Mitigating the scourge of non-alcoholic fatty liver disease in Ghana

Non-alcoholic fatty liver disease (NAFLD) is fast becoming the leading cause of liver disease in Western countries, affecting 25% of the general population1 and increasing to 90% of obese individuals with diabetes and other features of the metabolic syndrome.2 Moreover, its prevalence is expected to continue to rise in parallel with the obesity epidemic due to the adoption of sedentary lifestyle and increased consumption of high fat diet.3 In the United States, NAFLD is expected to become the leading indication for liver transplantation (LT) within the next 10 years.4 NAFLD is currently considered to be a major health burden in developedcountries and is gradually increasing in developing countries due to urbanization and change in lifestyle habits, particularly in the countries of Arabian Gulf (with the highest incidence in the world), but it cannot be ignored in West Africa, where the problem is becoming steadily more prevalent

COVID-19 and medical education: an opportunity to build back better

The coronavirus disease 2019 (COVID-19) outbreak in the Hubei province of China has rapidly transformed into a global pandemic. In response to the first few reported cases of COVID-19, the government of Ghana implemented comprehensive social and public health interventions aimed at containing the disease, albeit its effect on medical education is less clear. Undoubtedly, the COVID-19 has brought changes that may impact the plan of career progression for both students and faculty. Hitherto, medical education had students getting into contact with patients and faculty in a facility setting. Their physical presence in both in-and outpatients’ settings has been a tradition of early clinical immersion experiences and the clerkship curriculum. Rotating between departments makes the students potential vectors and victims for COVID-19. COVID-19 has the potential to affect students throughout the educational process. The pandemic has led to a complete paradigm shift in the mode of instruction in a clinical care setting. Inperson training has either been reduced or cancelled in favour of virtual forms of pedagogy. The clinics have also seen a reduction in a variety of surgical and medical cases. This situation may result in potential gaps in their training.Outpatient clinics have transitioned mainly to telemedicine, thus minimizing students’ exposure to clinic encounters. Faced with this pandemic, medical educators are finding ways to best ensure rigorous training that will produce competent physicians. This article discusses the status of medical education and the effect of COVID-19 and explores potential future effects in a resource-limited country

Management of TB/HIV co-infection: the state of the evidence

Tuberculosis (TB) and HIV are strongly linked. There is a 19 times increased risk of developing active TB in people living with HIV than in HIV-negative people with Sub-Saharan Africa being the hardest hit region. According to the WHO, 1.3 million people died from TB, and an additional 300,000 TB-related deaths among people living with HIV. Although some progress has been made in reducing TB-related deaths among people living with HIV due to the evolution of diagnostics, treatment and antiretroviral HIV treatment, multi drug resistant TB is becoming a source of worry. Though significant progress has been made at the national level, understanding the state of the evidence and the challenges will better inform the national response of the opportunities for improved patient outcomes.Keywords: Tuberculosis, management, HIV, MDR TB, GhanaFunding: Non

Gastroenterology practice in the COVID-19 era: Ghana Association for the Study of Liver and Digestive Diseases (GASLIDD) position statement

The COVID-19 pandemic has impacted healthcare negatively across the globe. The practice of gastroenterology has been affected especially gastrointestinal (GI) endoscopy which is considered high risk for transmission of the virus. As a community of practitioners there is the need to share information and make evidence-based statements to guide GI practice in Ghana. This GASLIDD position statement based on the growing and rapidly evolving body of knowledge is to provide up to date information on the COVID-19 disease and guidance for the practice of gastroenterology in Ghana and beyond. It is to help the GI community of practice to maintain the highest level of health delivery and safety for our patients, staff, community and GI practitioners

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

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

Elevated rates of horizontal gene transfer in the industrialized human microbiome

Industrialization has impacted the human gut ecosystem, resulting in altered microbiome composition and diversity. Whether bacterial genomes may also adapt to the industrialization of their host populations remains largely unexplored. Here, we investigate the extent to which the rates and targets of horizontal gene transfer (HGT) vary across thousands of bacterial strains from 15 human populations spanning a range of industrialization. We show that HGTs have accumulated in the microbiome over recent host generations and that HGT occurs at high frequency within individuals. Comparison across human populations reveals that industrialized lifestyles are associated with higher HGT rates and that the functions of HGTs are related to the level of host industrialization. Our results suggest that gut bacteria continuously acquire new functionality based on host lifestyle and that high rates of HGT may be a recent development in human history linked to industrialization.Peer reviewe

Hepatocellular carcinoma in Ghana: a retrospective analysis of a tertiary hospital data

