University of Ghana Medical School
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Item Host cytokine genetic polymorphisms in a selected population of persons living with hepatitis B virus infection in the central region of Ghana(BMC Gastroenterology, 2024) Adu, M.; Aniakwaa-Bonsu, E. A.; Ateko, R.O.; et al.Background Hepatitis B virus (HBV) infection is a public health concern in resource limited settings like Ghana. Over the past decades, it is noted that the natural course of HBV in persons infected are taking a worse turn leading to liver cirrhosis and cancer. The outcome of HBV infection is influenced by viral and host factors including genetics. Cytokine variations affect virus survival and progression and may even influence associated complications. Cytokines such as tumor necrosis factor alpha (TNF-α), interleukins (IL-4, IL-6, IL-8, IL-10, IL-18), interferon gamma (IFN)-γ, and tumor growth factor-beta (TGF-β) have key roles in HBV infection and modulation. In this study, polymorphisms occurring in fve cytokines were analyzed to understand how they can influence prognosis of HBV infection. Methods The study is a single centre cross-sectional study involving 227 participants made up of HBV infected participants and HBV-negative controls. Recruitment was from March 2021 to April 2022. Blood samples were taken for full blood count, HBV antigen profile, liver function tests, HBV DNA quantification and cytokine genotyping. FIB score was calculated using available tools. Statistical analysis was undertaken with p<0.05 set as statistically significant. Results The 20–39-year-old group formed majority of the HBV infected participants with 60% of all participants being classified as healthy HBsAg carriers. IL2 rs1479920 GG carriers ((1258.93; 0.00–5011.87) IU/mL had reduced HBV DNA in comparison to IL2 rs1479920 AA ((5011.87; 2113.49–5956.62) /AG (3548.13; 0.00–6309.57) IU/mL carriers. TNF-α rs1800629 AA carriers (1258.93; 0.00–3981.07) IU/mL had a reduction in HBV DNA levels in comparison to TNF-α rs1800629 GG carriers (1584.89; 0.00–5011.87) IU/mL. The results of univariate (OR=0.08, 0.00–0.93; p=0.043) and multivariate (OR=0.02, 0.00–0.67; p=0.029) analysis, showed that carrying TNF-α rs1800629 AA genotype reduce susceptibility to high FIB score compared with GG genotypes. In univariate analysis, subjects aged 20–39 years (OR=5.00, 1.13–6.10; p=0.034) and 40–59 years (OR=41.99, 3.74–47.21; p=0.0002) were more susceptible to high FIB score compared to subjects aged 1–19 years. Being female (OR=2.42, 1.03–5.71; p=0.043) in the univariate models showed higher odds of having high levels of HBV DNA in the multivariate model. There was a reduced likelihood of herbal medicine usage infuencing HBV DNA levels signifcantly (OR=0.29, 0.10–0.86; p=0.025). Conclusion In conclusion, variations in IL2 rs1479920 GG and IL2 rs1479921 AA could ofer protective efects by reduc ing HBV DNA. TNF-α rs179924CT may also cause elevation in HBV DNA levels whiles TNF-α -308A/G, showed a potential protective efect on liver scarring in HBV infected participants. It is therefore important to take a further look at such variations for understanding of HBV modulation in the Ghanaian population.Item Navigating the challenging storms of cancer management in a national cancer centre: perspectives of female patients(BMC Public Health, 2024) Mensah, N.A.; Mensah, Y.B.; Dedey, F.Background Breast, cervical, and ovarian cancers are among the top ten global cancers, affecting women, with age-standardized rates per 100,000 being 47.8 for breast, 13.3 for cervical, and 6.6 for ovarian cancer. The journey from cancer symptoms, through diagnosis and treatment, to survivorship, presents numerous challenges. These challenges encompass physical, psychological, and social aspects, significantly impacting patients’ quality of life. It is crucial for research to explore not only the challenges faced by patients but also the strategies they employ to cope with these obstacles. Methods This study employed a cross-sectional qualitative approach. Twenty respondents, aged between 15 and 45 years and had been diagnosed with a reproductive cancer (breast, ovarian, or cervical), and were either undergoing treatment or had completed treatment within one year of the study period were purposively selected. Respondents were interviewed using a semi-structured interview guide. A thematic analysis was conducted on twenty in-depth interviews (IDIs) to understand the challenges and support systems for cancer patients. Results The study identified two principal themes: the challenges faced by patients and the available support systems. The findings are based on patient narratives regarding the obstacles encountered during diagnosis, treatment, and follow-up, along with the mitigation strategies employed. Patients reported a range of challenges, categorized into financial and non-financial. Prominent among the non-financial challenges were psychological distress, body image issues, reduced sexual drive, and overall health deterioration. Support was primarily found through personal relationships