Publications by authors named "Josephine Akpalu"

22 Publications

  • Page 1 of 1

Clinical characteristics of COVID-19 patients admitted at the Korle-Bu Teaching Hospital, Accra, Ghana.

Ghana Med J 2020 Dec;54(4 Suppl):33-38

Department of Medicine and Therapeutics, University of Ghana Medical School, University of Ghana, Accra, Ghana.

The study examined the clinical characteristics and outcomes of 2019 novel coronavirus disease (COVID-19) infections among hospitalized patients.

Design: Study design was a retrospective single-center review of hospital data.

Setting: The study was conducted at the COVID-19 Treatment Center of the Department of Medicine and Therapeutics of the Korle-Bu Teaching hospital in Accra, Ghana.

Participants And Study Tools: A total of fifty patients with laboratory (rRT-PCR) confirmed COVID-19 infection were involved in the study. A chart review of the medical records of the patients was conducted and the data obtained was documented using a data extraction form.

Results: The median age was 53 years and most (36% (18/50)) of the patients were at least 60 years of age. Eighty percent (40/50) of the patients were symptomatic, with cough and difficulty in breathing being the commonest presenting symptoms. The mean duration of hospitalization was 12.3 ± 7.3 days. Hypertension and Diabetes Mellitus were the commonest co-morbidities occurring in 52% (26/50) and 42% (21/50) of patients respectively. Fifty percent of patients developed COVID-19 pneumonia as a complication. The mortality rate was 12% (6/50).

Conclusion: In this study, SARS-CoV2 infection affected older adults with hypertension and diabetes mellitus being the common comorbidities. Patients with these comorbid conditions should be counselled by their clinicians to strictly observe the COVID-19 prevention protocols to reduce their risk of acquiring the infection. There is a need to pay critical and prompt attention to the management of patients with COVID-19 pneumonia particularly among people with diabetes to improve outcomes.

Funding: None declared.
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http://dx.doi.org/10.4314/gmj.v54i4s.6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8087357PMC
December 2020

Morbidity and Complications of Diabetes Mellitus in Children and Adolescents in Ghana: Protocol for a Longitudinal Study.

JMIR Res Protoc 2021 Jan 6;10(1):e21440. Epub 2021 Jan 6.

Ophthalmology and Visual Sciences (DCN), Faculty of Medicine and Health Sciences, School of Clinical Sciences, University Hospital, Nottingham, United Kingdom.

Background: Diabetes is associated with premature morbidity and mortality from its many complications. There are limited data on the chronic complications of diabetes in children and adolescents in sub-Saharan Africa.

Objective: The study aims to determine the (1) burden and related factors of chronic systemic complications of diabetes, including diabetic and nondiabetic ocular conditions in children and adolescents, and (2) quality of life (QoL) of participants compared to healthy controls. This manuscript describes the study methodology.

Methods: Demographic information, medical history, anthropometric measurements, and laboratory characteristics were collected, and the participants were screened for microvascular and macrovascular complications as well as nondiabetic ocular disease. QoL questionnaires were administered to participants, their caregivers, and controls. Participants were followed up annually up to 3 years to determine the natural history of and trends in these conditions. SPSS Version 25.0 will be used for data analysis. Continuous and categorical data will be presented as mean (SD) and as percentages (%), respectively. t tests and analysis of variance will be used to compare means, and chi-square tests will be used to compare categorical data. Correlation, regression, and logistic regression analyses will be employed to establish linear associations and causal associations as appropriate. Relative risk and odds ratios will be used to estimate risk. QoL outcomes in Ghanaian children and adolescents with diabetes mellitus compared with caregivers and healthy controls will be assessed using the Pediatric Quality of Life inventory. Significance will be set at α=.05.

Results: Institutional approval from the Ethical and Protocol Review Committee of the University of Ghana Medical School was received on August 22, 2014 (Protocol Identification Number: MS-Et/M.12-P4.5/2013-2014). Funding for the project was received from the University of Ghana Research Fund (#UGRF/9/LMG-013/2015-2016) in March 2016. Patient recruitment, clinical examination, and data collection commenced in August 2016 and was completed in September 2019. A total of 58 children and adolescents with diabetes mellitus have been recruited. Blood samples were stored at -80 °C for analysis, which was completed at the end of July 2020. Data analysis is ongoing and will be completed by the end of December 2020. Investigators plan to submit the results for publication by the end of February 2021.

