Browsing by Author "Nkrumah, K.N."
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Item Acute Upper Gastro-Intestinal Haernorrhage in Ghanaians - An Endoscopic Review at Korle-Bu Teaching Hospital.(Ghana Medical Journal, 1994) Nkrumah, K.N.; Archampong, E.Q.; Quartey-Papafio, I.B.; Ofori-Adjei, D.; Nakajima, A.Upper gastro-intestinal (UGI) endoscopy was per· formed at the Korle-Bu Teaching Hospital. between 1981·83, on patients with history of acute upper gastro-intestinal haemorrhage. Eighty six (86) such patients were endoscoped and results have been rei· respectively analysed to establish the major symptomatology, the underlying lesions, and any other relevant contributory factors. The role of endoscopy in the management of acute upper gastro-intestinal haemorrhage as well as its potential cost effective· ness are discussed. The term endoscopy, in the text, refers to oesophago-gastro-duodenoscopy, and GI bleed refers to upper gastrointestinal haemorrhage.Item Endoscopic evaluation of upper abdominal symptoms in adult patients, Saudi Aramco-Ai Hasa Health Center, Saudi Arabia(West African Journal of Medicine, 2002-01) Nkrumah, K.N.Upper oesophago-gastro-duodenoscopies (UGI endoscopies) were performed on adult patients who attended Saudi Aramco Health Centre at Al Hasa, Saudi Arabia, between June 1986 and December 1993, with complaint of upper abdominal pain. During this period, three hundred and fifteen (315) patients were examined. Sixty one percent were females and the rest males. Peptic ulcer disease including gastritis was the most common diagnosis made. Helicobacter pylori-like organisms were documented historically in biopsy samples in 113 of 178 (63%) patients. Nearly all were associated with gastritis; no organisms were reported in normal histology specimens. This confirms the association of this organism with gastritis. Gastric cancer suspected radiologically were not confirmed endoscopically or histologically. It is important to endoscope and biopsy for histology suspected gastric cancer and ulcer; a negative result may save the patient from unnecessary surgery, ideally all normal looking gastric mucosa should be biopsied so that histological gastritis is not missed.Item Epidemiology of helicobacter pylori infection in dyspeptic Ghanaian patients(Pan African Medical Journal, 2015-02) Archampong, T.N.A.; Asmah, R.H.; Wiredu, E.K.; Gyasi, R.K.; Nkrumah, K.N.; Rajakumar, K.Introduction: Helicobacter pylori is a gram-negative urease-producing bacterium causally linked with gastritis, peptic ulcer disease and gastric adenocarcinoma. Infection is more frequent and acquired at an earlier age in developing countries compared to European populations. The incidence of Helicobacter pylori infection in dyspeptic Ghanaian patients was 75.4%. However, epidemiological factors associated with infection vary across populations. Methods: This study used a cross-sectional design to consecutively sample dyspeptic patients at the Endoscopy Unit of the Korle-Bu Teaching Hospital, Accra between 2010 and 2012. The study questionnaire elicited their epidemiological clinical characteristics. Helicobacter pylori infection was confirmed by rapid-urease examination of antral biopsies at upper Gastro-intestinal endoscopy. Results: The sample population of dyspeptic patients attending the Endoscopy Unit for upper GI endoscopy yielded 242 patients of which 47.5% were females. The age distribution of H. pylori-infection was even across most age – groups, ranging from 69.2% (61 – 70) years to 80% (21 – 30) years. Helicobacter pylori prevalence decreased across areas mapping to the three residential classes in accordance with increasing affluence with rural areas having the highest prevalence. The unemployed and patients in farming had relatively high Helicobacter pylori infection rates of 92.3% and 91.7% respectively. Conclusion: Helicobacter pylori is endemic in Ghana but the persistently high prevalence across age groups despite significant community anti-microbial use suggests likely re-crudescence or re-infection from multiple sources in a developing country. Socio-cultural factors such as residential class and farming may be facilitating factors for its continued prevalence. © Timothy Nii Akushe Archampong et al.Item Fecal pancreatic elastase-1 in the diagnosis of chronic pancreatitis in patients attending a tertiary