and religious or spiritual beliefs. Conclusion The research highlights the extensive psychological and social effects of cancer and its treatment. The study revealed the intertwined nature of financial difficulties and non-financial challenges, emphasizing the importance of social support, including religious, family, healthcare, and peer support. The findings suggest that a comprehensive, multidisciplinary management plan which encompasses both medical and supportive care is required to enhance patient well-beingItem Anatomage virtual dissection versus traditional human body dissection in anatomy pedagogy: insights from Ghanaian medical students(BMC Medical Education, 2024) Koney, N.K-K.; Ansah, A.O.; Abdul-Rahman, M.; et al.Background Although traditional human body dissection has been the mainstay method for gross anatomy pedagogy, the popularity of virtual teaching methods has increased in recent years. The Anatomage table offers a life size digital representation of the human body and allows visualization, manipulation, and virtual dissection. This study investigated the perception of medical students towards virtual dissection vis-à-vis traditional dissection in anatomy pedagogy. Methods The cross-sectional survey included medical students at the University of Ghana who completed an internet-based questionnaire administered using Google® Forms. The questionnaire comprised 20 close-ended questions that solicited information on demographics, experience with traditional human body dissection and virtual dissection, and perception of virtual dissection. Data was summarized as frequencies and percentages with 95% confidence intervals. Results Of the 297 participants, 295 [99.4% (95% CI=97.3–99.9)] participated in human body dissection from which 93.2% had a positive and 6.8% had poor experiences. Whereas 223 [75.1% (95% CI=69.7–79.8)] of the participants would participate in dissection again given the opportunity, 74 [24.9% (95% CI=20.2–30.3)] were unwilling. Of 297 participants, 205 [69.0% (95% CI=69.7–74.2)] had used Anatomage table, while 92 [31.0% (95% CI=25.8–36.6)] had not. About 68% (95% CI=60.8–74.0) of the 205 agreed with the relative ease of operation and use of the Anatomage table compared to traditional human body dissection while 9.4% disagreed. Inadequate operational skills [51% (95% CI=48.9–53.4)] and limited accessibility [39% (95% CI=35.2–42.3)] were limitations to Anatomage use. 66.8% (95% CI=59.9–73.1) of participants agreed virtual dissection had a positive influence on learning anatomy while 6.6% disagreed. Of the 205, 87.9% (95% CI=82.3–91.8) discouraged virtual anatomy dissection completely replacing traditional human body dissection. Conclusion Virtual dissection is an effective supplement to traditional body dissection but not a replacement. Its use alongside traditional methods improves anatomy learning. Integrating technology into anatomy education will enhance student engagement and learning.Item Hepatitis B virus (HBV) viremia despite tenofovir disoproxil fumarate-containing antiretroviral therapy in persons with HBV/ HIV coinfection(Journal of Clinical Virology, 2024) Ryan, P.; Odegard, E.; Lartey, M.; et al.Background: The goal of treatment of hepatitis B virus (HBV) and human immunodeficiency virus (HIV) coin fection is suppression of both viruses; yet incomplete HBV suppression on tenofovir (TFV) disoproxil fumarate (TDF)-based antiretroviral therapy (ART) is common. This study investigated TFV resistance-associated muta tions (RAMs) in individuals with HBV/HIV coinfection with viremia on TDF/lamivudine (3TC)-containing ART. Methods: Samples from individuals with HBV DNA levels ≥20 IU/mL in a cross-sectional study of 138 persons with HBV/HIV coinfection in Ghana were analyzed in the present study. HBV was sequenced for RAM analysis. TFV-diphosphate (TFV-DP) concentration in peripheral blood mononuclear cells (PBMCs) was used to assess ART adherence level. Results: Nine of 138 participants (6.5 %) had detectable HBV DNA levels ≥20 IU/mL while on ART. Seven of the nine participants had TFV-DP concentrations commensurate with 7 doses per week, and six had suppressed HIV RNA. Phylogenetic analysis revealed that eight sequences were HBV genotype E, with one genotype E/A re combinant. Ten previously-reported TFV RAMs were present in the study samples; eight were wild-type for HBV genotype E. The non-genotype-E-wild-type point mutations M267L and K333Q were found in two and one pa tients, respectively. No 3TC RAMs were found. Conclusion: HBV viremia despite high adherence to TDF/3TC-based ART may be associated with the presence of TFV RAMs. These findings highlight the need for enhanced resistance monitoring and further research to examine the clinical significance of reported TFV RAMs. Individuals with HBV/HIV coinfection and TFV resis tance on TDF-based ART may need alternative treatment strategies.Item Hepatitis B virus (HBV) viremia despite tenofovir disoproxil fumarate-containing antiretroviral therapy in persons with HBV/ HIV coinfection(Journal of Clinical Virology, 2024) Ryan, P.; Lartey, M.; Tachi, K.; et