to receive chloroquine and 46 to receive artemisinin. Blantyre coma scores, temperature and parasitaemia were monitored. Mortality and neurological deficits were documented. There was no difference in mortality rates (chloroquine, 16.7 per cent; artesunate, 21.7 per cent; p = 0.6), neurological deficit at day 14 (chloroquine, 0 per cent; artesunate, 4.3 per cent; p = 0.3), resolution of fever (p = 0.55), and coma recovery time (p = 0.8), between the two groups. The results suggest that syrup chloroquine and intramuscular/oral artesunate currently give comparable clinical responses in the treatment of cerebral malaria in Ghana. Possible reasons for this are discussed, and suggestions are made for future antimalarial drug policy.Item Comparison of chloroquine with quinimax in the treatment of cerebral malaria in Ghanaian children(Ghana Medical Journal, 2003-09) Goka, B.Q.; Rodrigues, O.P.; Adjei, G.O.; Quarshie, B.; Akanmori, B.D.; Kurtzhals, J.A.L.; Neequaye, J.Despite earlier reports of R2 and R3 resistance of Plasmodium,1 falciparum to chloroquine. it remained the drug of choice for the treatment of cerebra1 malaria in Ghana. The World Health Organization, however, recommends the use of parenteral quinine salts in such circumstances. In order to guide local treatment policies, an open randomized trial comparing the effect of enteral chloroquine and intravenous followed by oral Quinimax. a quinine preparation approved by the World Health Organization was conducted in 70 children with cerebral malaria. The primary endpoints were mortality, prevalence of residual neurologic sequalae and treatment failure (clinical and parasitological). Thirty-three patients received chloroquine and 37 received Quinimax"'. There was no significant difference in mortality rates (chlorO(IUine. 12.1 %; Quinimax 10.8%; p= 1.00) and neurologic sequelae on day 7 (chloroquine. 12.1%; Quinimax ·, 8.1%; p: O.70) . There was a significantly higher prevalence of early treatment failure in the chloroqU111e group (chloroquine, 12.1 %; Quinimax®. 0%; 1)-"-0.045). Significantly more patients on chloroquine were parasitaemia on day 3 (chloroquine, 21.8%; Qumimax ~. 2.7%; p 0.022) but times to parasite clearance. fever clearance and recovery of full consciousness were similar. We conclude that treatment failure is more likely when chloroquine is used to treat cerebral malaria th'111 when Quinimax® is used. We therefore recommend that quinine salts, or other antimalarial 110 drugs of equal efficacy be used to treat cerebral malaria in Ghanaian children instead of chloroquine.Item Complement binding to erythrocytes is associated with macrophage activation and reduced haemoglobin in Plasmodium falciparum malaria(Transactions of the Royal Society of Tropical Medicine and Hygiene, 2001-09) Goka, B.Q.; Kwarko, H.; Kurtzhals, J.A.L.; Gyan, B.; Ofori-Adjei, E.; Ohene, S.A.; Hviid, L.; Akanmori, B.D.; Neequaye, J.We have examined IgG and complement factor C3d deposition on erythrocytes by means of the direct Coombs' test (DAT) and looked for an association with the anaemia seen in falciparum malaria in children living in an area of hyperendemic malaria transmission (in Ghana). In one study (in 1997), 53 out of 199 patients had a positive DAT. Of these, 45 samples reacted with anti-C3d antibodies, 2 with anti-IgG and 6 with both reagents. There were significantly lower haemoglobin (Hb)-levels and higher prevalence of spleen enlargement in DAT-positive than in DAT-negative patients. Hb-levels were independently associated with DAT and age. This initial study was designed to investigate the role of intravascular haemolysis (IVH), but we found no association between IVH and either DAT result or anaemia. Because of the risk of selection bias we repeated the study using consecutive enrolment of malaria patients and were able to confirm the results in a total of 49 DAT-positive and 183 DAT-negative patients. This second study (in 1998) was designed to look at the importance of erythrophagocytosis through measurement of plasma neopterin levels and total nitrite and nitrate as markers of NO-release. Both parameters were significantly higher in DAT-positive than in DAT-negative patients (P < 0.001), indicating that complement binding to erythrocytes was associated with macrophage activation. Plasma levels of haptoglobin, interleukin-10 and tumour necrosis factor-α did not vary between the groups. The studies support the role of complement activation and erythrophagocytosis in [-the pathogenesis of anaemia in falciparum malaria in African children.Item Congenital rubella syndrome in Korle Bu Teaching Hospital(Ghana Medical Journal, 2000-09) Oduro-Boatey, C.; Neequaye, J.; Goka, B.Eight cases of Congenital Rubella Syndrome (CRS) were reported between 1st July and 30th September 1998 at the Department of Child