Conclusions: The prevalence, natural history, trends in diabetic complications and nondiabetic ocular disease, and QoL will be provided. Our data may inform policies and interventions to improve care given to children and adolescents with diabetes.

International Registered Report Identifier (irrid): DERR1-10.2196/21440.
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http://dx.doi.org/10.2196/21440DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7817364PMC
January 2021

Pre-Stroke Depression in Ghana and Nigeria: Prevalence, Predictors and Association With Poststroke Depression.

J Geriatr Psychiatry Neurol 2020 Oct 19:891988720968274. Epub 2020 Oct 19.

University of California, San Francisco, CA, USA.

Objectives: Depression is a risk factor for stroke. There is a knowledge gap on the predictors of prestroke depression in stroke survivors living in low- and middle-income countries (LMICs). We estimated prevalence and predictors of prestroke depression, as well as its association with poststroke depression (PSD) in the largest study of stroke in Africa.

Methods: We evaluated information collected as part of the Stroke Investigative Research and Education Network (SIREN) study, a multicentre, case-control study conducted at 15 sites in Ghana and Nigeria. Prestroke depression status was ascertained in stroke survivors using a validated self-report tool, while PSD was assessed using a stroke specific screening tool for depression ("HRQOLISP-E"). Independent associations were investigated using complementary log-log regression and binary logit models.

Results: Among 1,977 participants, prestroke depression was found in 141 (7.1%). In multivariate analyses, prestroke depression was significantly associated with tachycardia (OR = 2.22, 95% CI = 1.37-3.56) and low consumption of green leafy vegetables (OR = 1.91, 95% CI = 1.12-3.24). Forty-one (29.1%) of the prestroke depression sub-sample developed PSD. However, prestroke depression was not significantly associated with PSD.

Conclusion: The findings should energize before-the-stroke identification and prioritization of limited treatment resources in LMICs to persons with depression who have multiple, additional, risks of stroke.
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http://dx.doi.org/10.1177/0891988720968274DOI Listing
October 2020

Psychosocial distress, clinical variables and self-management activities associated with type 2 diabetes: a study in Ghana.

Clin Diabetes Endocrinol 2020 14;6:14. Epub 2020 Jul 14.

Department of Medicine and Therapeutics, University of Ghana Medical School, College of Health Sciences, University of Ghana, Legon, Accra, Ghana.

Aim: Psychosocial distress can act as a barrier to diabetes self-care management and thus compromise diabetes control. Yet in Ghana, healthcare centres mainly focus on the medical aspect of diabetes to the neglect of psychosocial care. This study determined the relationship amongst psychosocial distress, clinical variables, and self-management activities associated with type 2 diabetes management.

Method: Questionnaires were administered to 162 patients from four hospitals in Accra, Ghana, to assess psychosocial distress (e.g. diabetes distress), clinical variables (e.g. glycaemic control), and self- management activities (e.g. medication intake) related to diabetes. In assessing diabetes distress, the use of the PAID allowed evaluation of broader range of emotional concerns (diabetes-related emotional distress), while the DDS allowed evaluation of factors more closely related to diabetes self-management (diabetes distress).

Results: Diabetes-related emotional distress, diabetes distress and depressive symptoms were reciprocally positively correlated, while non-supportive family behaviour correlated negatively with these psychological variables. Diabetes-related emotional distress correlated positively with systolic and diastolic blood pressure, and correlated negatively with exercise regimen. On the other hand, diabetes distress correlated negatively with dietary and exercise regimen and correlated positively with glycaemic levels, while depressive symptoms correlated positively with glycaemic levels, diabetes complication and systolic blood pressure. Contrary to the literature, non-supportive family behaviour correlated positively with diet, exercise and medication regimen.

Conclusion: The positive association of psychological variables with glycaemic levels and blood pressure levels, and the positive association of non-supportive family behaviour with self-management activities suggests the need for psychosocial care to be incorporate in the management of type 2 diabetes in Ghana. Patients can be screened for diabetes-related distress and symptoms of depression and provided psychosocial care where necessary.
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http://dx.doi.org/10.1186/s40842-020-00102-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7362489PMC
July 2020

Steroid-induced dysglycaemia in patients with haematological disorders a ten-year review in a tertiary hospital in Ghana.

Ghana Med J 2019 Jun;53(2):156-162

Korle Bu teaching hospital, Department of Medicine, Accra, Ghana.

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.

