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Item Epidemiology of Maternal Nutritional Status and Risk of Adverse Birth Outcomes in Undernourished Mothers with Sickle Cell Disease: A Systematic Review and Meta-Analysis Protocol(Methods and Protocols, 2023) Klein, L.J.; Ayete-Nyampong, J.B.; Oppong, S.A.; et al.In pregnancies complicated by sickle cell disease (SCD), the maternal-fetal dyad is at high risk for mortality and morbidity. In healthy pregnancies, maternal nutritional status is a critical factor for the healthy growth and development of the fetus. However, there are no reviews of the current research on the nutritional status of pregnant women with SCD and pregnancy outcomes. First, we aim to assess the burden of malnutrition on pregnant women with SCD. Next, we aim to systematically evaluate if pregnant women with SCD who have poor nutritional status are at increased risk for adverse birth outcomes compared to pregnant women with sickle cell disease and normal nutritional status. We will systematically search multiple electronic databases. Our exposure pregnant women with SCD and poor nutritional status. The primary outcomes of interest include low birth weight (categorical) and birth weight z-scores (continuous). We will also evaluate maternal and perinatal outcomes as secondary outcomes. We will evaluate the risk of bias and overall certainty of evidence with Risk of Bias in Non-randomized Studies—of Interventions (ROBINS-I), and the overall evidence will be assessed using Grading of Recommendation Assessment, Development, and Evaluation (GRADE) criteria. We will pool findings with a meta-analysis if sufficient homogeneity exists among studies. Findings will be published in a peer-reviewed journal and disseminated to SCD advocacy groups. PROSPERO registration number: CRD42023429412.Item Tumor sequencing of African ancestry reveals differences in clinically relevant alterations across common cancers(Elsevier Inc, 2023) Jiagge, E.; Jin, D.X.; Dei-Adomakoh, Y.; et al.Cancer genomes from patients with African (AFR) ancestry have been poorly studied in clinical research. We leverage two large genomic cohorts to investigate the relationship between genomic alterations and AFR ancestry in six common cancers. Cross-cancer type associations, such as an enrichment of MYC amplificance with AFR ancestry in lung, breast, and prostate cancers, and depletion of BRAF alterations, are observed in colorectal and pancreatic cancers. There are differences in actionable alterations, such as depletion of KRAS G12C and EGFR L858R, and enrichment of ROS1 fusion with AFR ancestry in lung cancers. Interestingly, in lung cancer, KRAS mutations are less common in both smokers and non-smokers with AFR ancestry. whereas the association of TP53 mutations with AFR ancestry is only seen in smokers, suggesting an ancestry-environment interaction that modifies driver rates. Our study highlights the need to increase the representation of patients with AFR ancestry in drug development and biomarker development.Item Evaluation of treatment patterns, healthcare resource utilization and cost of illness for sickle cell disease in Ghana: a private medical insurance claims database study(BMC Health Services Research, 2023) Marfo, K.; Dei‑Adomakoh, Y.; Segbefa, C.; et al.Background Sickle cell disease (SCD) is a major public health concern in sub-Saharan Africa, accounting for nearly 75% of the global disease burden. The current analysis evaluated patient characteristics, treatment patterns, health‑ care resource utilization (HCRU) and associated costs in patients with SCD based on a Private Medical Insurance Database in Ghana. Methods This retrospective longitudinal cohort study was conducted using an e-claims database from Ghana (01 January 2015 to 31 March 2021). Patients were stratifed by age (0 month to <2 years, ≥2 years to ˂6 years, ≥6 years to <12 years, ≥12 years to <16 years; ≥16 years), vaso-occlusive crisis (VOC) (<1, ≥1 to <3, and ≥3 per year), and con‑ tinuous enrolment. Study outcomes related to patient characteristics, comorbidities, treatment