Health, Karle Bu Teaching Hospital. Accra. All the cases were born at term, with six of them small for age. Five of the mothers were multiparous, while three were primiparous. All the cases had cataracts, and all were compatible CRS according to WHO guidelines for the diagnosis of CRS. These eight cases of CRS recorded within three months in one hospital is alarming considering the fact that only 12 cases were reported in the United States of America in a three year period from 1994 to 1996. Further studies are needed to find the true burden of CRS in Ghana to ascertain whether preventive measures should be instituted.Item Effects of factor v Leiden polymorphism on the pathogenesis and outcomes of preeclampsia(BMC Medical Genetics, 2019-11-27) Ababio, G.K.; Adu-Bonsaffoh, K.; Abindau, E.; Narh, G.; Tetteh, D.; Botchway, F.; Morvey, D.; Neequaye, J.; Quaye, I.K.Background: Factor V Leiden polymorphism is a well-recognized genetic factor in the etiology of preeclampsia. Considering that Ghana is recording high incidence of preeclampsia, we examined if factor V Leiden is a contributory factor to its development and pregnancy outcomes. Methods: STROBE consensus checklist was adopted to recruit eighty-one (81) consenting subjects after ethical clearance. Subjects were followed up till delivery to obtain outcomes of PE. Routine blood chemistry and proteinuria were done on all samples. Factor V Leiden was characterized by polymerase chain reaction and restriction fragment length polymorphism (RFLP). The data was captured as protected health information (PHI) and analyzed with SPSS version 22. Results: Overall allelic frequencies found in FVL exon 10 were 0.67 and 0.33 for G and A alleles respectively. The FVL mutation was more in PE and hypertensive patients. Increased white blood cells, increased uric acid and a three – fold increment of AST / ALT ratio was observed in PE cases when stratified by FVL exons (exon 8 and 10). Significant differences were also observed between FVL and age, systolic blood pressure (SBP), diastolic blood pressure (DBP), liver enzymes, white blood cells (wbc), hemoglobin levels. Conclusion: FVL mutation allele frequency was 0.33, a first report. The mutation was associated with increased uric acid, liver enzymes and blood cell indices suggestive of acute inflammation.Item Endomyocardial fibrosis associated with Schistosoma haematobium infection(Ghana medical journal, 2014-12) Assimeng, J.; Segbefia, C.I.; Neequaye, J.Endomyocardial fibrosis (EMF) is a form of restrictive cardiomyopathy common in the tropics and subtropics. The aetiology of EMF is unknown but helminth infestations such as schistosomiasis have been implicated. Two boys aged 8 and 10 years with EMF associated with Schistosoma haematobium, are described. The schistosomes in both cases may have been acquired from contact with contaminated water collected and stored in containers and subsequently used for bathing. Both patients were managed conservatively. Overall prognosis of EMF is poor and this report emphasizes the importance of public health interventions in the control of schistosomiasis.Item Failure of intrathecal antitetanus serum to improve survival in neonatal tetanus.(Archives of Disease in Childhood, 1983) Neequaye, J.; Nkrumah, F.K.In a prospective study, 161 infants with neonatal tetanus were randomised to receive (a) standard treatment, or (b) standard treatment together with intrathecal equine antitetanus serum, or (c) intrathecal antitetanus serum with systemic betamethasone. There was no difference in survival between the three treatment groups in infants with severe tetanus, but in mild tetanus those who received standard treatment alone had an improved survival rate. Parenteral intramuscular diazepam as a sedative was found to be preferable to paraldehyde, as the latter was associated with a higher incidence of secondary infections.Item Frequency of EBV LMP-1 promoter and coding variations in burkitt lymphoma samples in Africa and South America and peripheral blood in uganda(MDPI AG, 2018-06) Liao, H.-M.; Liu, H.; Li, B.; Chin, P.-J.; Tsai, S.; Bhatia, K.; Gutierrez, M.; Epelman, S.; Biggar, R.J.; Nkrumah, F.; Neequaye, J.; Ogwang, M.D.; Reynolds, S.J.; Lo, S.