Funding: None declared.
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http://dx.doi.org/10.4314/gmj.v53i2.11DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6697763PMC
June 2019

Differential Impact of Risk Factors on Stroke Occurrence Among Men Versus Women in West Africa.

Stroke 2019 04;50(4):820-827

Centre for Genomic and Precision Medicine, University of Ibadan, Nigeria (R.A., A.A., M.O.).

Background and Purpose- The interplay between sex and the dominant risk factors for stroke occurrence in sub-Saharan Africa has not been clearly delineated. We compared the effect sizes of risk factors of stroke by sex among West Africans. Methods- SIREN study (Stroke Investigative Research and Educational Networks) is a case-control study conducted at 15 sites in Ghana and Nigeria. Cases were adults aged >18 years with computerized tomography/magnetic resonance imaging confirmed stroke, and controls were age- and sex-matched stroke-free adults. Comprehensive evaluation for vascular, lifestyle, and psychosocial factors was performed using validated tools. We used conditional logistic regression to estimate odds ratios and reported risk factor specific and composite population attributable risks with 95% CIs. Results- Of the 2118 stroke cases, 1193 (56.3%) were males. The mean±SD age of males was 58.1±13.2 versus 60.15±14.53 years among females. Shared modifiable risk factors for stroke with adjusted odds ratios (95% CI) among females versus males, respectively, were hypertension [29.95 (12.49-71.77) versus 16.1 0(9.19-28.19)], dyslipidemia [2.08 (1.42-3.06) versus 1.83 (1.29-2.59)], diabetes mellitus [3.18 (2.11-4.78) versus 2.19 (1.53-3.15)], stress [2.34 (1.48-3.67) versus 1.61 (1.07-2.43)], and low consumption of green leafy vegetables [2.92 (1.89-4.50) versus 2.00 (1.33-3.00)]. However, salt intake and income were significantly different between males and females. Six modifiable factors had a combined population attributable risk of 99.1% (98.3%-99.6%) among females with 9 factors accounting for 97.2% (94.9%-98.7%) among males. Hemorrhagic stroke was more common among males (36.0%) than among females (27.6%), but stroke was less severe among males than females. Conclusions- Overall, risk factors for stroke occurrence are commonly shared by both sexes in West Africa favoring concerted interventions for stroke prevention in the region.
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http://dx.doi.org/10.1161/STROKEAHA.118.022786DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6433514PMC
April 2019

Visual Outcome of Patients with Pituitary Adenomas Following Surgery and Its Contributory Factors at a Tertiary Hospital in Ghana.

Ethiop J Health Sci 2019 Jan;29(1):895-902

Department of Community Dentistry, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana.

Background: Craniotomy and transphenoidal microsurgery are surgical options for treatment of pituitary adenoma at Korle Bu Teaching Hospital(KBTH). Despite major advances and reported success rates of transphenoidal resection globally, paucity of local data regarding visual outcome of either procedure exists. We evaluated the visual outcome of patient with pituitary adenoma following surgery in a tertiary hospital in Ghana.

Methods: This is a prospective study of 18 of 45 consecutive new patients with pituitary adenoma seen from November 2010 to July 2013 at Korle-Bu Teaching Hospital(KBTH), Accra, Ghana. Sixteen (88.9%) of the 18 had surgery by transphenoidal route and 2(11.1%) by craniotomy. All patients had macroadenoma (tumour size >1cm) and histological confirmation of diagnosis. Pre-operative and post-operative visual acuity and its relationship to tumour size and duration of symptoms before diagnosis were evaluated.

Results: Data on 18 patients aged 33-60 years, mean (SD) 45.9±8.5, was analysed. Eleven (61.1%) were females. Visual blur, 15(83.3%), and headache,13(72.2%), were predominant presenting complaints. Common neuro-ophthalmic signs included unilateral or bilateral optic atrophy, 17(94.4%), Relative Afferent Pupillary Defect (RAPD) in 8(44.4%) and impaired colour vision in 32 of 36(88.9%) eyes. Preoperatively, 8(22.2%) and 13(36.1%) of 36 eyes were visually impaired or blind respectively. Postoperatively, 6(16.7%) eyes were visually impaired and 17(47.2%) eyes blind. Blindness was associated with late presentation (p<0.005) and larger tumour width (p<0.036).

Conclusions: More than a third of eyes of patients with pituitary adenoma were blind before and after surgery. Blindness was associated with late presentation and larger tumours. Transphenoidal surgery may be beneficial following early diagnosis to avoid irreversible blindness/visual impairment.
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http://dx.doi.org/10.4314/ejhs.v29i1.11DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6341437PMC
January 2019

Knowledge, attitudes and practices related to stroke in Ghana and Nigeria: A SIREN call to action.