pattern, HCRU were evaluated for pre- and post-index period (index period was between July 2015 to March 2020). Descriptive analysis was used to analyse diferent study variables. Results The study included 2,863 patients (mean age: 20.1 years; Min age: 0; Max age: 83; females 56.1%). Overall, 52.2% (n=1,495) of SCD patients were ≥16 years and 17.0% (n=486) were in the ≥2 to ˂6-years age group. The majority of patients aged≥16 years (62.5%) in the database did not have reported VOC episodes, 35.9% of patients had 1 to 3 VOCs per year and 1.5% had≥3 VOCs per year during the follow-up period. Consultation-based prevalence of SCD was 0.5% [95% confdence interval (CI): 0-1.3%] −1.4% [CI: 0.6-2.2%]. Malaria, upper respiratory tract infection (URTI) and sepsis were the common complications of SCD. Analgesics were the most frequently prescribed medi‑ cations followed by anti-infectives, hematinics, and antimalarials. Hydroxyurea, a routine standard of care for SCD was under-utilized. SCD patients had median cost incurred for consultation/hospital services of $11.3 (Interquartile range [IQR] $6.2 - $27.2). For patients with VOC, maximum median cost was incurred for medications ($10.9 [IQR $5.0 $32.6]). Overall median healthcare cost was highest for individuals with ≥3 VOCs per year during the follow-up period ($166.8 [IQR $70.3-$223.5]). Conclusion In this retrospective private insurance claims database analysis, SCD imposes a signifcant healthcare burden, especially in patients with VOC. There is a need for reimbursed treatment options that could reduce the long term burden associated with SCD and VOC.Item Cervical precancer screening with HPV DNA testing and mobile colposcopy in women with sickle cell disease in Accra, Ghana(ecancer, 2023) Dei-Adomakoh, Y.; Effah, K.; Tekpor, E.; et al.Background: Worldwide, about 20–25 million people are affected by sickle cell disease (SCD), with 60% of patients living in sub-Saharan Africa. Despite recent therapeutic advancements resulting in improved life expectancy among SCD patients, the prevalence of high-risk human papillomavirus (hr-HPV) and cervical lesions have not been studied in women with SCD. We determined the prevalence of hr-HPV and cervical lesions among women with SCD and recommended strategies for reducing cervical cancer incidence in this cohort. Methods: Through the mPharma 10,000 Women Initiative, women with SCD attending routine visits at the Ghana Institute of Clinical Genetics SCD clinic were screened by trained nurses. Screening was performed via concurrent MA-6000 hr-HPV DNA testing and enhanced visual assessment (EVA) mobile colposcopy from mobileODT. Results: Among 168 participants screened (mean age, 43.0 years), the overall prevalence rates of hr-HPV infection and cervical lesions were 28.6% (95% CI, 21.7–35.4) and 3.6% (95% CI, 0.8–6.4), respectively. The hr-HPV prevalence rates stratified by haemoglobin genotype were 29.4% (95% CI, 19.7–39.1) and 28.6% (95% CI, 18.5–38.7) for genotypes SS and SC, respectively. None of the five women with the SF genotype tested hr-HPV positive, and the only patient with Sbthal genotype tested hr-HPV positive. Two women were EVA ‘positive’ but hr-HPV negative, whereas four were EVA positive and hr-HPV positive. Exploratory analysis revealed no significant associations between hr-HPV posi tivity and age, education level, marital status or parity. Conclusion: In the absence of a comprehensive national cervical screening programme aimed at including women with SCD as a special population, cervical cancer may increase in frequency among SCD patients. Thus, there is a need to build capacity and expand the scope of screening services for women with SCD.Item Acute pain episodes, acute chest syndrome, and pulmonary thromboembolism in pregnancy(Hematology, 2022) Asare, E.V.; DeBaun, M.R.; Olayemi, E.; Boafor, T.; Oppong, S.A.Pregnancy in women with sickle cell disease (SCD) is a life - threatening condition. In both high - and low - income countries, there is an 11 - fold increased risk of maternal death and a 4 - fold increased