Department of Medicine and Therapeutics

Permanent URI for this collectionhttp://197.255.125.131:4000/handle/123456789/24144

Browse

Now showing 1 - 20 of 121

African leaders¿ views on critical human resource issues for the implementation of family medicine in Africa
(2014-01-17) Moosa, Shabir; Downing, Raymond; Essuman, Akye; Pentz, Stephen; Reid, Stephen; Mash, Robert
Abstract Background The World Health Organisation has advocated for comprehensive primary care teams, which include family physicians. However, despite (or because of) severe doctor shortages in Africa, there is insufficient clarity on the role of the family physician in the primary health care team. Instead there is a trend towards task shifting without thought for teamwork, which runs the risk of dangerous oversimplification. It is not clear how African leaders understand the challenges of implementing family medicine, especially in human resource terms. This study, therefore, sought to explore the views of academic and government leaders on critical human resource issues for implementation of family medicine in Africa. Method In this qualitative study, key academic and government leaders were purposively selected from sixteen African countries. In-depth interviews were conducted using an interview guide. All interviews were audio-recorded, transcribed and thematically analysed. Results There were 27 interviews conducted with 16 government and 11 academic leaders in nine Sub-Saharan African countries: Botswana, Democratic Republic of Congo, Ghana, Kenya, Malawi, Nigeria, Rwanda, South Africa and Uganda. Respondents spoke about: educating doctors in family medicine suited to Africa, including procedural skills and holistic care, to address the difficulty of recruiting and retaining doctors in rural and underserved areas; planning for primary health care teams, including family physicians; new supervisory models in primary health care; and general human resource management issues. Conclusions Important milestones in African health care fail to specifically address the human resource issues of integrated primary health care teamwork that includes family physicians. Leaders interviewed in this study, however, proposed organising the district health system with a strong embrace of family medicine in Africa, especially with regard to providing clinical leadership in team-based primary health care. Whilst these leaders focussed positively on entry and workforce issues, in terms of the 2006 World Health Report on human resources for health, they did not substantially address retention of family physicians. Family physicians need to respond to the challenge by respondents to articulate human resource policies appropriate to Africa, including the organisational development of the primary health care team with more sophisticated skills and teamwork.
Alkaloids of Desmodiurn Adscendens.
(Ghana Medical Journal, 1988-12) Asante-Poku, S.; Sakakibara, J.; Addy, M.E.
Five alkaloids: three β-phenethylamine. one tetrahydroisoquinoline and one indole-3-alkylamine have been isolated from the stem-leaves of Desmodium adscedens, a plant used in Ghana for the management of asthma. Spectral (Ultraviolet. infrared. mass spectral) evidence and comparison with reference materials established their identities as tyramine. N,N-dime thyltyramine, 3.4-dimethoxy-β-phenethylamine, Salsoline and N,N-dimethyltryptamine, In addition, several unidentified indole and other minor basic components were detected by thin layer chromatography.
APOL1 genotype associated risk for preeclampsia in African populations: Rationale and protocol design for studies in women of African ancestry in resource limited settings
(PLOS ONE, 2022) Osafo, C.; Thomford, N.E.; Coleman, J.; Carboo, A.; Guure, C.; Okyere, P.; Adu, D.; Adanu, R.; Parekh, R.S.; Burke, D.
Background Women of African ancestry are highly predisposed to preeclampsia which continues to be a major cause of maternal death in Africa. Common variants in the APOL1 gene are potent risk factor for a spectrum of kidney disease. Recent studies have shown that APOL1 risk variants contribute to the risk of preeclampsia. The aim of the study is to understand the con tribution of APOL1 risk variants to the development of preeclampsia in pregnant women in Ghana. Methods The study is a case-control design which started recruitment in 2019 at the Korle Bu Teaching Hospital in Ghana. The study will recruit pregnant women with a target recruitment of 700 cases of preeclampsia and 700 normotensives. Clinical and demographic data of mother- baby dyad, with biospecimens including cord blood and placenta will be collected to assess clinical, biochemical and genetic markers of preeclampsia. The study protocol was approved by Korle Bu Teaching Hospital Institutional Review Board (Reference number: KBTH-IRB/000108/2018) on October 11, 2018. Preliminary results As of December 2021, a total of 773 mother-baby pairs had been recruited and majority of them had complete entry of data for analysis. The participants are made up of 384 pre eclampsia cases and 389 normotensive mother-baby dyad. The mean age of participants is 30.69 ± 0.32 years for cases and 29.95 ± 0.32 for controls. Majority (85%) of the participants are between 20-30years. At booking, majority of cases had normal blood pressure com pared to the time of diagnosis where 85% had a systolic BP greater than 140mmHg and a corresponding 82% had diastolic pressure greater than 90mmHg. Conclusion Our study will ultimately provide clinical, biochemical and genotypic data for risk stratification of preeclampsia and careful monitoring during pregnancy to improve clinical management and outcomes.