al.Background: The goal of treatment of hepatitis B virus (HBV) and human immunodeficiency virus (HIV) coin fection is suppression of both viruses; yet incomplete HBV suppression on tenofovir (TFV) disoproxil fumarate (TDF)-based antiretroviral therapy (ART) is common. This study investigated TFV resistance-associated muta tions (RAMs) in individuals with HBV/HIV coinfection with viremia on TDF/lamivudine (3TC)-containing ART. Methods: Samples from individuals with HBV DNA levels ≥20 IU/mL in a cross-sectional study of 138 persons with HBV/HIV coinfection in Ghana were analyzed in the present study. HBV was sequenced for RAM analysis. TFV-diphosphate (TFV-DP) concentration in peripheral blood mononuclear cells (PBMCs) was used to assess ART adherence level. Results: Nine of 138 participants (6.5 %) had detectable HBV DNA levels ≥20 IU/mL while on ART. Seven of the nine participants had TFV-DP concentrations commensurate with 7 doses per week, and six had suppressed HIV RNA. Phylogenetic analysis revealed that eight sequences were HBV genotype E, with one genotype E/A re combinant. Ten previously-reported TFV RAMs were present in the study samples; eight were wild-type for HBV genotype E. The non-genotype-E-wild-type point mutations M267L and K333Q were found in two and one pa tients, respectively. No 3TC RAMs were found. Conclusion: HBV viremia despite high adherence to TDF/3TC-based ART may be associated with the presence of TFV RAMs. These findings highlight the need for enhanced resistance monitoring and further research to examine the clinical significance of reported TFV RAMs. Individuals with HBV/HIV coinfection and TFV resis tance on TDF-based ART may need alternative treatment strategies.Item Asymptomatic malaria parasitaemia and virological non-suppression among children living with HIV in a low transmission area in Accra, Ghana: a cross-sectional study(BMC Infectious Diseases, 2024) Afrane, A.K.A.; Alhassan, Y.; Amoah, L.E.; et al.Background Human Immunodeficiency Virus (HIV) and malaria are two major diseases in sub-Saharan Africa. Co-infection can significantly impact the clinical outcomes of both conditions. We assessed the proportion of HIV infected children at Korle Bu Teaching Hospital (KBTH) and Princess Marie Louise Hospital (PML) with malaria parasites. The association between asymptomatic malaria parasitaemia and virological non-suppression was also determined in these children. Methods This cross-sectional study of 277 asymptomatic malaria in children receiving care at paediatric HIV clinics at KBTH and PML was conducted from September to November 2022. Patients who had been on antiretroviral therapy (ART) for at least six months were eligible to participate. Structured questionnaires were used to collect socio-demographic information, malaria prevention behaviors, and ART-related data using in-person interviews. Microscopy and PCR were used to screen for malaria, and GeneXpert was used to determine viral load. To examine the determinants of malaria PCR positivity and virological non-suppression, chi-square tests and logistic regression were performed. Results The median age of the participants was 9 years (range: 6–12 years). Males comprised 158 (57%) of the study population. We detected 10 (3.6%) and 21 (7.6%) malaria cases by microscopy and PCR, respectively. Virological non-suppression (VL>1000 copies/ml) was observed in 82 (29.6%) of the 277 participants. Among the suppressed individuals, 62 (22.4%) exhibited low-level viraemia (VL level 40-1000 copies/ml) and 133 (48%) had undetectable viral load levels. No factors were associated with the presence of malaria PCR positivity carriage. Poor adherence to ART was associated with a five-fold increase in the risk of viral load non-suppression (AOR=4.89 [CI=2.00-11.98], p=0.001). Conclusion The proportion of children living with HIV with asymptomatic malaria parasitaemia was low. Approximately one-third of the study population had virological non-suppression. The interaction between malaria parasitemia and viral replication may not be the main cause for virological non-suppression in this low transmission area.Item Asymptomatic malaria parasitaemia and virological non-suppression among children living with HIV in a low transmission area in Accra, Ghana: a cross-sectional study(BMC Infectious Diseases, 2024) Afrane, A.K.A.; Alhassan, Y.; Amoah, L.E.; Nyarko, M. Y.; Addo-Lartey, A.Background Human Immunodeficiency Virus (HIV) and malaria are two major diseases in sub-Saharan Africa. Co-infection can significantly impact the clinical outcomes of both conditions. We assessed the proportion of HIV infected children at Korle Bu Teaching Hospital (KBTH) and Princess Marie Louise Hospital (PML) with malaria parasites. The association between asymptomatic malaria parasitaemia and virological non-suppression was also determined in these children. Methods This cross-sectional study of 277 asymptomatic malaria in children receiving care at paediatric HIV clinics at KBTH and PML was conducted from September to November 2022. Patients who had been on