Browsing by Author "Tachi, K."
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Item Hepatitis C virus infection in Ghana: time for action is now(2018-03) Tachi, K.Chronic hepatitis C virus (HCV) infection is a blood borne infection just like hepatitis B virus (HBV) and Human Immunodeficiency Virus (HIV) with a significant global health impact. Since the discovery of the HCV, several developments including a better understanding of the clinical epidemiology, availability of diagnostics and approval of newer therapies over the last decade have occurred and changed the frontiers of HCV management. Many nations now place HCV infection as a priority public health issue. In Ghana however, awareness, advocacy and treatment of HCV still plays a second fiddle to HBV and HIV. This must change and the time to act is now. The WHO estimates there has been a decline in the in the number of persons living with chronic HCV infections from about 130–150million to about 80million currently.1 This decline is due partly to the fall in new infections since the discovery of the HCV virus in 1989. Ironically, deaths from HCV are on the increase.2 A large number of persons infected 30–60 years ago are now dying from HCV-related cirrhosis and hepatocellular carcinoma (HCC), as these complications often take decades to develop.2 This mortality trend is projected to continue for several more decades unless treatment is scaled up considerably. In Ghana, the most recent estimates of HCV infection from a systematic review by Agyeman et al is 3%.3 Given that HCV transmission is highest amongst intravenous drug users, HIV infected individuals and homosexuals and that majority of the studies in that review were in low risk individuals; blood donors and pregnant women, this is likely an underestimation. Since HCV infection is clinically silent in majority of carriers until late, the true prevalence and the burden it imposes on the Ghanaian health care system is likely to remain unknown unless a comprehensive national screening policy is implemented. Blankson et al reports that 1 in 14 cases of cirrhosis is caused by HCV in Ghana.4 Also, Yang et al, reports that HCC occurs at an early age in Sub-Saharan Africa including Ghana and HCV is an important cause.5 Therefore, it is most likely that HCV is afflicting mainly the workforce of Ghana. This should be a concern to all, and for stakeholders to commit to interventions that will tackle this disease. In the absence of an HCV vaccine, treatment of infected individuals is a major intervention to control this menace. Pre-treatment evaluation includes determination of HCV viral load, HCV genotype and degree of liver fibrosis either via liver biopsy or fibroscan. These evaluations are expensive and often limit the initiation of treatment in Ghanaians.Item Khat-related liver disease in sub-Saharan Africa: neglected, yet important – Authors' reply(The Lancet Global Health, 2019-03) Vento, S.; Dzudzor, B.; Cainelli, F.; Tachi, K.We thank Stian Orlien and colleagues for raising attention to the issue of khat use as a recreational drug in sub-Saharan Africa in response to our Comment.1 Although we mentioned the fact that traditional herbal medicine could contribute to the burden of cirrhosis in this region, as the use of khat is associated with a substantial increase in liver fibrosis,2 we do not think that the available evidence shows that khat is a major contributor to chronic liver disease. Khat is used in parts of east Africa, including Djibouti, Ethiopia, Somalia, Somaliland, Kenya, Sudan, Uganda, and Madagascar. Apart from its long-standing popularity as a recreational drug, it can be used for the treatment of erectile dysfunction, malaria, influenza, vomiting, and headache.3 The Central African Republic, Gabon, and Côte d'Ivoire were in the top 10% of countries for cirrhosis-related deaths in 2010 but khat use is uncommon in west or central Africa.4Item Liver cirrhosis in sub-Saharan Africa: neglected, yet important(The Lancet Global Health, 2018-09) Vento, S.; Dzudzor, B.; Cainelli, F.; Tachi, K.Clinical efforts and research on liver diseases have been scarce in sub-Saharan Africa. The first Conference on Liver Disease in Africa (Nairobi, Sept 13–15, 2018), gathering all stakeholders from the continent, is a welcome step towards greater attention to the problem, and the important issue of liver cirrhosis. Cirrhosis-related deaths doubled in sub-Saharan Africa between 1980 and 2010, and the Central African Republic, Gabon, Malawi, Uganda, and Cote d'Ivoire were among the highest 10% of countries for these deaths in 2010.1 Most cases of cirrhosis were attributed to hepatitis B virus (HBV), alcohol misuse, and hepatitis C virus (HCV), but around 30% were unrelated to these causes.1 The understudied non-alcoholic fatty liver disease probably has a role in these latter cases, considering the increase in obesity in sub-Saharan Africa, and traditional herbal medicine could also contribute, because its use is associated with a substantial increase in liver fibrosis.