Liver cirrhosis in sub-Saharan Africa: neglected, yet important

Clinical efforts and research on liver diseases have been scarce in sub-Saharan Africa. The first Conference on Liver Disease in Africa (Nairobi, Sept 13–15, 2018), gathering all stakeholders from the continent, is a welcome step towards greater attention to the problem, and the important issue of liver cirrhosis

Khat-related liver disease in sub-Saharan Africa: neglected, yet important reply

The question of khat's liver toxicity is complex. It contains numerous compounds, including alkaloids, terpenoids, flavonoids, sterols, glycosides, tannins, amino acids, vitamins, and minerals.5 Research into the deleterious effects of khat has largely concentrated on the pharmacological effects of cathinone and cathine on the cardiovascular system and CNS, and studies on possible liver toxicity in humans are restricted to Ethiopia and Somaliland and to reports from western Europe almost exclusively involving Somali men. Additional research is necessary to establish the prevalence of liver toxicity in people who chew khat in Ethiopia versus Djibouti (where liver toxicity is apparently not observed)6 and Yemen (which has the highest proportion of users worldwide),7 and in Kenya, Uganda, and Madagascar, where studies have not been done. Also necessary is investigating the mechanisms and progression of liver damage induced by khat, the effects of gender (khat toxicity is observed much more frequently in males)8 and genetics (genetic variants in CYP2D6 might play a role in liver toxicity),9 and the contribution of other compounds found in khat and of contaminating herbicides and pesticides to liver disease.10 Current evidence shows that hepatitis viruses and alcohol are the main contributors to the incidence of liver cirrhosis throughout sub-Saharan Africa1 and efforts should continue to curb their effects. We declare no competing interests

Liver cirrhosis in sub-Saharan Africa: neglected, yet important

Clinical efforts and research on liver diseases have been scarce in sub-Saharan Africa. The first Conference on Liver Disease in Africa (Nairobi, Sept 13–15, 2018), gathering all stakeholders from the continent, is a welcome step towards greater attention to the problem, and the important issue of liver cirrhosis

Khat-related liver disease in sub-Saharan Africa: neglected, yet important reply

The question of khat's liver toxicity is complex. It contains numerous compounds, including alkaloids, terpenoids, flavonoids, sterols, glycosides, tannins, amino acids, vitamins, and minerals.5 Research into the deleterious effects of khat has largely concentrated on the pharmacological effects of cathinone and cathine on the cardiovascular system and CNS, and studies on possible liver toxicity in humans are restricted to Ethiopia and Somaliland and to reports from western Europe almost exclusively involving Somali men. Additional research is necessary to establish the prevalence of liver toxicity in people who chew khat in Ethiopia versus Djibouti (where liver toxicity is apparently not observed)6 and Yemen (which has the highest proportion of users worldwide),7 and in Kenya, Uganda, and Madagascar, where studies have not been done. Also necessary is investigating the mechanisms and progression of liver damage induced by khat, the effects of gender (khat toxicity is observed much more frequently in males)8 and genetics (genetic variants in CYP2D6 might play a role in liver toxicity),9 and the contribution of other compounds found in khat and of contaminating herbicides and pesticides to liver disease.10 Current evidence shows that hepatitis viruses and alcohol are the main contributors to the incidence of liver cirrhosis throughout sub-Saharan Africa1 and efforts should continue to curb their effects. We declare no competing interests

Treatment of Acute Liver Failure in Resource-Constrained Settings without Transplantation Facilities Can Be Improved

Acute liver failure affects previously healthy and often young people and has a very high mortality due to rapid multi-organ failure. The diagnosis is based on the presence of coagulopathy (International normalized ratio >2 or prothrombin rate <50%) and hepatic encephalopathy within 8 weeks of onset of jaundice in patients with no previous liver disease (1). In resource-constrained developing countries, hepatitis A, B, and E infections, traditional medicines (2), drugs, herbal supplements (3), and halothane (4) are the main causes. Even though liver transplantation is the treatment of choice nowadays, the survival rate without liver transplantation in adults is as high as 40% in high-income countries (5, 6). Unfortunately, it is much lower in developing countries (7) where cases are diagnosed too late or considered untreatable in the absence of a transplant center. We propose a practical approach that can be used in Intensive Care Unit-equipped hospitals in resource-constrained countries to try and reduce the high mortality rate where liver transplantation is not available