APOL1 genotype associated risk for preeclampsia in African populations: Rationale and protocol design for studies in women of African ancestry in resource limited settings
(PLOS ONE, 2022) Osafo, C.; Adu, B.; et al.
Background Women of African ancestry are highly predisposed to preeclampsia which continues to be a major cause of maternal death in Africa. Common variants in the APOL1 gene are potent risk factor for a spectrum of kidney disease. Recent studies have shown that APOL1 risk variants contribute to the risk of preeclampsia. The aim of the study is to understand the contribution of APOL1 risk variants to the development of preeclampsia in pregnant women in Ghana. Methods The study is a case-control design which started recruitment in 2019 at the Korle Bu Teaching Hospital in Ghana. The study will recruit pregnant women with a target recruitment of 700 cases of preeclampsia and 700 normotensives. Clinical and demographic data of mother- baby dyad, with biospecimens including cord blood and placenta will be collected to assess clinical, biochemical and genetic markers of preeclampsia. The study protocol was approved by Korle Bu Teaching Hospital Institutional Review Board (Reference number: KBTH-IRB/000108/2018) on October 11, 2018. Preliminary results As of December 2021, a total of 773 mother-baby pairs had been recruited and majority of them had complete entry of data for analysis. The participants are made up of 384 preeclampsia cases and 389 normotensive mother-baby dyad. The mean age of participants is 30.69 ± 0.32 years for cases and 29.95 ± 0.32 for controls. Majority (85%) of the participants are between 20-30years. At booking, majority of cases had normal blood pressure compared to the time of diagnosis where 85% had a systolic BP greater than 140mmHg and a corresponding 82% had diastolic pressure greater than 90mmHg. Conclusion Our study will ultimately provide clinical, biochemical and genotypic data for risk stratification of preeclampsia and careful monitoring during pregnancy to improve clinical management and outcomes
APOL1, CDKN2A/CDKN2B, and HDAC9 Polymorphisms and Small Vessel Ischemic Stroke
(Acta Neurologica Scandinavica, 2018-01) Tiwari, H.K.; Arnett, D.K.; Ovbiagele, B.; Irvin, M.R.; Wahab, K.; Sarfo, F.; Srinivasasainagendra, V.; Adeoye, A.; Perry, R.T.; Akpalu, A.; Jenkins, C.; Arulogun, O.; Gebregziabher, M.; Owolabi, L.; Obiako, R.; Sanya, E.; Komolafe, M.; Fawale, M.; Adebayo, P.; Osaigbovo, G.; Sunmonu, T.; Olowoyo, P.; Chukwuonye, I.; Obiabo, Y.; Onoja, A.; Akinyemi, J.; Ogbole, G.; Melikam, S.; Saulson, R.; Owolabi, M.
OBJECTIVE: Worldwide, the highest frequencies of APOL1-associated kidney variants are found in indigenous West Africans among whom small vessel disease (SVD) ischemic stroke is the most common stroke phenotype. The objective of this study was to investigate the association and effect sizes of 23 selected SNPs in 14 genes of relevance, including the APOL1 G1 variants, with the occurrence of SVD ischemic stroke among indigenous West African participants in the Stroke Investigative Research and Education Network (SIREN) Study. MATERIALS AND METHODS: Cases were consecutively recruited consenting adults (aged 18 years or older) with neuroimaging-confirmed first clinical stroke. Stroke-free controls were ascertained using a locally validated version of the Questionnaire for Verifying Stroke-Free Status (QVSFS). Logistic regression models adjusting for known vascular risk factors were fitted to assess the associations of the 23 SNPs in rigorously phenotyped cases (N = 154) of SVD ischemic stroke and stroke-free (N = 483) controls. RESULTS: Apolipoprotein L1 (APOL1) rs73885319 (OR = 1.52; CI: 1.09-2.13, P-value = .013), rs2383207 in CDKN2A/CDKN2B (OR = 3.08; CI: 1.15-8.26, P -value = .026) and rs2107595 (OR = 1.70; CI: 1.12-2.60, P-value = .014) and rs28688791 (OR = 1.52; CI: 1.03-2.26, P-value = .036) in HDAC9 gene were associated with SVD stroke at 0.05 significance level. Polymorphisms in other genes did not show significant associations. CONCLUSION: This is the first report of a specific association of APOL1 with a stroke subtype. Further research is needed to confirm these initial findings and deepen understanding of the genetics of stroke in people of African ancestry with possible implications for other ancestries as all humans originated from Africa.
