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

Adverse events following immunisation (AEFI) of COVISHIELD vaccination among healthcare workers in Ghana

Objective To describe the incidence of adverse events following immunisation (AEFI) and determine the factors that affect the onset and duration of AEFI after COVISHIELD vaccination among healthcare workers.Design Prospective cohort study.Setting Tertiary healthcare, Korle-Bu, Ghana.Participant Three thousand and twenty-two healthcare workers at least 18 years of age were followed up for 2 months after receiving two doses of the COVISHIELD vaccine.Primary outcome The occurrence of the AEFI was identified by self-reporting to the AEFI team members.Results A total of 3022 healthcare workers had at least one AEFI (incidence rate of 706.0 (95% CI 676.8 to 736.1) per 1000 doses) with an incidence rate of 703.0 (95% CI 673.0 to 732.0) per 1000 doses for non-serious AEFI and an incidence rate of 3.3 (95% CI 1.6 to 6.1) per 1000 doses for serious AEFI. The most commonly reported systemic adverse events were headache (48.6%), fever (28.5%), weakness (18.4%) and body pains (17.9%). The estimated median time to onset of the AEFI following the first-dose vaccination was 19 hours and the median AEFI duration was 40 hours or 2 days. Delayed-onset AEFI occurred in 0.3% after first dose and 0.1% after second dose. Age, sex, previous SARS-CoV-2 infection, history of allergies and comorbidity were not significantly associated with the onset and duration of AEFI. However, participants who used paracetamol seemed to be significantly protected (HR 0.15; 95% CI 0.14, 0.17) from having a long duration of AEFI.Conclusion The results of our study indicate a high incidence of non-serious AEFI and the rare occurrence of serious AEFI after COVISHIELD vaccination in healthcare workers. The rate of AEFI was higher after the first dose than after the second dose. Sex, age, previous SARS-CoV-2 infection, allergies and comorbidity were not significantly associated with the onset and duration of AEFI

Metformin versus Insulin in the Management of Pre-Gestational Diabetes Mellitus in Pregnancy and Gestational Diabetes Mellitus at the Korle Bu Teaching Hospital: A Randomized Clinical Trial

<div><p>Objective</p><p>To determine if metformin monotherapy or metformin in combination with insulin is equally effective as insulin monotherapy at glycemic control in diabetes mellitus in pregnancy among Ghanaians.</p><p>Methods</p><p>This was a study involving 104 pregnant women with type 2 diabetes mellitus (T2DM) or gestational diabetes mellitus (GDM) at 20-30 weeks gestation. Participants were randomized into metformin and insulin treatment groups. Starting dose of metformin was 500 mg once a day and increased gradually over two (2) weeks, to meet glycemic targets. Insulin was added if targets could not be reached on metformin alone at maximum doses. Total daily dose of premixed insulin at initiation was calculated as 0.3 IU/kg body weight and titrated upwards to achieve glycemic control. Glycemic profile monitoring was done every two weeks.</p><p>Results</p><p>The two hour post prandial blood glucose (2HPG) levels were significantly lower in the metformin group than the insulin group (p= 0.004).</p><p>Conclusion</p><p>The findings of this study suggest that metformin monotherapy is effective in achieving glycemic targets in the management of diabetes in pregnancy. It is more effective than insulin in lowering the 2HPG level.</p><p>Trial Registration</p><p>Australian New Zealand Clinical Trials Registry (ANZCTR) <a href="http://www.ANZCTR.org.au/ACTRN12614000942651.aspx" target="_blank">ACTRN12614000942651</a></p></div

Demographic characteristics of participants.

<p>*One patient each in the metformin group had malaria, multiple uterine fibroid, anemia as a co-morbid condition whiles one each for insulin had hepatitis B, G6PD and goiter</p><p>**One patient each in the metformin group had intrauterine fetal demise (IUFD), gestational diabetes, and gestational hypertension in their obstetric history whiles insulin group had one patient each with gestational diabetes, post-partum hemorrhage and IUFD.</p><p>Demographic characteristics of participants.</p

Mean FBG levels at baseline, one month from enrolment and at term for the two treatment groups.

<p>Mean FBG levels at baseline, one month from enrolment and at term for the two treatment groups.</p

Mean glycemic profile from enrolment till term.

<p>Mean glycemic profile from enrolment till term.</p

Flow diagram of participants from enrolment to term.

<p>Flow diagram of participants from enrolment to term.</p

Mean 2HPG levels at baseline, one month from enrolment and at term for the two treatment groups.

<p>Mean 2HPG levels at baseline, one month from enrolment and at term for the two treatment groups.</p