risk of perinatal death. We high light the epidemiology of SCD - specific and obstetric com plications commonly seen during pregnancy in SCD and pro pose definitions for acute pain and acute chest syn drome (ACS) episodes during pregnancy. We conducted a systematic review of the recent obstetric and hematology literature using full research articles published within the last 5 years that reported out comes in pregnant women with SCD. The prevalence of acute pain episodes during pregnancy ranged between 4 % and 75 %. The prevalence of ACS episodes during pregnancy ranged between 4 % and 13 %. The estimated prevalence of pulmonary thromboembolism in women with SCD during pregnancy is approximately 0.5 to 1 %. ACS is the most common cause of death and is often preceded by acute pain episodes. The most crucial time to develop these complications in pregnancy is during the third trimester and post par tum period. In a pooled anal y sis from studies in low - and middle - income set tings, maternal death in women with SCD is approximately 2393 and 4300 deaths per 100 000 live births with and without multi-disciplinary care, respectively. In com par i son, in the US and north ern Europe, the general maternal mortality rate is approximately 23.8 and 8 deaths per 100 000 live births, respectively. A multi-disciplinary SCD obstetrics care approach reduces maternal and perinatal morbidity and mortality in low - and middle - income countriesItem Red cell agglutination, anaemia and a dermatomal rash(Australian Journal of General Practice, 2019-11) Olayemi, E.; Adeyemi, B.O.; Bandara, M.A woman aged 68 years with a history of hypertension presented to her general practitioner (GP) with a one-day history of a painful rash on the left side of her forehead. The eruption was preceded by a two-day history of burning pain. She had no ocular symptoms. Clinical examination showed a unilateral dermatomal vesicular rash consistent with a left-sided varicella-zoster virus (VZV) infection of the first branch of the trigeminal nerve (shingles). The patient did not smoke and had an alcohol intake of approximately two standard drinks per day and two alcohol-free days per week. Incidentally, she was also scheduled to review the results of her annual blood examination results taken five days earlier. The pathology service provider used routinely includes lactate dehydrogenase (LDH) in requests for liver function tests (LFTs). Her blood test results (Table 1) showed mild anaemia, reticulocytosis, macrocytosis, hyperbilirubinaemia and elevated LDH. Red cell agglutination and polychromasia were reported on the blood filmItem Third trimester and early postpartum period of pregnancy have the greatest risk for ACS in women with SCD(American Journal of Hematology, 2019-09-16) Olayemi, E.; Asare, E.V.; Boafor, T.; Dei-Adomakoh, Y.; Dip, E.M.; Benjamin, C.H.; Covert, B.; Kassim, A.A.; James, A.; Rodeghier, M.; DeBaun, M.R.; Oppong, S.A.Pregnancy is a life‐threatening occurrence in women with sickle cell disease (SCD), with increased odds of maternal and perinatal mortality compared to pregnant women without SCD.1 During pregnancy, women with SCD can also experience SCD related maternal morbidities, including acute vaso‐occlusive pain episode, acute chest syndrome (ACS), and venous thromboembolism with expected increased incidence rates when compared to not being pregnant.2 We previously demonstrated in a case series that 87% of all maternal deaths were due to ACS, with almost 80% of episodes preceded by an acute pain event.3 In another prospective study, we demonstrated increased incidence rates of acute pain and ACS in pregnant women with SCD4 compared to historical non‐pregnant women with SCD.5 As a planned follow‐up to our prospective cohort study, we extended the outcome in our pre‐existing cohort of pregnant women with SCD4 to determine the impact of pregnancy on acute pain events pre‐ and postpartum. We tested the hypothesis that pregnant women with SCD have higher incidence rates of acute pain requiring hospitalization and ACS during pregnancy compared to one‐year