Association Between Perfluoroalkyl Substance Exposure and Renal Function in Children With CKD Enrolled in H3Africa Kidney Disease Research Network
(Kidney International Reports, 2019-08-06) Osafo, C.; Sood, S.; Ojo, A.O.; Adu, D.; Kannan, K.; Ghassabian, A.; Koshy, T.; Vento, S.M.; Pehrson, L.J.; Gilbert, J.F.; Arogundade, F.A.; Ademola, A.D.; Salako, B.O.; Raji, Y.; Antwi, S.; Trachtman, H.; Trasande, L.
The prevalence of chronic kidney disease (CKD) is increasing at an accelerated pace in countries with limited health resources compared to developed countries. 1 There is a need for more studies of the epidemiology and clinical characteristics of CKD in pediatric populations in sub-Saharan Africa, where risk factors are common.2 Perflouroalkyl substances (PFASs), a group of synthetic chemicals with a fluorinated hydrophobic linear carbon chain attached to hydrophilic heads, are characterized by resistance to thermal, chemical, and biological degradation.3 They are used in household products such as cookware, clothing, sofas, and carpets to make them stain resistant, waterproof, and nonstick. 3,S1 Exposure occurs through diet, dust, tap or bottled drinking water, and inhalation.3,4,S2-S5 PFASs are detected in serum from over 98% of a studied sample of the US population aged 12 to 60 years.4,S6 Children have elevated serum PFAS concentrations compared to adults
Authors’ reply to Del Giudice: the global prevalence and correlates of skin bleaching
(International Journal of Dermatology, 2019-07-28) Lartey, M.; Sagoe, D.; Pallesen, S.; Dlova, N.C.; Ezzedine, K.; Dadzie, O.
Our study responds to the inclusion criteria of their study. From 1992 to 1993, we conducted an epidemiologic and clinical study in Dakar, Senegal. Women were questioned about the use of skin-lightening creams and examined for potential adverse skin reactions; 685 Senegalese women participated in the study; 26% were using skin-lightening creams, and 36% had used them at some times
Authors’ reply to Del Giudice: the global prevalence and correlates of skin bleaching
(International Journal of Dermatology, 2019-07-28) Lartey, M.; Sagoe, D.; Pallesen, S.; Dlova, N.C.; Ezzedine, K.; Dadzie, O.
I read the meta-analysis and meta-regression analysis of skin bleaching by Sagoe et al with great interest.1 The authors included 68 studies, resulting in publications ranging from 1972 to 2017. I am surprised because we conducted one of the first epidemiological studies on this problem which was published in this review in 2002,2 and this article is lacking in the meta-analysis. Our study responds to the inclusion criteria of their study. From 1992 to 1993, we conducted an epidemiologic and clinical study in Dakar, Senegal. Women were questioned about the use of skin-lightening creams and examined for potential adverse skin reactions; 685 Senegalese women participated in the study; 26% were using skin-lightening creams, and 36% had used them at some times
BE-SMART (Basal Early Strategies to Maximize HbA1c Reduction with Oral Therapy): Expert Opinion
(Diabetes Therapy, 2019-03-19) Lamptey, R.; Bajaj, S.; Das, A.K.; Kalra, S.; Sahay, R.; Saboo, B.; Das, S.; Shunmugavelu, M.; Jacob, J.; Priya, G.; Khandelwal, D.; Dutta, D.; Chawla, M.; Surana, V.; Tiwaskar, M.; Joshi, A.; Shrestha, P.K.; Bhattarai, J.; Bhowmik, B.; Latt, T.S.; Aye, T.T.; Vijayakumar, G.; Baruah, M.; Jawad, F.; Unnikrishnan, A.G.; Chowdhury, S.; Pathan, M.F.; Somasundaram, N.; Sumanathilaka, M.; Raza, A.; Bahendeka, S.K.; Coetzee, A.; Ruder, S.; Ramaiya, K.; Bavuma, C.; Shaikh, K.; Uloko, A.; Chaudhary, S.; Abdela, A.A.; Akanov, Z.; Rodrı`guez-Saldan˜a, J.; Faradji, R.; Tiago, A.; Reja, A.; Czupryniak, L.