referral hospital in Ghana(Gastroenterology International, 2002-03) Nkrumah, K.N.; Rana, S.V.; Amanquah, S.D.Fecal pancreatic elastase-1 assays were performed in 56 patients attending medical and gastroenterology clinics with complaints of chronic or recurrent upper abdominal pains. Some of the patients already had confirmed diagnosis of chronic pancreatitis. The levels showed good correlation with these findings; they also enabled a firm diagnosis of chronic pancreatitis to be made in several cases.Item Fibreoptic Gastro-Intestinal Endoscopy at the Korle Bu Teaching Hospital, Accra, Ghana: A Historical Perspective(Ghana medical journal, 2017-12) Nkrumah, K.N.; Archampong, E.Q.Fibreoptic (or Flexible) endoscopy has revolutionized and completely transformed practice of gastroenterology, and many other medical specialties, over the past half century or so. At the Korle Bu Teaching Hospital, Accra the development of this facility has evolved gradually, especially involving specialists from the Departments of Medicine and Surgery since the 1970s. This article is an attempt to trace and record this journey and to highlight some of the problems and challenges yet to be overcome. It is an anecdotal account based on the authors' recollection with attempts at verification of important dates.Item Inflammatory bowel disease at Korle-bu teaching hospital: case reports(Ghana Medical Journal, 2000-03) Nkrumah, K.N.Inflammatory bowel disease is regarded as uncommon or even rare in Sub-Saharan Africa. Four cases documented at The Korle Bu Teaching Hospital between June 1997 and May 1998 are described and the literature briefly reviewed.Item Inflammatory Bowel Disease at The Korle Bu Teaching Hospital, Accra(Ghana Medical Journal, 2008-03) Nkrumah, K.N.Case files of patients with Inflammatory Bowel Disease (IBD) managed by the author in the Medical Department over the period 1997 – 2004 have been reviewed to identify some features of the disease that may aid improved diagnosis and management. The findings indicate that IBD may not be rare in the country and that there is usually a long delay in establishing the diagnosis. It appears that, in Ghana, more males than females are affected and that most are fifty years of age or below. Malignant colonic change is uncommon but there is a high default rate among the patients. Five patients (29%) died. Cases managed in an Arab country, between 1987 and 1996, have been compared. In that group more female than male patients were affected but the commonest age group affected was similar. The diagnosis was similarly delayed but no deaths were recorded as opposed to the Ghana patients. Since Inflammatory Bowel Disease (IBD) is a potentially treatable condition medical practitioners need increased awareness to avoid undue delay in diagnosis.Item Inflammatory bowel disease in Accra: What new trends? [Maladie Inflammatoire Intestinale: Quelles sont les nouvelles tendances?](West African Journal of Medicine, 2013-03) Archampong, T.N.A.; Nkrumah, K.N.BACKGROUND: Inflammatory bowel disease (IBD) has been more common in Western Europe and North America. Initially IBD had been thought to be low in incidence among Sub- Saharan Africans. However, it is now being increasingly recognised in patients of African descent. OBJECTIVE: A comparative assessment of the patterns of IBD in Accra from 1997 to 2011. METHODS: This study used a retrospective design to access clinical details of follow-up patients attending the Gastroenterology Unit of the Korle-Bu Teaching Hospital, Accra between February, 1997 and May, 2011. It was a comparative seven-year review of clinical presentations of IBD between April, 2004 – August, 2011 (t2) and February, 1997 – March, 2004 (t1) for changing patterns of disease in tertiary care. RESULTS: Twenty-eight (28) new IBD patients were seen in the Gastroenterology Clinic, KBTH with IBD during 2004 – 2011 (t2) in comparison to 17 patients over1997 – 2004 (t1). Presentations of severe diarrhoea were 70.4% and 55.6% in (t1) and (t2) respectively. Eighty-two percent (82%) of patients with IBD in (t2) had a severely inflamed colon on the index colonoscopy. Most patients (70–80%) responded to medical therapy (steroids, sulfasalazine) with no colon resections for steroid-refractory colitis. CONCLUSION: Although relatively uncommon, IBD recorded a 65% rise in incidence over the