postpartumItem A report on Human Immuno- deficiency virus (HIV) Infection in Ghana up to December 1986(Ghana Medical Journal, 1987-09) Neequaye, A.R.; Mingle, J.A.A.; Neequaye, J.E.; Agadzi, V.K.; Nettey, V.; Osei-Kwasi, M.; Hayami, M.; Ishikawa, K,; Ankra-Badu, G.; Bentsi, C.; Asamoah-Adu, A.; Aggrey, S.E.; Ampofo, W.; Brandful, J.A.; Grant, F.; Biggar, R.J.One hundred and fifteen people detected to be seropositive for HIV infection in Ghana in 1986 are described. Ninety per cent were female, most were of the sexually active age group. Ninety-six per cent had recently resided abroad, particularly in Cote d'lvoire. and many had worked abroad as prostitutes. They had most probably acquired infection there. Seventy-six per cent were ill with AIDS or AIDS related complex. Random sampling of groups of the general population revealed no seropositives, although 4 prostitutes working in Accra/ Tema were infected. Of attendants at an Accra venereal disease clinic 3 were infected all of whom had been to Cote d’Ivoire recently. Our results show that the AIDS virus has now spread into Ghana and urgent measures are described to try to prevent the spread of AIDS throughout the community.Item Ghanaian children of women infected with human immuno- deficiency virus (HIV).(Ghana Medical Journal, 1988-09) Neequaye, J.E.; Neequaye, A.R.; Mingle, J.A.A.; Ankra- Badu, G.A.; Asamoah-Adu, A.Seven children of HIV-I .infected Ghanaian women are described including one pair of twins. They were detected because the mothers gave a history of high risk behaviour in La Cote d’Ivoire. The twins and 2 others were seen at birth; 2 others were diagnosed under the age of 1 year; and one was 6 years old. Six of the 7 children and 3 of the mothers have died. The twins died from prematurity, and the other 4 died of disease due to HIV infection. One child with AIDS related complex (A.R.C) is still alive. Infection was diagnosed either because of the presence of active production by the child of anti HIV-I antibody (3 cases), or on the basis of clinical criteria consistent with the WHO clinical definition. These are the first known cases of AIDS in the paediatric age group in Ghana.Item Red cell antigens in the Ga Ethnic Group of Ghana(Ghana Medical Journal, 1990-09) Acquaye, J.K.The frequencies of some red cell antigens were determined in 230 blood donors all belonging to the Go tribe. Commercial blood grouping sera were used following the manufacturers instructions. The frequencies for A.B.O. were 0.1165. 0.1567 and 0.7268. out of the total number of donors 3.9% were rhesus (D) negative. The commonest rhesus gave complexes were cDe. cde, CDe and cDE with Ro Ro, Ro, and RoR1 being the commonest combinations The MNSs fil/dings were similar to reports In Ewes. The Kell/Cellano and the Duffy systems were similar to findings in some other negro populationsItem Red Cell Antigens in the Ewes of Ghana(Ghana Medical Journal, 1992) Acquaye, J.K.The ABO and Rhesus Blood groups were determined by standard methods in 568 blood donors of the Ewe ethnic group. The MNSs. Kidd. Lutheran Duffy and Kell blood groups were also determined in some of them. The frequencies obtained for the ABO and Rhesus genes were not much different from earlier results and similar to those of other negro populations. The commonest rhesus gene complexes were cDe, cdc. Cdc, cDE. cdE and CDe. with R°R°, R°T. R°r', R°R2 being the commonest combinations. The MNSs frequencies were slightly different from earlier results in the Ga ethnic group. JK (a-b-) and Lu(a-b-) phenotypes were relatively high. The frequencies of the Kell and Duffy were similar to findings in some negro populations.Item Photochemotherapy of Vitiligo with Oral Trioxsalen and Tropical Sunlight.