-C.; Mbulaiteye, S.M.Epstein-Barr virus (EBV) is linked to several cancers, including endemic Burkitt lymphoma (eBL), but causal variants are unknown. We recently reported novel sequence variants in the LMP-1 gene and promoter in EBV genomes sequenced from 13 of 14 BL biopsies. Alignments of the novel sequence variants for 114 published EBV genomes, including 27 from BL cases, revealed four LMP-1 variant patterns, designated A to D. Pattern A variant was found in 48% of BL EBV genomes. Here, we used PCR-Sanger sequencing to evaluate 50 additional BL biopsies from Ghana, Brazil, and Argentina, and peripheral blood samples from 113 eBL cases and 115 controls in Uganda. Pattern A was found in 60.9% of 64 BL biopsies evaluated. Compared to PCR-negative subjects in Uganda, detection of Pattern A in peripheral blood was associated with eBL case status (odds ratio [OR] 31.7, 95% confidence interval: 6.8–149), controlling for relevant confounders. Variant Pattern A and Pattern D were associated with eBL case status, but with lower ORs (9.7 and 13.6, respectively). Our results support the hypothesis that EBV LMP-1 Pattern A may be associated with eBL, but it is not the sole associated variant. Further research is needed to replicate and elucidate our findings. © 2018 by the authors. Licensee MDPI, Basel, Switzerland.Item Kawasaki disease in ghana: case reports from Korle Bu teaching hospital(Ghana medical journal, 2011-03) Badoe, E.V.; Neequaye, J.; Oliver-Commey, J.O.; Amoah, J.; Osafo, A.; Aryee, I.; Nyarko, M.Y.Kawasaki disease, an acute febrile vasculitis, predominantly affects children under the age of 5 years and is thought to be a rare disease in the developing world. It has previously never been reported in Ghana. We report 3 cases from February, 2007 to February, 2008. This potentially serious disease has no definitive diagnostic test and it is not unusual for diagnosis to be delayed with serious consequences. Any child with irritability and persisting fever (>5 days) not responding to antipyretics and antibiotics, accompanied by a rash and non purulent conjunctivitis should be suspected to have Kawasaki disease.Item Oral Chloroquine in the treatment of cerebral malaria in Ghanaian Children(Ghana Medical Journal, 2000-06) Neequaye, J.; Prempeh, O.B.; Ofori-Adjei, E; Goka, B.Q.; Quarshie, B.; Kurtzhals, J.A.L.; Ofori- Adjei, D.The usefulness of chloroquine as the first line drug for the treatment of acute simple and complicated malaria has been threatened in many Sub-Saharan African countries by the emergency of P. falciparum resistant to chloroquine. In Ghana, anecdotal and published reports suggested that resistance was becoming a major clinical problem, although it remained the first line treatment for simple and complicated malaria including cerebral malaria. This study was undertaken in 1997 to determine the effectiveness of chloroquine in cerebral malaria. Between July and August 1997, 196 children with cerebral malaria were admitted to the Children's Emergency Ward of the Korle Bu Teaching Hospital, Accra. Mortality was 15.3%. Eighty-eight treated initially with chloroquine were studied to Day 7 or longer. Thirty-one of 60 (52%) children tested had parasites in their peripheral blood film at Day 3. In 3 (5%) the parasitaemia was >25% of the Day zero value (R11 resistance) but 2 of these were well. Taking clinical parameters such as fever and worsening coma score into consideration early treatment failure occurred in 10 patients (11.4%) and these had their treatment changed 10 amodiaquine. The results indicate that resistance to chloroquine is demonstrably increasingItem Specific transfer factor with activity against epstein-barr virus reduces late relapse in endemic Burkitt's lymphoma(Anticancer Research, 1990) Neequaye, J.; Viza, D.; Pizza, G.; Levine, P.H.; De Vinci, C.; Ablashi, D.V.; Biggar, R.J.; Nkrumah, F.K.Twenty-seven children with abdominal Burkitt's lymphoma (stage III), who had achieved complete remission, were entered into a prospective controlled trial of adjunct treatment with Epstein-Barr virus (EBV)-specific transfer factor (TF). Two patients treated with TF and 2 controls relapsed early (? 12 weeks). Two out of 12 TF-treated patients and 5 out of 11 controls subsequently suffered relapses. Time to first late relapse was longer among TF-treated patients (p = 0.08), and no late relapse occurred while a patient was receiving TF treatment. Thus it seems that specific TF might be useful in the management of endemic Burkitt's lymphoma and also in the treatment of other virus-associated cancers and diseases.Item Transfer factor in prevention of Burkitt's lymphoma relapses.(Journal of Experimental Pathology, 1987) Nkrumah, F.K.; Pizza, G.; Neequaye, J.; Viza, D.; De Vinci, C.; Levine, P.H.Twenty-two African children with endemic Burkitt's lymphoma entered a study to evaluate the possible efficacy of a transfer factor (TF) with specific activity against Eptein-Barr virus in preventing disease relapses. Five of eleven patients have so far relapsed in the non TF-treated group as against two of eleven in the TF-treated group. The patterns of relapse and observable increased disease free remission duration in the TF-treated group strongly suggest a beneficial effect particularly in the prevention of late relapses. A larger series of patients treated with this specific TF are needed to confirm these observations in endemic Burkitt's lymphoma.