The past three decades have seen a quadruple rise in the number of people affected by diabetes mellitus worldwide, with the disease being the ninth major cause of mortality. Type 2 diabetes mellitus (T2DM) often remains undiagnosed for several years due to its asymptomatic nature during the initial stages. In India, 70% of diagnosed diabetes cases remain uncontrolled. Current guidelines endorse the initiation of insulin early in the course of the disease, specifically in patients with HbA1c > 10%, as the use of oral agents alone is unlikely to achieve glycemic targets. Early insulin initiation and optimization of glycemic control using insulin titration algorithms and patient empowerment can facilitate the effective management of uncontrolled diabetes. Early glucose control has sustained benefits in people with diabetes. However, insulin initiation, dose adjustment, and the need to repeatedly assess blood glucose levels are often perplexing for both physicians and patients, and there are misconceptions and concerns regarding its use. Hence, an early transition to insulin and ideal intensification of treatment may aid in delaying the onset of diabetes complications. This opinion statement was formulated by an expert panel on the basis of existing guidelines, clinical experience, and economic and cultural contexts. The statement stresses the timely and appropriate use of basal insulin in T2DM. It focuses on the seven vital Ts-treatment initiation, timing of administration, transportation and storage, technique of administration, targets for titration, tablets, and tools for monitoring
Binge Drinking among adolescents is related to the development of Alcohol Use Disorders: results from a Cross-Sectional Study
(Scientific Reports, 2018-12) Addolorato, G.; Vassallo, G.A.; Antonelli, G.; Antonelli, M.; Tarli, C.; Mirijello, A.; Agyei-Nkansah, A.; Mentella, M.C.; Ferrarese, D.; Mora, V.; Barbàra, M.et.al.
Binge drinking (BD) is a common pattern of alcohol consumption among adolescents. At present few data are available on the possible relationship between BD and alcohol use disorders (AUD) in adolescents. The aim of this study was to assess the prevalence of BD and relationship between BD behavior and AUD among adolescents. A total of 2704 students attending 10 purposively selected high schools from three Italian provinces were surveyed. Questionnaires regarding socio-demographic data, pattern and amount of alcohol intake, smoking habits, use of illicit drugs, and physical activity were administered. AUD and affective disorders were also evaluated. Alcohol intake was reported by 2126 participants; 1278 reported at least one episode BD in the last year and 715 in the last month. A diagnosis of AUD was made in 165 adolescents. The prevalence of AUD was higher in adolescents that reported BD behavior than in those that did not report BD (11.6% vs 0.9%, respectively; p < 0.0001). Logistic regression showed a positive relationship between a diagnosis of AUD and BD behavior (OR 9.6; 95% CI 4.7–22·9; p < 0.0001). In conclusion alcohol consumption with the pattern of BD among adolescents is highly related to development of AUD. © 2018, The Author(s).
Brief Report: Relationship Between ABCC4 SNPs and Hepatitis B Virus Suppression During Tenofovir-Containing Antiretroviral Therapy in Patients With HIV/HBV Coinfection
(JAIDS Journal of Acquired Immune Deficiency Syndromes, 2019-12-01) Archampong, T.; Ojewale, O.; Bears, K.; Chen, Y.; Lartey, M.; Sagoe, K.; Obo-Akwa, A.; Gong, Y.; Langaee, T.; Kwara, A.