study periods with a male preponderance. Most patients with IBD were presenting late with severe clinical and endoscopic features of disease yet medically responsive. Non-specific (indeterminate) colitis gained prominence in (t2). © 2013, West African Journal of Medicine. All rights reserved.Item Irritable bowel syndrome and related functional bowel disorders in an urban gastroenterology practice(Changing Trends in Mental Health Care and Research in Ghana, 2014) Archampong, T.N.A.; Nkrumah, K.N.Item Oesophageal varices in patients with liver cirrhosis attending a major tertiary hospital in Ghana(Pan African Medical Journal, 2018-12) Duah, A.; Nkrumah, K.N.; Tachi, K.Introduction: oesophageal variceal bleeding is a potentially fatal consequence of portal hypertension in cirrhotic patients. In Ghana, bleeding oesophageal varices (OV) are a significant cause of acute upper gastrointestinal bleeding with comparatively high mortality. This study was to determine the prevalence of OV and its clinical correlate in cirrhotic patients. Methods: this was a cross sectional hospital based study of 149 subjects with liver cirrhosis from 5th November, 2015 to 4th November, 2016. Demographic and other clinical data were collected using standardized questionnaire. Liver function, full blood count, HBsAg and anti-HCV Ab tests were done for all patients. All patients underwent an abdominal ultrasound to assess liver and document ascites. Upper GI endoscopy (UGIE) was done to screen for and grade varices. Results: a total of 149 patients with a mean age of 45 ± 12.28 years were evaluated. Men were 77.85% and 22.15% were women, with male to female ratio of 3.5:1. By Child-Pugh Classification, 12 (8.16%) patients were in class A, 64 (43.54%) in class B and 71 (48.3%) in class C at presentation. On UGIE, 135 (90.60%) had varices and 14 patients (9.40%) had no varices. One hundred and eleven of the varices (82.22%) were large varices and the rest (17.78%) small varices. Conclusion: majority of cirrhotic patients present late with advance disease to this referral centre. Most have large varices on their first screening endoscopy. Prophylactic treatment should be considered for all cirrhotics especially patients with decompensated liver cirrhosis when UGIE cannot be done immediately.Item Prevalence and predictors for spontaneous bacterial peritonitis in cirrhotic patients with ascites admitted at medical block in korle-bu teaching hospital, Ghana(Pan African Medical Journal (PAMJ), 2019-05-16) Nkrumah, K.N.; Nkrumah, A.Introduction: spontaneous bacterial peritonitis (SBP) is one of the most common and life-threatening complications of patients with cirrhotic ascites. Recognition and prompt treatment of this condition is essential to prevent serious morbidity and mortality. This study aimed to determine the prevalence of SBP among in-patients with cirrhotic ascites attending our facility and to determine the clinical and laboratory parameters associated with SBP. Methods: a cross-sectional study was conducted involving one hundred and three (103) patients admitted at medical block in the Korle-Bu Teaching Hospital (KBTH) with cirrhotic ascites from 25th March, 2016 to 25th November, 2016. Demographic and clinical data were collected using a standardized questionnaire. Ascitic fluid culture and cell count were conducted. Positive ascitic fluid culture and/or ascitic polymorphonuclear leukocyte ≥ 250cells/mm3 were diagnostic for SBP. Results: of the 103 patients with cirrhotic ascites, the mean age was 43.5 ± 12.2 years. There were fifty eight (58) male patients. The prevalence of SBP was 25.24% (26/103). Majority, 5 (55.6%) of the bacteria isolated from ascitic fluid with SBP was Escherichia coli. Severe ascites and high INR were found to be independent predictors of SBP. Conclusion: SBP is common among patients with cirrhotic ascites admitted at KBTH. Severe ascites and high INR were highly suggestive of SBP. Diagnostic paracentesis should be done immediately on admission to confirm the diagnosis irrespective of the clinical characteristics as part of baseline investigation.Item Pyoderma Gangrenosum and Inflammatory Bowel Disease- Case Reports(Ghana Medical Journal, 2005-12) Nkrumah, K.N.; Addo, H.A.; Tachi, K.Two cases of ulcerative colitis preceded by pyoderma gangrenosum in two female patients are described. One patient