PLoS One 2018 16;13(11):e0206548. Epub 2018 Nov 16.

University of Ghana Medical School, Accra, Ghana.

Introduction: Stroke is a prominent cause of death, disability, and dementia in sub-Saharan Africa (SSA). The Stroke Investigative Research and Education Network works collaboratively with stroke survivors and individuals serving as community controls to comprehensively characterize the genomic, sociocultural, economic and behavioral risk factors for stroke in SSA.

Purpose: In this paper, we aim to: i) explore the attitudes, beliefs, and practices related to stroke in Ghana and Nigeria using the process of qualitative description; and ii) propose actions for future research and community-based participation and education.

Methods: Stroke survivors, their caregivers, health care professionals, and community representatives and faith-based leaders participated in one of twenty-six focus groups, which qualitatively explored community beliefs, attitudes and practices related to stroke in Ghana and Nigeria. Arthur Kleinman's Explanatory Model of Illness and the Social Ecological Model guided the questions and/or thematic analysis of the qualitative data. We hereby describe our focus group methods and analyses of qualitative data, as well as the findings and suggestions for improving stroke outcomes.

Results And Discussion: The major findings illustrate the fears, causes, chief problems, treatment, and recommendations related to stroke through the views of the participants, as well as recommendations for working effectively with the SIREN communities. Findings are compared to SIREN quantitative data and other qualitative studies in Africa. As far as we are aware, this is the first paper to qualitatively explore and contrast community beliefs, attitudes, and practices among stroke survivors and their caregivers, community and faith-based leaders, and health professionals in multiple communities within Nigeria and Ghana.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0206548PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6239297PMC
April 2019

Depression and glycaemic control among type 2 diabetes patients: a cross-sectional study in a tertiary healthcare facility in Ghana.

BMC Psychiatry 2018 11 6;18(1):357. Epub 2018 Nov 6.

Department of Physiology, School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana.

Background: Diabetes and depression are both chronic debilitating conditions, and their coexistence has been associated with adverse outcomes. In this study, we investigated the association between glycaemic control and depression in type 2 diabetes (T2DM) patients attending a tertiary healthcare facility in Ghana.

Methodology: In a cross-sectional study design, Patient Health Questionnare-9 (PHQ-9) was used to assess depression in 400 T2DM, aged 30-65 years. Anthropometric characteristics and blood pressure were measured. Venous blood was collected to measure the levels of glycated haemoglobin (HbA1c).

Results: The prevalence of depression was 31.3% among T2DM patients. Female gender, being unmarried, frequent intake of alcohol, previous smoking status and insulin use were associated with increased odds of depression, whereas being educated above basic school level was associated with a decreased odds of depression. In a multivariable logistic regression model, being unmarried and poor glycaemic control were associated with an increase in odds of depression after adjusting for age, gender, and social factors. The association between depression and glycaemic control was attenuated when clinical factors were introduced into the model.

Conclusion: In our study population, we found that depression is common among Ghanaians with T2DM, and not associated with poor glycaemic control in a fully multivariable-adjusted model.
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http://dx.doi.org/10.1186/s12888-018-1933-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6219193PMC
November 2018

Examination of Dysglycaemia among Newly Diagnosed Tuberculosis Patients in Ghana: A Cross-Sectional Study.

Tuberc Res Treat 2018 24;2018:1830372. Epub 2018 Sep 24.

Department of Psychiatry, School of Medicine & Dentistry, College of Health Sciences, Korle-Bu, Ghana.