HIV and SARS-Coronavirus-2 Epidemics: Possible Interactions and Need for Studies, Especially in Africa

info:eu-repo/semantics/publishe

Prevalence of common adverse events experienced following COVID‐19 vaccination and its associated factors in Ghana: Cross‐sectional study design

Abstract Background and Aims The novel severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) (COVID‐19) pandemic devasted the general life of people and various human activities across the globe, and Ghana is of no exception. This led to development of vaccines within record time to combat morbidity and mortality associated with the virus. In Ghana, COVID‐19 vaccines were introduced in addition to existing COVID‐19 protocols. However, the vaccines have adverse events among those who received them. In this study, we determined the prevalence of some common adverse events of the COVID‐19 vaccines and its associated sociodemographic factors in Ghana. Methods An online snowball cross‐sectional survey was conducted between April and June 2021 among 240 people who had taken at least one dose of any of the COVID‐19 vaccines approved in Ghana. The penalized binary logistic regression model was used to assess the factors associated with experience of at least one adverse event and the experience of number of adverse events using Stata version 16. Results Among the 240 participants, 88.2% had experienced at least one adverse event. The most common adverse event after the first dose was pain at injection site (65.8%), headache (57.5%), tiredness (55.8%), fever (51.7%), chills (39.6%), and muscle pains (38.3%). Experience of adverse events was 16 times higher among those who took their vaccines in Ghana (adjusted odd ratio [AOR]: 16.2, 95% confidence interval [CI]: 1.98–132.56, p = 0.009), 94% less among those who took AstraZeneca (India) compared to AstraZeneca (Oxford) (AOR: 0.06, 95% CI: 0.01–0.37, p = 0.002) and 86% less among 40–49 years compared with less than 30 years old (AOR: 0.14, 95% CI: 0.03–0.58, p = 0.007). Conclusion Pain at the injection site, headache, tiredness, fever, chills, and muscle pains were the most frequently reported adverse events. The study identified country of vaccination, country of origin of AstraZeneca vaccine and age to be associated with adverse events of vaccination

Serum 25‐hydroxyvitamin D and hyaluronic acid levels as markers of fibrosis in patients with chronic liver disease at the main tertiary referral hospital in Ghana: A case‐control study design

Abstract Background and Aims Liver fibrosis leading to chronic liver disease (CLD) is a major cause of morbidity, mortality and health‐care expenditure worldwide. The “gold standard” for diagnosis and staging of liver fibrosis is histological analysis of liver tissue obtained by liver biopsy, an invasive procedure. Therefore, there is the need to identify noninvasive and inexpensive markers for diagnosis and staging of liver fibrosis. This study aimed at evaluating the correlation of hyaluronic acid (HA) and 25‐hydroxyvitamin D (25‐OH vitamin D) serum levels as markers of fibrosis with histologically staged and graded liver biopsies obtained from CLD patients. Methods This was a case‐control study involving 40 CLD patients requiring liver biopsies and 40 controls. Liver biopsies were staged to determine the degree of fibrosis. Serum levels of 25‐OH vitamin D and HA were determined using ELISA. Statistical analyses were performed to determine differences in HA and 25‐OH vitamin D levels between controls and patients as well as to correlate the biomarkers with the stages of fibrosis. Results CLD patients showed significant (p < 0.001) increase in the levels of AST, ALT, GGT, compared to the controls. Patients also had significantly (p < 0.001) lower serum 25‐OH vitamin D and higher HA (p < 0.001) levels compared to the controls. Additionally, 25‐OH vitamin D levels of the CLD patients were significantly different across the stages of liver fibrosis likewise serum HA levels. Furthermore, 25‐OH vitamin D levels inversely correlated with the severity of liver fibrosis. A significant negative correlation (r = −0.33, p < 0.05) between CLD patients' HA and 25‐OH vitamin D were found. Conclusion CLD patients had significantly reduced serum 25‐OH vitamin D and higher HA. Both markers correlated with the degree of liver fibrosis. These findings have major clinical translatable implication in the use of vitamin D supplementation in the management of CLD in Ghana