(Ghana Medical Journal, 1992) Addy, J.H.Six black adults suffering from widespread symmetrical vitiligo (5 with and I without associated autoimmune disease) of 2 to 10 years duration were treated for 18 months on alternate days with orally administered trioxsalen, 10mg. followed 2 hours later by 30 minutes lesion-exposure to tropical midday sunlight Whereas all lesions became intensely but transiently pruritic and erythematous immediately after each treatment session, repigmentation started in 4 weeks (Le. after several treatment sessions) from normal skin at periphery of lesions and around bait follicles within lesions as pin-bead-sized black macules which enlarged Slowly and eventually coalesced to obliterate the white patches. Lesions overlying soft tissue and muscle bulk pigmented well while those over bony prominences failed to pigment satisfactorily. Re-pigmented areas have remained stable and cosmetically acceptable for up to 5 years. Two patients complained of burning sensation after each treatment but were able to complete the treatment Response to above treatment with over 75% (in 4 patients) and 50% (in 2 patients) repigmentation of originally diseased skin without significant side effects led to the conclusion that photochemotherapy utilizing trioxsalen and sunlight was effective against widespread vitiligo in dark-skinned patients in the tropicsItem Pigmentation of the Black Skin in Health and Disease(Ghana Medical Journal, 1992) Addy, J.H.Appearing in this issue of the Journal are two articles which deal with pigmentation abnormalities of the black skin. This editorial comment is designed [0 provide some background information, and thereby facilitate understanding and appreciation of the two articles by all readers. 1be colour of human skin is due predominantly to the presence of the biological brownish black. pigment melanin in the epidermis. Other pigments such as carotenoids (yellow), oxyhaemoglobin (red), reduced haemoglobin (blue) which play relatively insignificant roles when melanin pigmentation is heavy, assume some significance in individuals who lack melanin completely. such as albinos, or have very little of it., (very fair Caucasians) in whom the skin assumes a pink colour. For practical purposes therefore. human skin pigmentation means melanin pigmentation. the function of melanin is protection of the individual against the harmful effects of ultraviolet light. Light is essential for vital biological functions such as Vitamin 0 synthesis and vision, however the Ultra-Violet B (UVB) pan of the spectrum (wavelength 290-32Onm) is capable of destroying tissue leading to sunburn, premature ageing and neoplastic degenerationItem Some Aspects of Blood Transfusion Practice In West Africa(Ghana Medical Journal, 1994) Acquaye, J.K.Blood transfusion began in Ghana in 1954 at the Medica1 Research Institute Laboratories, Korle-Bu, to meet the demand by surgeons and obstetricians. Until about ten years ago over sixty per cent of blood usage in Ghana was for surgery Surgeons and obstetricians have therefore played and continue to play significant roles in the development of transfusion medicine in West Africa especially in those countries without transfusion medicine experts. As indicated below, the pattern of blood usage in Ghana has changed with diseases of children and women making the most demand on the blood supply. Practice of blood transfusion for a long time was on the basis of "bleed and give" with only a casual check on the donor's blood hemoglobin and enquiries on a past history of jaundice. Until recently there was no screening for syphilis or hepatitis B. The blood was given immediately or stored in a sma11 blood bank refrigerator or domestic refrigerator for a few hours or days.Item Blood Transfusion Practice in District Hospitals(Ghana Medical Journal, 1997) Acquaye, J.K.The objective of the study was to determine whether the key elements of prepared guidelines for the transfusion of blood. blood components and blood substitutes were being practised. Blood transfused in three district hospiw.ls were prospectively followed. information on age. sex, full diagnosis. pre and post transfusion haemoglobin and volume of blood given was obtained. Using the guidelines, the following were determined; the justification for the transfusion. adequacy of blood given. whether the transfusion was evaluated and the extent of rise of the haemoglobin. There were 486 transfused patients of whom 155 were adults. 