Background: Incomplete hepatitis B virus (HBV) suppression during antiretroviral therapy (ART) in HIV and HBV coinfected patients is common, but underlying factors are not fully elucidated. We hypothesize that genetic factors that influence nucleoside analog pharmacokinetics will affect HBV treatment response. Methods: HIV/HBV coinfected patients on tenofovir disoproxil fumarate/lamivudine (TDF/3TC)-containing ART were enrolled. Selected ABCC4 single nucleotide polymorphisms (SNPs) with known effects on nucleoside pharmacokinetics were genotyped using TaqMan assays. Relationship between ABCC4 SNPs and unsuppressed HBV DNA (HBV DNA ≥20 IU/mL) were examined. Results: Of the 50 participants on TDF/3TC-containing ART for a median (range) of 1.5 (1–7.4) years, 20 (40%) had unsuppressed HBV DNA. Participants with unsuppressed compared with those with suppressed HBV DNA were more likely to have negative HBe antibody, lower body mass index, and lower CD4 count at enrollment. Carriers of ABCC4 rs11568695 (G3724A) variant allele were more likely than noncarriers to have unsuppressed HBV (61.1% vs. 29.0%, P = 0.038). Among 36 patients with suppressed HIV RNA (presumed good ART adherence), ABCC4 rs11568695 variant carriers were more likely than noncarriers to have unsuppressed HBV (58.8% vs. 20.0% P = 0.021). Logistic regression analysis that included genetic and nongenetic factors identified ABCC4 rs11568695 variant allele, body mass index, and male sex as predictors of unsuppressed HBV DNA. Conclusions: We identified a novel association between ABCC4 rs11568695 SNP and poor HBV treatment response. If confirmed in further studies, ABCC4 genotyping could be used to identify individuals who may need intensified HBV therapy
Building a rheumatology team for Africa: enhancing the roles of patients and non-specialists
(Rheumatology (Oxford, England), 2018-02) Etomi, O.; Fink, D.L.; Olaosebikan, H.; Dey, I.D.; Adelowo, O.O.
Sir, We are grateful to Genga et al. [1] for elegantly outlining the urgent need for improved rheumatology care in sub-Saharan Africa (SSA). The authors frame their discussion with the key observation that in many regions of SSA with ageing populations we have entered the era of non-communicable disease as the main driver of morbidity and mortality [2]. Rheumatic and musculoskeletal diseases (RMD) are the third most common cause of disability globally [3]. As Genga et al. observe, African specific risk factors, including the high frequency of manual occupations and increasingly western diets and behaviours, are poorly understood. Nigeria alone has a population of over 180 million people; West Africa has a population exceeding 320 million [4]. Comparable to the data from East Africa quoted by Genga et al. there are currently 26 consultant rheumatology physicians in West Africa. Outside of South Africa, the only fully accredited rheumatology training programme in SSA awarding its own certificate of specialization is based in Lagos, Nigeria. Trainees on rheumatology specialist programmes in Ghana and Kenya must currently complete their specialist training in South Africa or outside the continent owing to insufficient numbers to provide domestic senior supervision. The West African programme was established in 2000 by Professor Olufemi Adelowo. At this month’s American College of Rheumatology meeting (3–8 November 2017) Professors Adelowo and Oyoo presented data on behalf of the African League of Associations in Rheumatology reporting that the Nigerian programme has produced 12 consultant rheumatologists and 19 trainees with capacity for four trainees a year [5]. This programme provides a template for rheumatology training across the continent supported by the African League of Associations in Rheumatology and the International League Against Rheumatism [6]. We recently hosted the first rheumatology plenary session at the Nigerian Institute of Medical Research (NIMR) 4th International Scientific Conference (7–9 November 2017). It brought together rheumatology specialists and interested non-specialists from all over West Africa. Recently published data on behalf of Community Oriented Program for Control of Rheumatic Diseases suggest that musculoskeletal morbidity is high in Nigeria with 58% point prevalence of musculoskeletal symptoms in this population-based survey [7]. As alluded to by Genga et al., the conference discussed the major problem of delayed presentation of RMD to specialist care associated with increased morbidity and mortality from undiagnosed and inappropriately managed disease. Even in Lagos, where rheumatology provision is superior to other regions, the average time to specialist care from onset of symptoms exceeds 4 years [8]. Across West Africa presentations of SLE are often managed as infection given the perceived high prevalence of communicable disease: mortality is 48% in those admitted to hospital according to unpublished data (Dey et al. 2017). Specialist physicians cannot meet this adversity alone. Awareness of rheumatic conditions among both patients and non-specialist physicians is fundamental to improving care outcomes in SSA. Survey forms were given to 60 attendees of the NIMR conference at random with 53 respondents. Respondents were asked ‘What is the single most important barrier to improving the care of patients with musculoskeletal disease?’ Fifty-seven per cent reported either patient or non-specialist doctor awareness of RMD (see Fig. 1). Only 6% reported that availability or use of specialist treatments was the single most important barrier.