The burden of both tuberculosis (TB) and diabetes mellitus in developing countries including Ghana is high; often, the two coexist and impact each other negatively. . The study aimed to determine the prevalence and predictive factors of dysglycaemia among newly diagnosed smear positive tuberculosis patients at a tertiary tuberculosis treatment centre in Ghana. . Dysglycaemia at diagnosis was determined by the use of oral glucose tolerance test (OGTT), while sputum smear microscopy was used to assess the sputum status. Only smear positive patients were included in the study. Information on sociodemographic, anthropometrical, clinical, and medication history was also obtained. . In all, 146 participants, aged 18 to 75 years with a mean age of 38.7 years comprising 115 (78.8%) males and 31 (21.2%) females, were involved in the analysis. Upon initial screening, using fasting plasma glucose (FPG), 91.1 % had normal fasting level, 5.5 % had impaired fasting, and 3.4% were diagnosed with diabetes. Using 2-hour postprandial values (2HPP), 59.6% had normal plasma glucose, 28.8 % had impaired glucose tolerance (IGT), and 11.6 % were diagnosed with diabetes. Overall, the prevalence of dysglycaemia (i.e., impaired fasting and diabetes) was 8.9% (95% CI: 5.21-14.82%) with FPG test and 40.4% (95% CI: 32.68-48.65%) with 2HPP test. The analysis revealed that 2HPP was associated with high mean age compared to FPG (36.67 ± 13.97 versus 41.69 ± 13.97, p-value = 0.033). In addition, marital status was significantly associated with FPG status of patients (p = 0.028). . The prevalence of dysglycaemia was high among smear positive TB patients in Ghana. Higher mean age and marital status were associated with abnormal glucose tolerance and fasting plasma glucose, respectively. Clinical management of patients with tuberculosis should include screening for diabetes.
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http://dx.doi.org/10.1155/2018/1830372DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6174760PMC
September 2018

Stroke Outcome and Determinants among Patients with and without Diabetes in a Tertiary Hospital in Ghana.

Stroke Res Treat 2018 12;2018:7521351. Epub 2018 Sep 12.

Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, P.O. Box GP 4236, Accra, Ghana.

Background: Diabetes mellitus, a well-established independent risk factor for stroke, has varied association with stroke outcome from previous studies. This study investigated stroke outcome and determinants among patients with and without diabetes in a tertiary hospital in Ghana.

Methods: A prospective study conducted among stroke patients with and without diabetes admitted in a Ghanaian tertiary hospital. Baseline clinical and biochemical data were documented. Functional stroke outcome was evaluated at 1, 3, and 6 months after stroke using the modified Rankin Scale.

Results: Number of participants enrolled were 326 and 105 (32.20%) had diabetes. Higher proportions of diabetes patients had poor functional stroke outcome at 1, 3, and 6 months (79%, 75.23%, 73.33%) compared with those without diabetes (70.13%, 65.16, 61.99) (p>0.05). Stroke patients with diabetes had lower survival compared with those without diabetes (p=0.0745). Mortality at 6 months was more likely among ischaemic stroke patients with diabetes compared with those without diabetes (Odds Ratio 2.037; CI: 1.058-3.923). Determinants of poor functional stroke outcome for diabetes patients were older age (Adjusted Odds Ratio (AOR)-1.07; CI-1.03-1.12), female gender (AOR-3.74; CI-1.26-12.65), and pneumonia (AOR-11.32; CI-1.93-220.05) whereas the determinants for those without diabetes were unemployment (AOR-4.19; CI-1.24-19.50), speech abnormalities (AOR-1.99; CI1.08-3.73), and pneumonia (AOR-4.05; CI-1.83-9.77). High fasting plasma glucose (HR-1.15; CI-1.07-1.23), elevated temperature (HR-1.41; CI-1.11-1.79), and pneumonia (HR-2.25; CI-1.44-3.50) were determinants of low survival among all stroke patients.

Conclusion: Trends towards poorer functional outcome and reduced survival were found among Ghanaian stroke patients with diabetes compared with those without diabetes. Older age, female gender, pneumonia, elevated temperature, and fasting plasma glucose were determinants of adverse outcome in stroke patients with diabetes.
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http://dx.doi.org/10.1155/2018/7521351DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6157204PMC
September 2018

Knowledge, attitudes and practices of West Africans on genetic studies of stroke: Evidence from the SIREN Study.

Int J Stroke 2019 01 24;14(1):69-79. Epub 2018 Jul 24.

7 Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria.

Background: It is crucial to assess genomic literacy related to stroke among Africans in preparation for the ethical, legal and societal implications of the genetic revolution which has begun in Africa.

Objective: To assess the knowledge, attitudes and practices (KAP) of West Africans about stroke genetic studies.

Methods: A comparative cross-sectional study was conducted among stroke patients and stroke-free controls recruited across 15 sites in Ghana and Nigeria. Participants' knowledge of heritability of stroke, willingness to undergo genetic testing and perception of the potential benefits of stroke genetic research were assessed using interviewer-administered questionnaire. Descriptive, frequency distribution and multiple regression analyses were performed.