303 children and equal representation of sexes: ages were not stated in 28. Provisional cause of the Anaemia was stated in 176 patients. Transfusion was justified in 71 %. Pre transfusion estimate of blood given was correct in 35.6%. Rise in haemoglobin was satisfactory in 26% of patients. The transfusion was not evaluated in a third of the patients. It is concluded that there is poor compliance of the transfusion guidelines.Item 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.Item 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.Item Exploring Overlaps Between the Genomic and Environmental Determinants of LVH and Stroke :A Multicenter Study in West Africa(Global Heart, 2017) Adeoye, A.M.; Ovbiagele, B.; Kolo, P.; Appiah, L.; Aje, A.; Adebayo, O.; Sarfo, F.; Akinyemi, J.; Adekunle, G.; Agyekum, F.; Shidali, V.; Ogah, O.; Lackland, D.; Gebregziabher, M.; Arnett, D.; Tiwari, H.K.; Akinyemi, R.; Olagoke, O.O.; Oguntade, A.S.; Olunuga, T.; Uwanruochi, K.; Jenkins, C.; Adadey, P.; Iheonye, H.; Owolabi, L.; Obiako, R.; Akinjopo, S.; Armstrong, K.; Akpalu, A.; Fakunle, A.; Saulson, R.; Aridegbe, M.; Olowoyo, P.; Osaigbovo, G.; Akpalu, J.; Fawale, B.; Adebayo, P.; Arulogun, O.; Ibinaiye, P.; Agunloye, A.; Ishaq, N.; Wahab, K.; Akpa, O.Background Whether left ventricular hypertrophy (LVH) is determined by similar genomic and environmental risk factors with stroke, or is simply an intermediate stroke marker, is unknown. Objectives We present a research plan and preliminary findings to explore the overlap in the genomic and environmental determinants of LVH and stroke among Africans participating in the SIREN (Stroke Investigative Research and Education Network) study. Methods SIREN is a transnational, multicenter study involving acute stroke patients and age-, ethnicity-, and sex-matched control subjects recruited from 9 sites in Ghana and Nigeria. Genomic and environmental risk factors and other relevant phenotypes for stroke and LVH are being collected and compared using standard techniques. Results This preliminary analysis included only 725 stroke patients (mean age 59.1 ± 13.2 years; 54.3% male). Fifty-five percent of the stroke subjects had LVH with greater proportion among women (51.6% vs. 48.4%; p < 0.001). Those with LVH were younger (57.9 ± 12.8 vs. 60.6 ± 13.4; p = 0.006) and had higher mean systolic and diastolic blood pressure (167.1/99.5 mm Hg vs 151.7/90.6 mm Hg; p < 0.001). Uncontrolled blood pressure at presentation was prevalent in subjects with LVH (76.2% vs. 57.7%; p < 0.001). Significant independent predictors of LVH were age <45 years (adjusted odds ratio [AOR]: 1.91; 95% confidence interval [CI]: 1.14 to 3.19), female sex (AOR: 2.01; 95% CI: 1.44 to 2.81), and diastolic blood pressure > 90 mm Hg (AOR: 2.10; 95% CI: 1.39 to 3.19; p < 0.001). Conclusions The prevalence of LVH was high among stroke patients especially the younger ones, suggesting a genetic component to LVH. Hypertension was a major modifiable risk factor for stroke as well as LVH. It is envisaged that the SIREN project will elucidate polygenic overlap (if present) between LVH and stroke among Africans, thereby defining the role of LVH as a putative intermediate cardiovascular phenotype and therapeutic target to inform interventions to reduce stroke risk in populations of African ancestry. © 2017 World Heart Federation (Geneva)Item Prevalence and Prognostic Features of ECG Abnormalities in Acute Stroke: Findings From the SIREN Study Among Africans(Global Heart, 2017) Adeoye, A.M.; Ogah, O.S.; Ovbiagel, B.; Akinyemi, R.; Shidali, V.; Agyekum, F.; Aje, A.; Adebayo, O.; Akinyemi, J.O.; Kolo, P.; Appiah, L.T.; Iheonye, H.; Kelechukwu, U.; Ganiyu, A.; Olunuga, T.O.; Akpa, O.; Olagoke, O.O.; Sarfo, F.S.; Wahab, K.; Olowookere, S.; Fakunle, A.; Akpalu, A.; Adebayo, P.B.; Nkromah, K.; Yaria, J.; Ibinaiye, P.; Ogbole, G.; Olumayowa, A.; Lakoh, S.; Calys-Tagoe, B.; Olowoyo, P.; Innocent, C.; Tiwari, H.K.; Arnett, D.; Godwin, O.; Ayotunde, B.; Akpalu, J.; Obiora, O.; Joseph, O.; Omisore, A.; Jenkins, C.; Lackland, D.; Owolabi, L.; Isah, S.; Dambatta, A.H.; Komolafe, M.; Bock-Oruma, A.; Melikam, E.S.; Imoh, L.C.; Sunmonu, T.; Gebregziabher, M.; Olabisi, O.; Armstrong, K.; Onyeonoro, U.U.; Sanya, E.; Agunloye, A.M.; Ogunjimi, L.; Arulogun, O.; Farombi, T.H.; Obiabo, O.; Obiako, R.; Owolabi, M.Background