antiretroviral therapy (ART) for at least six months were eligible to participate. Structured questionnaires were used to collect socio-demographic information, malaria prevention behaviors, and ART-related data using in-person interviews. Microscopy and PCR were used to screen for malaria, and GeneXpert was used to determine viral load. To examine the determinants of malaria PCR positivity and virological non-suppression, chi-square tests and logistic regression were performed. Results The median age of the participants was 9 years (range: 6–12 years). Males comprised 158 (57%) of the study population. We detected 10 (3.6%) and 21 (7.6%) malaria cases by microscopy and PCR, respectively. Virological non-suppression (VL>1000 copies/ml) was observed in 82 (29.6%) of the 277 participants. Among the suppressed individuals, 62 (22.4%) exhibited low-level viraemia (VL level 40-1000 copies/ml) and 133 (48%) had undetectable viral load levels. No factors were associated with the presence of malaria PCR positivity carriage. Poor adherence to ART was associated with a five-fold increase in the risk of viral load non-suppression (AOR=4.89 [CI=2.00-11.98], p=0.001). Conclusion The proportion of children living with HIV with asymptomatic malaria parasitaemia was low. Approximately one-third of the study population had virological non-suppression. The interaction between malaria parasitemia and viral replication may not be the main cause for virological non-suppression in this low transmission areaItem A rare case of intusscusception in a 6-month-old baby(Sciencedirect, 2024-06-30) Fiagbedzi, E.; Arkorful, J.; Appiah, E.; Otumi, N.; Ofori, I.; Gorleku, N.P.This case report discusses the clinical presentation, imaging findings, and successful management of a rare case of intussusception in a 6-month-old female infant referred to a re- gional hospital in Ghana. The patient presented with vomiting, lethargy, fever, and currant jelly stool. Differential diagnoses considered included Merkel diverticulum, volvulus, lym- phadenopathy, and hypertrophic pyloric stenosis. Ultrasound imaging revealed a concentric lesion with characteristic signs of intussusception. Ileo-caeco coli intussusception was confirmed as the diagnosis. Surgical management was used for this patient. The postsurgery phase was without any complications. The patient recovered well and was discharged with a switch to oral medications. Infant intussusception is still a disease with a low morbidity rate.Item Emerging trends of marketing surgical cases in Africa: Balancing health financing strategies exploitation and ethical concerns(HSI Journal, 2024) Toboh, B.; Agyekum, F.; Doku, A.The unmet health needs in African communities, especially for surgical interventions, have resulted in desperate attempts by families and groups to raise the necessary financial resources. Open marketing of illness and leveraging on empathy from communities deny the sufferers the dignity of humanity. This article delves into the evolving landscape of marketing surgical cases in Africa, examining its role as a health financing strategy and highlighting potential ethical concerns.Item Availability and geographic access to breast cancer pathology services in Ghana(PLoS ONE, 2024) Price, M.D.; Mali, M.E.; Abrahams, A.O.D.; et al.Introduction Breast cancer poses a significant health challenge in Sub-Saharan Africa, particularly in Ghana, where late-stage diagnoses and limited healthcare access contribute to elevated mortality rates. This study focuses on the crucial role of pathology and laboratory medical (PALM) services in the timely diagnosis of breast cancer within Ghana. Methods A cross-sectional survey of hospitals was completed from November 2020 to October 2021, with 94.8% of identified in-country hospitals participating. Pathology service-related param eters assessed included whether pathology was available for the diagnosis of breast cancer on-site or via external referral, the number of pathology personnel, additional breast cancer diagnostic capabilities including estrogen and progesterone and/or HER2 testing, and the time from biopsy to patients receiving their results. Geospatial mapping was used to identify areas of limited access. Results Of the 328 participating hospitals, 136 (41%) reported breast cancer pathology services, with only 6 having on-site capabilities. Pathology personnel, comprising 15 consultants and 15 specialists, were concentrated in major referral centers, particularly in Greater Accra and Kumasi. An assessment of referral patterns suggested that 75% of the population reside within an hour of breast cancer pathology services. Among the 136 hospitals with access to breast cancer pathology, only a limited number reported that results included ER/PR (38%) and HER2 testing (33%). Conclusion Ghana has been able to ensure significant pathology service availability through robust referral pathways with centralized labs. Despite this, difficulties persist with the majority of pathology results not including hormone receptor testing which is important in providing tumor specific treatment.