The burden of stroke in Africa: A glance at the present and a glimpse into the future
(Cardiovascular Journal of Africa, 2015-03) Owolabi, M.O.; Akarolo-Anthony, S.; Akinyemi, R.; Arnett, D.; Gebregziabher, M.; Jenkins, C.; Tiwari, H.; Arulogun, O.; Akpalu, A.; Sarfo, F.S.; Obiako, R.; Owolabi, L.; Sagoe, K.; Melikam, S.; Adeoye, A.M.; Lackland, D.; Ovbiagele, B.
Objective: Information on the current burden of stroke in Africa is limited. The aim of this review was to comprehensively examine the current and projected burden of stroke in Africa. Methods: We systematically reviewed the available literature (PubMed and AJOL) from January 1960 and June 2014 on stroke in Africa. Percentage change in age-adjusted stroke incidence, mortality and disability-adjusted life years (DALYs) for African countries between 1990 and 2010 were calculated from the Global Burden of Diseases (GBD) model-derived figures. Results: Community-based studies revealed an age-standardised annual stroke incidence rate of up to 316 per 100 000 population, and age-standardised prevalence rates of up to 981 per 100 000. Model-based estimates showed significant mean increases in age-standardised stroke incidence. The peculiar factors responsible for the substantial disparities in incidence velocity, ischaemic stroke proportion, mean age and case fatality compared to high-income countries remain unknown. Conclusions: While the available study data and evidence are limited, the burden of stroke in Africa appears to be increasing.
Causes of death and factors associated with early mortality of HIV-infected adults admitted to Korle-Bu teaching hospital
(Pan African Medical Journal, 2017) Saavedra, A.; Campinha-Bacote, N.; Hajjar, M.; Kenu, E.; Gillani, F.S.; Obo-Akwa, A.; Lartey, M.; Kwara, A.
Introduction: This study sought to identify common causes of death as well as the factors associated with the high inpatient mortality rate of HIV-infected patients at the Korle-Bu Teaching Hospital (KBTH). Methods: The retrospective study reviewed the medical records of 547 HIV-infected adults aged 18 years or older admitted to the KBTH between the months of January 2012 and October 2013. Using standardized abstraction forms, clinical and demographic data of eligible patients was collected. Data was summarized using descriptive statistics. Demographic and clinical characteristics of patients who died within 7 days (early) and after (late) admission were compared using Rank Sum tests or Chi-square tests. Results: Of 547 eligible patients during the period, 222 (40.6%) died during hospitalization, with 124 (55.9%) of them dying within a week of admission. Of the 222 patients who died, 190 (85.6%) were previously known HIV-positive. Yet, 141 (63.5%) of the 222 patients who died had no prior highly active antiretroviral therapy (HAART). The most common admitting diagnoses were anemia (34.2%), cerebral toxoplasmosis (29.3%), and pneumonia (25.7%); the most common causes of death were tuberculosis (34.7%), anemia (30.2%) and cerebral toxoplasmosis (27.5%). Tuberculosis was the only factor significantly associated with early death (P<0.05). Conclusion: The inpatient mortality rate among HIV-infected adults admitted to the KBTH is high. A majority of the patients were not receiving HAART despite known HIV diagnosis. Earlier initiation of HAART may lower the risk of opportunistic infections and HIV mortality rates. Additionally, a high index of suspicion and initiation of empiric treatment for TB may reduce early deaths. © Adriana Saavedra et al.
Causes of Death in Hospitalized HIV Patients in the Early Anti-Retroviral Therapy Era
(Ghana medical journal, 2015-03) Lartey, M.; Asante-Quashie, A.; Essel, A.; Kenu, E.; Ganu, V.; Neequaye, A.
OBJECTIVE: To establish the cause(s) of death among persons with HIV and AIDS admitted to the Fevers Unit of the Korle-Bu Teaching Hospital (KBTH) in 2007 and to determine whether they were AIDS-related in the era of availability of HAART.METHOD: Retrospective chart review of all deaths that occurred in the year 2007 among inpatients with HIV infection. Cause of Death (COD) was established with post mortem diagnosis, where not available ICD-10 was reviewed independently by two physicians experienced in HIV medicine and a consensus reached as to the most likely COD.RESULTS: In the year under review, 215 (97%) of the 221 adult deaths studied were caused by AIDS and HIV-associated illnesses. Of these, 123 (55.7%) were due to an AIDS-defining illness as described in CDC Category 3 or WHO stage 4. Infections accounted for most of the deaths 158 (71.5%), many of them opportunistic 82 (51.8%). Tuberculosis was the commonest COD. Clinical diagnosis of TB was accurate in 54% of deaths, but was not validated by autopsy in 36% of deaths. There were few deaths (14.5%) in patients on HAART.CONCLUSION: In a developing country like Ghana where HAART was still not fully accessible, AIDS-related events remained the major causes of death in persons living with HIV. Total scale-up of the ART programme with continuous availability of antiretrovirals is therefore imperative to reduce deaths from AIDS and HIV associated illnesses. There is need for interventions for early diagnosis as well as reduction in late presentation and also better diagnostic tools for tuberculosis.