Results: Only 49% of 2029 stroke patients and 57% of 2603 stroke-free individuals knew that stroke was a heritable disorder. Among those who knew, 90% were willing to undergo genetic testing. Knowledge of stroke heritability was associated with having at least post-secondary education (OR 1.51, 1.25-1.81) and a family history of stroke (OR 1.20, 1.03-1.39) while Islamic religion (OR=0.82, CI: 0.72-0.94), being currently unmarried (OR = 0.81, CI: 0.70-0.92), and alcohol use (OR = 0.78, CI: 0.67-0.91) were associated with lower odds of awareness of stroke as a heritable disorder. Willingness to undergo genetic testing for stroke was associated with having a family history of stroke (OR 1.34, 1.03-1.74) but inversely associated with a medical history of high blood pressure (OR = 0.79, 0.65-0.96).

Conclusion: To further improve knowledge of stroke heritability and willingness to embrace genetic testing for stroke, individuals with less formal education, history of high blood pressure and no family history of stroke require targeted interventions.
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http://dx.doi.org/10.1177/1747493018790059DOI Listing
January 2019

Pachydermoperiostosis in a patient with chronic hepatitis B virus infection referred as acromegaly: a case report.

J Med Case Rep 2018 Mar 8;12(1):59. Epub 2018 Mar 8.

Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Legon, Accra, Ghana.

Background: Primary hypertrophic osteoarthropathy also known as pachydermoperiostosis is a rare genetic disorder that has often been confused with acromegaly because of similar clinical features. Vascular endothelial growth factors which have been implicated in the clinical features of pachydermoperiostosis, have also been shown to be present in chronic hepatitis and implicated in the malignant transformation of hepatitis B infection to hepatocellular carcinoma. To the best of our knowledge there is one reported case of pachydermoperiostosis with chronic hepatitis B infection. We do not imply a causal relationship between pachydermoperiostosis and hepatitis B infection because pachydermoperiostosis is a genetic disorder; however, the question is raised whether hypertrophic osteoarthropathy is one of the many extrahepatic manifestations of chronic hepatitis B infection.

Case Presentation: A 21-year-old African (Ghanaian) man with chronic hepatitis B infection was referred to our Endocrine unit as having acromegaly with changing facial features, enlarging hands and feet, and large knee joint effusions which affected activities of daily living. He was finally diagnosed as having pachydermoperiostosis when acromegaly, rheumatological disorders, as well as cardiopulmonary disorders were ruled out. He improved with arthrocentesis, a tapering regime of steroids, non-steroidal anti-inflammatory drugs, and proton pump inhibitors.

Conclusions: The possible role of hepatitis B in hypertrophic osteoarthropathy, that is, secondary hypertrophic osteoarthropathy, needs to be explored; however, with digital clubbing in his father our patient is likely to have pachydermoperiostosis.
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http://dx.doi.org/10.1186/s13256-018-1578-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5842528PMC
March 2018

Epidemiology and Clinical Features of Thyroid-associated Orbitopathy in Accra.

Middle East Afr J Ophthalmol 2017 Oct-Dec;24(4):183-189

Department of Surgery, Eye Unit, School of Medicine and Dentistry, University of Ghana, Accra, Ghana.

Purpose: Thyroid-associated orbitopathy (TAO), a clinical manifestation of Graves' disease, is an autoimmune disorder of the orbital and periorbital tissue. Data on the epidemiology and clinical presentation of TAO in Africa are generally scarce and unavailable in Ghana. We investigated the epidemiology and clinical features of TAO among patients with thyroid disorders attending the Korle Bu Teaching Hospital, Accra.

Subjects And Methods: This was a descriptive cross-sectional study of patients diagnosed with thyroid disorders which was conducted at the endocrine and orbital clinics of the Korle Bu Teaching Hospital. Diagnosis was based on clinical features and confirmed by a thyroid function test. Data collected and analyzed included demography, systemic and ocular features of thyroid disorder, and thyroid function tests.

Results: Of the 194 patients with thyroid disorders recruited, 117 (60.30%) had TAO. The mean age was 45.22 years (standard deviation: 13.90). The male:female ratio was 1:4.45. The most common ocular symptoms were "bulging eyes" (76/65.00%) and "puffy eyelid" (62/53.00%), and the common signs were eyelid retraction (97/82.91%) and proptosis (80/68.38%). Mild TAO was diagnosed in 64.96% of patients with only 6.84% having the severe form. The outcomes of the thyroid function test, thyroid disorder, and severity of TAO did not record any statistically significant differences.