Africa has a growing burden of stroke with associated high morbidity and a 3-year fatality rate of 84%. Cardiac disease contributes to stroke occurrence and outcomes, but the precise relationship of abnormalities as noted on a cheap and widely available test, the electrocardiogram (ECG), and acute stroke outcomes have not been previously characterized in Africans. Objectives The study assessed the prevalence and prognoses of various ECG abnormalities among African acute stroke patients encountered in a multisite, cross-national epidemiologic study. Methods We included 890 patients from Nigeria and Ghana with acute stroke who had 12-lead ECG recording within first 24 h of admission and stroke classified based on brain computed tomography scan or magnetic resonance imaging. Stroke severity at baseline was assessed using the Stroke Levity Scale (SLS), whereas 1-month outcome was assessed using the modified Rankin Scale (mRS). Results Patients' mean age was 58.4 ± 13.4 years, 490 were men (55%) and 400 were women (45%), 65.5% had ischemic stroke, and 85.4% had at least 1 ECG abnormality. Women were significantly more likely to have atrial fibrillation, or left ventricular hypertrophy with or without strain pattern. Compared to ischemic stroke patients, hemorrhagic stroke patients were less likely to have atrial fibrillation (1.0% vs. 6.7%; p = 0.002), but more likely to have left ventricular hypertrophy (64.4% vs. 51.4%; p = 0.004). Odds of severe disability or death at 1 month were higher with severe stroke (AOR: 2.25; 95% confidence interval: 1.44 to 3.50), or atrial enlargement (AOR: 1.45; 95% confidence interval: 1.04 to 2.02). Conclusions About 4 in 5 acute stroke patients in this African cohort had evidence of a baseline ECG abnormality, but presence of any atrial enlargement was the only independent ECG predictor of death or disability. © 2017 World Heart Federation (Geneva)Item Burden of Sickle Cell Disease in Ghana: The Korle-Bu Experience(Advances in Hematology, 2018-12) Asare, E.V.; Wilson, I.; Kuma, A.B.A.; Dei-Adomakoh, Y.; Sey, F.; Olayemi, E.In Africa, sickle cell disease (SCD) is a major public health problem with over 200,000 babies born per year. In Ghana, approximately 15,000 (2%) of Ghanaian newborns are diagnosed with SCD annually. A retrospective review of medical records of all SCD patients aged 13 years and above, who presented to the sickle cell clinic at Ghana Institute of Clinical Genetics (GICG), Korle-Bu, from 1st January 2013 to 31st December 2014, was carried out, using a data abstraction instrument to document their phenotypes, demographics, attendance/clinic visits, pattern of attendance, and common complications seen. During the period under review 5,451 patients were seen at the GICG, with 20,788 clinic visits. The phenotypes were HbSS (55.7%) and HbSC (39.6%) with other sickle cell phenotypes (4.7%). Out of the 20,788 clinic visits, outpatient visits were 15,802 (76%), and urgent care visits were 4,986 (24%), out of which 128 (2.6%) patients were admitted to the Teaching Hospital for further management of their acute complications. There were 904 patient referrals (out of 5,451 patients) for specialist care; the 3 specialties that had the most referrals were Obstetrics and Gynaecology (168 patients), Orthopaedics (150 patients), and Ophthalmology (143 patients). In 2014, complications seen at KBTH included 53 patients with avascular necrosis (AVN) and 61 patients with chronic leg ulcers. Our centre has a large number of patients living with sickle cell disease. From our experience, early recognition and referral of sickle cell related complications can reduce morbidity and mortality associated with this disease. A multidisciplinary approach to care of SCD patients is therefore important.