Introduction: Hepatocellular carcinoma (HCC) is a cancer of global public health concern because of its high incidence and mortality. The impact is greatest in areas with high prevalence of its major risk factors including chronic hepatitis B virus (HBV). HBV is endemic in Ghana but a comprehensive data on HCC is lacking. The aim of this study was to describe the clinical, laboratory and radiological features of HCC at the Korle Bu Teaching Hospital in Ghana. Methods: the medical records of 194 HCC cases attended to at the Gastrointestinal Clinic of the Korle Bu Teaching Hospital between January 2015 and December 2018 were retrospectively analyzed for demographic, clinical, laboratory and radiological data. Results: the male: female ratio was 2:1 and mean age was 45.2 years. Weight loss and abdominal pain were the major presenting symptoms. No patients were identified through surveillance. HBsAg was positive in 109/145 (75.2%) of cases tested. Sixty-five (59.6%) of 109 HBsAg positives were aware of their HBsAg status but only 3 were receiving medical follow ups prior to the diagnosis of HCC. Raised alpha-fetoprotein level >165.2 IU/ML was found in 53.9%. One hundred and forty-four patients were eligible for only analgesia. Conclusion: HBV infection is the leading aetiologial risk factor associated with HCC. Majority of HBV carriers are aware of their status but do not receive care prior to HCC diagnosis. Majority present late and are eligible for only palliative treatment. Improvement in the health seeking behavior of HBV carriers can aid early detection of HCC

The Prevalence, Predictors, and In-Hospital Mortality of Hepatic Encephalopathy in Patients with Liver Cirrhosis Admitted at St. Dominic Hospital in Akwatia, Ghana

Background. Hepatic encephalopathy (HE) is one of the most debilitating complications of cirrhosis leading to death. Decrease in HE mortality and recurrence has been linked with timely identification and early treatment. There is a need to document the burden, predictors, and treatment outcomes of HE in an adult population with liver cirrhosis in our setting as only reports from resource-endowed countries abound in the literature. This study aimed therefore to determine the prevalence, predictors, and treatment outcomes of patients with liver cirrhosis admitted at St. Dominic Hospital (SDH) in Akwatia, Ghana. Materials and Methods. A prospective study was conducted involving one hundred and sixty-seven (167) patients admitted at the medical wards in SDH with liver cirrhosis from January 1st, 2018, to March 24th, 2020. The demographic and clinical features of the patients were collected using a standardized questionnaire. Biochemical, haematological, and abdominal ultrasound scans were done for all patients. Patients were then followed up until discharge or death. Results. There were 109 (65.3%) males out of the 167 patients with a mean age of 45.8 and 47.5 years for those with and without HE, respectively. The prevalence of HE was 31.7% (53/167). Out of 53 participants with HE, 75.5% (40/53) died. There was a strong association between HE and death (p<0.001). The major precipitating factor of HE was infection (64.2%). Severe ascites (OR = 0.009) were clinical feature independently associated with HE, whereas high creatinine (OR = 0.987), blood urea nitrogen (BUN) (OR = 1.199), Child–Pugh score (CPS) (OR = 5.899), and low platelets (OR = 0.992) were the laboratory parameters and scores independently predictive of HE. Conclusion. HE was common among patients with liver cirrhosis admitted at SDH with high in-patient mortality. The commonest precipitating factor for HE was infection(s). Severe ascites, low platelet count, high creatinine, BUN, and CPS were independent predictors of HE

Bacterial Infections in Patients with Liver Cirrhosis: Prevalence, Predictors, and in-Hospital Mortality at a District Hospital in Ghana

BackgroundIn-patients with liver cirrhosis, bacterial infections are common with high in-hospital mortality. In Ghana, bacterial infections in liver cirrhosis patients and their impact on in-patient mortality are generally unknown. This study was conducted to define the prevalence, predictors, and treatment outcomes of cirrhotic patients with bacterial infections admitted to a district hospital in Ghana. MethodsPatients with liver cirrhosis hospitalized from 1st January, 2018 to 24th April, 2020 were consecutively recruited. The demographic data and clinical presentations of the patients were collected using standardized questionnaire. Full blood count, liver function test, renal function test, ascitic fluid analysis and culture, urinalysis and culture, hepatitis B surface antigen, anti-hepatitis C antibodies and abdominal ultrasound scans of the abdomen were conducted for all patients. ResultsThere were 110 (65.09%) males out of the 169 patients with a mean age of 47.10±12.88 years. The prevalence of infections was 42.01% (71/169). Out of 71 participants with infections, 59.15% (42/72) died. Fever, encephalopathy, high white cell count, Child-Pugh Class C and Blood urea nitrogen were independent predictors of bacterial infections ConclusionBacterial infection among the participants admitted to district hospital with liver cirrhosis was common with high in-hospital mortality. Rwanda J Med Health Sci 2022;5(1):46-5