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 Overt and occult hepatitis B virus infection detected among chronic kidney disease patients on haemodialysis at a Tertiary Hospital in Ghana(PLOS ONE, 2024) Dzudzor, B.; Nsowah, K.K.; Agyemang, S.; Vento, S.; Amarh, V.; Boima, V.; Tachi, K.Hepatitis B virus (HBV) infection is endemic in Ghana and chronic kidney disease patients on haemodialysis are a high-risk group for HBV infection. We determined the prevalence of overt and occult HBV infection among haemodialysis patients at the Korle Bu Teaching Hos pital in Ghana. 104 consenting End Stage Renal Disease patients on long-term haemodialy sis were recruited for the study and their socio-demographic, clinical and laboratory information were obtained using structured questionnaire. All the participants were tested for the hepatitis B surface antigen (HBsAg). The HBsAg-negative participants were re tested for hepatitis B surface antibody (HBsAb), hepatitis B core antibody (HBcAb) and HBV DNA using chemiluminescence and Roche COBAS Ampli-Prep/TaqMan analyser and real time polymerase chain reaction. Eight (7.7%) of the total participants were positive for HBsAg. Among the 96 HBsAg-negative participants, 12.5% (12) were HBcAb-positive, 7.3% (7) had detectable HBV DNA (mean = 98.7±53.5 IU/mL) and 40.6% (39) were positive for HBsAb. Five out of the 7 HBV DNA-positive participants were males and only one partici pant was negative for HBcAb. Seventy-three out of the 96 HBsAg-negative participants were vaccinated and 37 of these vaccinated individuals had significant HBsAb titres (mean = 423.21± 380.72 IU/mL). Our data demonstrated that the prevalence of overt and occult HBV infection among the haemodialysis (HD) patients was 7.7% and 7.3%, respectively, and only 50.7% of those who showed proof of vaccination were protected from HBV infectionItem 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 Sociodemographic and medical characteristics of liver cirrhosis deaths in a Ghana ian tertiary hospital(Ghana Medical Journal, 2022) Agbozo, W.K.; Dzudzor, B.; Nyarko, E.N.Y.; Lartey-Abrahams, K.; Mensah, R.N.A.; Tachi, K.Objective: Cirrhosis is common in Ghana because of its high risk factors prevalence. However, information on cirrhosis in Ghana is lacking. This study aimed to study the clinical, and laboratory characteristics of cirrhotic patients in a tertiary hospital in Ghana. Design: This was a retrospective study of sociodemographic characteristics, symptoms and signs, biochemical and fibrotic indices, treatments, and complications data of 247 patients with cirrhosis who died on admission. Setting: This study was carried out at the Gastroenterology Unit of the Korle-Bu Teaching Hospital, Ghana, Results: Two-thirds (68.0%) of the patients were within 30 to 60 years, with more than half (73.7%) being males. The most common aetiological factors among the patients were Hepatitis B virus infection (53.8%), alcohol use (31.6%) and Hepatitis C virus infection (4.9%). More than half (55.0%) of the patients reported late for admission, and 67.2% died within the first two weeks of admission. The most common clinical feature was abdominal distension (61.1% of patients), and the least was upper-abdominal mass (14.2%). The levels of most liver test parameters were elevated, fibrotic indices were high, and haemoglobin and albumin levels were reduced. More than half (53.8%) of the patients were in Child Pugh class B. The most common complication was hepatic encephalopathy; the least was hepato-renal syndrome. Definite treatment for complications of cirrhosis was lacking. Conclusion: Deaths from cirrhosis at the hospital were mostly of young males with chronic hepatitis B infection. Implementation of hepatitis B prevention and treatment guidelines can help reduce cirrhosis deaths.