Conclusions: The epidemiology is similar to those reported from other parts of the world, but the ocular presentation seems to be milder than in Caucasians.
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http://dx.doi.org/10.4103/meajo.MEAJO_91_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5793449PMC
February 2018

The Bidirectional Relationship between Tuberculosis and Diabetes.

Tuberc Res Treat 2017 12;2017:1702578. Epub 2017 Nov 12.

Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Legon, Accra, Ghana.

The burden of tuberculosis (TB) especially in developing countries continues to remain high despite efforts to improve preventive strategies. Known traditional risk factors for TB include poverty, malnutrition, overcrowding, and HIV/AIDS; however, diabetes, which causes immunosuppression, is increasingly being recognized as an independent risk factor for tuberculosis, and the two often coexist and impact each other. Diabetes may also lead to severe disease, reactivation of dormant tuberculosis foci, and poor treatment outcomes. Tuberculosis as a disease entity on the other hand and some commonly used antituberculous medications separately may cause impaired glucose tolerance. This review seeks to highlight the impact of comorbid TB and diabetes on each other. It is our hope that this review will increase the awareness of clinicians and managers of TB and diabetes programs on the effect of the interaction between these two disease entities and how to better screen and manage patients.
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http://dx.doi.org/10.1155/2017/1702578DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5705893PMC
November 2017

Challenges in the Management of a Patient with Myxoedema Coma in Ghana: A Case Report.

Ghana Med J 2017 Mar;51(1):39-42

Neurology Unit, Department of Medicine and Therapeutics, School of Medicine and Dentistry, University of Ghana, PO Box GP 4236, Accra, Ghana.

Myxoedema coma is a rare life-threatening disease, and it is essential that it is managed appropriately to reduce the associated high mortality. However, in the setting where efficient healthcare delivery is hampered by inadequacies, the management of such cases may pose a significant challenge. We present the case of a middle-aged woman diagnosed with myxoedema coma and severe hyponatremia. The case report highlights some of the challenges that may be encountered during the management of myxoedema coma in similar settings and outlines the management strategies undertaken to overcome them in the absence of national guidelines. It also brings to the fore the need for clinicians to look out for clinical features suggestive of hypothyroidism particularly among high risk individuals for early diagnosis and treatment.

Funding: None declared.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5611947PMC
http://dx.doi.org/10.4314/gmj.v51i1.8DOI Listing
March 2017

Screening for Cushing Syndrome at the Primary Care Level: What Every General Practitioner Must Know.

Int J Endocrinol 2017 27;2017:1547358. Epub 2017 Jul 27.

Directorate of Medicine, Endocrine and Diabetes Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana.

Cushing's syndrome is a rare entity, and a high index of suspicion is needed for screening in a primary care setting. The clinical awareness of the primary care physician (PCP) to the highly indicative signs and symptoms such as facial plethora, proximal myopathy, reddish purple striae, and easy bruisability should alert him to look for biochemical evidence of Cushing's syndrome through any of the first-line screening tests, namely, 24-hour urinary free cortisol, overnight dexamethasone suppression test, or late-night salivary cortisol. Commonly used random cortisol measurements are unreliable; hence, general practitioners are encouraged to understand the use of these more reliable tests with increased sensitivity and specificity for screening Cushing's syndrome. In this write-up, we set out to increase awareness about the presentation of Cushing's syndrome and current recommended screening methods as well as their strengths and weaknesses. We relied mainly on the recommendations by the Endocrine Society Guidelines.
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http://dx.doi.org/10.1155/2017/1547358DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5551520PMC
July 2017

Prevalence and Prognostic Features of ECG Abnormalities in Acute Stroke: Findings From the SIREN Study Among Africans.

Glob Heart 2017 06 14;12(2):99-105. Epub 2017 Mar 14.

University of Ghana Medical School, Accra, Ghana.

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.
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http://dx.doi.org/10.1016/j.gheart.2017.01.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5582979PMC
June 2017

Exploring Overlaps Between the Genomic and Environmental Determinants of LVH and Stroke: A Multicenter Study in West Africa.

Glob Heart 2017 06 13;12(2):107-113.e5. Epub 2017 Mar 13.

University of Ibadan, Ibadan, Nigeria.

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.
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http://dx.doi.org/10.1016/j.gheart.2017.01.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5583025PMC
June 2017

Frequency and determinants of thyroid autoimmunity in Ghanaian type 2 diabetes patients: a case-control study.