Levels of Soluble Endothelium Adhesion Molecules and Complications among Sickle Cell Disease Patients in Ghana

Background: Soluble adhesion molecules are involved in the gathering and joining of inflammatory cells to vascular endothelium. Therefore, they serve as potential markers of endothelial dysfunction in vascular diseases including sickle cell disease (SCD). In Ghana, there are scarcely any report on the levels of adhesion molecules among SCD patients. The current study aimed to determine plasma levels of ICAM-1, VCAM-1 and E-Selectin as markers of endothelial dysfunction in SCD patients in steady state, complications and controls. Methodology: This was a cross-sectional study involving 60 HbAA controls, 46 HbSS steady state, 57 HbSS VOC, 18 HbSC VOC, 21 HbSS with leg ulcer and 11 HbSS with priapism. Blood samples were collected from all the study subjects (n = 213) and processed into plasma. The plasma levels of VCAM-1, ICAM-1 and E-Selectin concentrations of SCD patients and controls were measured using a double sandwich ELISA technique. Demographic information was also collected from the study subjects. Results: Levels of all soluble proteins (ICAM-1, VCAM-1 and E-Selectin) were significantly higher in HbSS steady-state patients compared to non-SCD controls (p &lt; 0.001). Generally, SCD patients with complications had relatively higher levels of the soluble proteins compared to those in the steady-state. Of the SCD patients with complications, those with vaso-occlusion crisis (HbSS VOC) had relatively higher levels of ICAM-1, VCAM-1 and E-Selectin at (62.42 ng/mL &plusmn; 26.09), (634.99 ng/mL &plusmn; 324.31) and (236.77 ng/mL &plusmn; 114.40) respectively; Conclusion: Although levels of adhesion molecules were high in all the SCD patients with complications, those with vaso-occlusive crisis had higher levels. This might reflect an ongoing endothelial dysfunction in these patients. SCD patients with vaso-occlusive crisis presents with a more severe pathophysiology condition

Correlation Between Soluble Endothelial Adhesion Molecules and Nitric Oxide Metabolites in Sickle Cell Disease.

Nitric Oxide (NO) and soluble adhesion molecules are promising biomarkers, which predict endothelial dysfunction in sickle cell disease (SCD). Several studies have investigated the relationship between NO (as well as its metabolites) and endothelial adhesion molecules in SCD. However, these studies were done mainly in the developed world, and it is difficult to extrapolate the findings to SCD populations in other geographical regions such as Africa due to significant disparities in the results. The aim of the current study was to determine the correlation between levels of nitric oxide metabolites (NOx) and adhesion molecules in SCD patients in a tertiary hospital in Ghana. A case control cross-sectional study involving 100 SCD (made up of HbSS and HbSC patients) and 60 healthy controls was conducted. Concentrations of NOx and soluble endothelial adhesion molecules (ICAM-1, VCAM-1 and E-selectin) were measured in all the study participants (n = 160) by the Griess reagent system and enzyme-linked immunosorbent assay (ELISA). Correlation analysis was performed to determine a possible link between the variables. Levels of soluble adhesion molecules were higher in the HbSS patients. Correlation of NOx with ICAM-1 almost approached significance (r = 0.565, p = 0.058) in the HbSS patients. There were no correlations between NOx and E-selectin in both HbSS and HbSC patients. There were no significant correlations between NOx and VCAM-1 in all the study participants (p &gt; 0.05). Of the soluble adhesion molecules, ICAM-1 showed a significant positive correlation with VCAM-1 in the HbSC patients. There were no significant differences between the adhesion molecules and the age of participants in the various study groups. Whether or not a significant correlation exists between NOx and soluble adhesion molecules may not depend on the sickle cell genotype. The expression of adhesion molecules may not depend on age