Changes in origin of acute chest pain in a sub-Saharan African setting
(SAGE, 2022) Tettey, M.; Edwin, F.; Doku, A.; Ndanu, T.; Entsua-Mensah, K.; Adzamli, I.
Our aim was to demonstrate a shifting epidemiology of acute chest pain in Ghana. Efforts to increase physician awareness and best practices are urgently required. Patients presenting with acute chest pain to the two leading tertiary care centres in Accra were investigated
Clinical characteristics of males with systemic lupus erythematosus (SLE) in an inception cohort of patients in Ghana
(Ghana medical journal, 2019-03-01) Dey, D.; Ofori, E.; Hutton-Mensah, K.A.; Akutek, M.L.K.; Okine, R.; Amoaba, I.; Agyemang-Duah, K.; Kwarko, H.
BACKGROUND: Systemic Lupus Erythematosus (SLE) is said to be rare in Sub-Saharan Africa and even rarer in males worldwide. SLE is mostly considered a disease of women, though men may also be affected, and this may lead to a delay in diagnosis in men. The result is a greater burden of inflammation and subsequent organ damage over time. METHOD: Data from the medical records of 13 male patients diagnosed with SLE at the Rheumatology Clinic of Korle- Bu Teaching Hospital between January 2014 and January 2017 was retrospectively analyzed. RESULTS: A total of 13 male patients out of a total of 134 SLE patients were included in our analysis. The mean age was 30.62 ± SD 8.47 years (range of 17 to 46 years). All of them (100%) presented with constitutional features. The most common ACR criteria observed was 61.5 % rash, 54.5 % oral ulcers, 92.3% arthritis, 61.5 % serositis and 38.5% renal involvement, 46.2 % CNS involvement. Looking at their serological profile, 91.7 % had a positive antinuclear antibody (ANA). 33.3 % had positive anti-dsDNA and 58.3 % extractable nuclear antigens. The mean duration from onset of symptoms to diagnosis was 21.31 months. Five patients were diagnosed with lupus nephritis, all at the time of diagnosis. There were no mortalities. CONCLUSION: Male SLE patients in Ghana are comparable to other populations, with arthritis and constitutional features being predominant early features and lupus nephritis being the main early indicator of organ damage. This should warrant aggressive management in male patients.
Clinical Features of HIV Infection in Accra
(Ghana Medical Journal, 1987-09) Neequaye, A.R.; Ankra-Badu, G.A.; Affram, R.K.
The clinical features of 30 patients with H.I.V. infection have been described. 18 patients had severe disease and satisfied the WHO clinical definition of AIDS in Africa. The usefulness of this definition in underdeveloped countries has been discussed. The remaining 12 patients had milder disease and the importance of identifying this group of patients in the control of HIV infection in the community has also been discussed. In the main, the clinical features of HIV infection in Accra is similar to those found in East and Central Africa.
Clinical psychology in Ghana
(Clinical Psychology Forum, 2010) Ofori-Atta, A.L.
This article describes the history of clinical psychology in Ghana, the contribution already made and the challenges still to be faced as clinical psychology evolves to meet local needs and strives to establish itself as a profession.
Coinfection of Cutaneous Leishmaniasis and HIV Infection. Ghana.
(2006-09) Lartey, M.; Adusei, L.; Hanson-Nortey, L.; Addy, J.
SummaryCutaneous leishmaniasis has recently been discovered in some parts of Ghana. The case of an HIV infected patient presenting with cutaneous leishmaniasis at the Korle-Bu Teaching Hospital is discussed. The diagnosis of leishmaniasis was confirmed by histology. Also highlighted is the fact that this is the first reported case of dual infection of HIV and Leishmaniasis in Ghana.The possibility of rapid spread to other members of the community, both immunecompetent and immunesuppressed in view of the large numbers of organisms present in the lesion is discussed.