BMC Endocr Disord 2017 Jan 17;17(1). Epub 2017 Jan 17.

Directorate of Medicine, Komfo Anokye Teaching Hospital, Endocrine and Diabetes Unit, P.O. Box 1934, Kumasi, Ghana.

Background: The link between type 1 diabetes and thyroid autoimmunity is well described. The same cannot be said for type 2 diabetes where results have been mixed so far. We investigated the prevalence and determinants of thyroid autoimmunity among Ghanaian type 2 diabetes patients.

Methods: This was a case-control study involving 302 type 2 diabetes patients and 310 non - diabetic controls aged 40-80 years. Anthropometric and blood pressure measurements were obtained. Fasting samples were analyzed for glucose, thyroid function, and antibodies to thyroglobulin and thyroid peroxidase.

Results: The prevalence of thyroid autoimmunity was significantly higher among T2DM subjects (12.2% vs. 3.9%, p = 0.0004). Among T2DM subjects, 44 (14.7%) tested positive for TPOAb, 5 (1.7%) tested positive for TGAb and 15 (5.0%) tested positive for both autoantibodies. Females T2DM subjects showed a 3-fold increased risk of thyroid autoimmunity compared to males (OR:3.16, p =0.004), T2DM subjects with hyperthyroidism had a 41% increased risk of thyroid autoimmunity (OR: 1.41, p < 0.001), sub-clinical hyperthyroidism increased the risk of thyroid autoimmunity by 2 fold, (OR:2.19, p < 0.001), subclinical hypothyroidism increased the risk of autoimmunity by 4-fold, (OR:3.57 95% p < 0.0001), and hypothyroidism was associated with a 61% increased risk of thyroid autoimmunity (OR: 1.61,1.35-2.23). Dyslipidaemia was associated with a 44% increased risk of thyroid autoimmunity (OR: 1.44, p = 0.01) and a percentage increase in HbA1c was associated with 46% increased risk of thyroid autoimmunity (OR:1.46, p < 0.0001).

Conclusion: We observed a high prevalence of thyroid autoimmunity in Ghanaian T2DM subjects compared to the general population. Thyroid autoimmunity in T2DM subjects was significantly associated with female gender, thyroid dysfunction, dyslipidaemia and poor glycemic control.
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http://dx.doi.org/10.1186/s12902-016-0152-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5286684PMC
January 2017

Response to N.B. Andrews.

Ghana Med J 2016 03;50(1):60-1

University of Ghana Dental School, College of Health Sciences, Korle-Bu Teaching Hospital, Accra, Ghana.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4994488PMC
March 2016

Peripheral artery disease and exertional leg symptoms in diabetes patients in Ghana.

BMC Cardiovasc Disord 2016 Apr 19;16:68. Epub 2016 Apr 19.

Department of Medicine & Therapeutics, School of Medicine & Dentistry, University of Ghana, Accra, Ghana.

Background: Peripheral arterial disease (PAD) is a major health problem in diabetes patients in high-income countries, but the PAD burden in sub-Saharan Africa is largely undetermined. We studied the prevalence of PAD and exertional leg symptoms in diabetes (DM) patients in a tertiary hospital in Ghana.

Methods: In a case control study design, 485 DM and 330 non-diabetes participants were recruited. PAD was diagnosed as Ankle Brachial Index (ABI) < 0.9. Edinburgh Claudication Questionnaire (ECQ) was used to assess exertional leg symptoms.

Results: The overall prevalence of classical intermittent claudication was 10.3 % and ABI-diagnosed PAD was 26.7 %, with 3.5 % of the participants having both classic intermittent claudication and ABI-diagnosed PAD. The prevalence of exertional leg symptoms were similar in diabetes patients with and without PAD. In non-diabetes participants, intermittent claudication and rest pain were higher in PAD patients than in non-PAD participants. In multivariable logistic regression, intermittent claudication [OR (95 % CI), 3.39 (1.14 - 8.1), p < 0.05] and rest pain [4.3 (1.58 - 9.67), p < 0.001] were independently associated with PAD in non-diabetes group, and rest pain [1.71 (1.13 - 2.17), p < 0.05] was associated with PAD in all participants.

Conclusions: There is high burden of PAD and exertional leg pains in DM patients in Ghana. PAD is expressed as intermittent claudication and rest pain in non-diabetes individuals.
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http://dx.doi.org/10.1186/s12872-016-0247-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4837554PMC
April 2016