developed leg ulcers, pre-sumed to be due to sickle cell disease; the other developed crops of ulcers all over the body for several years. These patients attended and were managed at the Medical and the Reconstructive Surgical Units of the Korle Bu Teaching Hospital. The unusual presentation of pyoderma gangreno-sum and the importance of diagnosing underlying probable inflammatory bowel disease is high-lighted.Item The Significance of Variceal Haemorrhage in Ghana: A Retrospective Review(Ghana medical journal, 2015-09) Archampong, T.N.; Tachi, K.; Agyei, A.A.; Nkrumah, K.N.Background: This study describes the burden of bleeding oesophageal varices at the main tertiary referral centre in Accra. Design: Retrospective design to describe the endoscopic spectrum and review mortality data following acute upper gastro-intestinal bleeding at the Korle-Bu Teaching Hospital. Endoscopic data was reviewed in the Endoscopy Unit between 2007 and 2010. Mortality data was collated from the Department of Medicine between 2010 and 2013. Interventions: The study questionnaire compiled clinical and demographic characteristics, endoscopic diagnoses, length of hospital admission and treatment regimens. Main outcome measures: Aetiology and time-trend analysis of mortality rates following acute upper gastro- intestinal bleeding; variceal bleeding treatment modalities. Results: On review of the endoscopic diagnoses, gastro- oesophageal varices were identified in 21.9% of cases followed by gastritis 21.7%, duodenal ulcer, 17.0%, and gastric ulcer, 13.2%. Gastro-oesophageal varices were the predominant cause of death from acute upper gastro-intestinal haemorrhage from 46% in 2010 to 76% in 2013. Outcomes following acute upper gastro-intestinal bleeding were dismal with some 38% of fatalities occurring within the first 24 hours. Injection sclerotherapy was the dominant endoscopic modality for secondary prevention of variceal bleeding in comparison with band ligation, mainly as a result of cost and availability. Conclusions: At the tertiary centre in Accra, variceal bleeding is an increasingly common cause of acute upper gastro-intestinal haemorrhage in comparison with previous reviews in Ghana. Its significantly high in-hospital mortality reflects inadequate facilities to deal with this medical emergency. A strategic approach to care with endoscopic services equipped with all the necessary therapeutic interventions will be vital in improving the outcomes of variceal bleeding in Ghana.Item Spontaneous bacterial peritonitis among adult patients with ascites attending Korle-Bu Teaching Hospital(Ghana medical journal, 2019-03-01) Nkrumah, K.N.; Duah, A.BACKGROUND: Spontaneous bacterial peritonitis (SBP) is one of the most common and life-threatening complications of ascites, mostly in patients with cirrhotic ascites and children with nephrotic syndrome. Recognition and prompt treatment of this condition is essential to prevent serious morbidity and mortality. It is therefore important to determine the prevalence of SBP among in-patients with ascites attending our facility and to determine the clinical characteristics associated with SBP among these patients. METHODS: A cross-sectional study was conducted involving 140 patients with ascites irrespective of the underlying cause from 25th March 2016 to 25th November 2016. Demographic information and clinical data were collected using a standardized questionnaire. Ascitic fluid culture, the gold standard for SBP diagnosis and ascitic fluid cell count was done. Positive ascitic fluid culture and/ or ascitic polymorpho nuclear leukocyte ≥250cells/mm3 were diagnostic for SBP. RESULTS: Of the 140 patients with ascites the mean age was 44.7±13.2 years. There were seventy six (76) male and sixty four (64) female patients. The prevalence of SBP was 21.43% (30/140). Majority, (41.7%) of the bacteria isolated from ascitic fluid with SBP was Escherichia coli. History of jaundice, low arterial blood pressure on admission and encephalopathy were found to be independent predictors of SBP. CONCLUSION: SBP is common among patients with ascites admitted at the Korle-Bu Teaching Hospital. Jaundice, encephalopathy and low blood pressure are highly suggestive of SBP and diagnostic paracentesis should be done immediately on admission to confirm the diagnosis.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.