A review of chest radiographic patterns in mild to moderate novel corona virus disease 2019 at an urban hospital in Ghana

Introduction: The novel corona virus disease 2019 (COVID-19) was diagnosed in Wuhan, China in December 2019 and, in Ghana, in March 2020. As of 30th July 2020, Ghana had recorded 35,142 cases. COVID-19 which can be transmitted by both symptomatic and asymptomatic individuals usually manifest as pneumonia with symptoms like fever, cough, dyspnoea and fatigue. The current non-availability of a vaccine or drug for COVID-19 management calls for early detection and isolation of affected individuals. Chest imaging has become an integral part of patient management with chest radiography serving as a primary imaging modality in many centres.Methods: The study was a retrospective study conducted at Ga East Municipal Hospital (GEMH). Chest radiographs of patients with mild to moderate disease managed at GEMH were evaluated. The age, gender, symptom status, comorbidities and chest x-ray findings of the patients were documented. Results: 11.4 % of the patients had some form of respiratory abnormality on chest radiography with 88.9% showing COVID-19 pneumonia features. 93.8% showed ground glass opacities (GGO), with 3.1% each showing consolidation (CN) only and CN with GGO. There was a significant association between COVID-19 radiographic features and patient’s age, symptom status and comorbidities but not with gender.Conclusion: Most radiographs were normal with only 11% showing COVID-19-like abnormality. There was a significant association between age, symptom status and comorbidities with the presence of COVID-19 like features but not for gender. There was no association between the extent of the lung changes and patient characteristics

minoHealth.ai: A Clinical Evaluation Of Deep Learning Systems For the Diagnosis of Pleural Effusion and Cardiomegaly In Ghana, Vietnam and the United States of America

A rapid and accurate diagnosis of cardiomegaly and pleural effusion is of the utmost importance to reduce mortality and medical costs. Artificial Intelligence has shown promise in diagnosing medical conditions. With this study, we seek to evaluate how well Artificial Intelligence (AI) systems, developed my minoHealth AI Labs, will perform at diagnosing cardiomegaly and pleural effusion, using chest x-rays from Ghana, Vietnam and the USA, and how well AI systems will perform when compared with radiologists working in Ghana. The evaluation dataset used in this study contained 100 images randomly selected from three datasets. The Deep Learning models were further tested on a larger Ghanaian dataset containing five hundred and sixty one (561) samples. Two AI systems were then evaluated on the evaluation dataset, whilst we also gave the same chest x-ray images within the evaluation dataset to 4 radiologists, with 5 - 20 years experience, to diagnose independently. For cardiomegaly, minoHealth-ai systems scored Area under the Receiver operating characteristic Curve (AUC-ROC) of 0.9 and 0.97 while the AUC-ROC of individual radiologists ranged from 0.77 to 0.87. For pleural effusion, the minoHealth-ai systems scored 0.97 and 0.91 whereas individual radiologists scored between 0.75 and 0.86. On both conditions, the best performing AI model outperforms the best performing radiologist by about 10%. We also evaluate the specificity, sensitivity, negative predictive value (NPV), and positive predictive value (PPV) between the minoHealth-ai systems and radiologists

A typical presentation of COVID-19 in a patient with type 2 diabetes at an urban primary care facility in Accra, Ghana

This is a case report of a 55-year-old man with Type 2 Diabetes Mellitus who presented with progressive breathlessness, chest pain and hyperglycaemia. An initial impression of a chest infection was made. Management was initiated with antibiotics, but this was unsuccessful, and he continued to desaturate. A screen for Coronavirus Disease of 2019 (COVID-19) returned positive. There was no prodrome of fever or flu-like illness or known contact with a patient known to have COVID-19. This case is instructive as he didn’t fit the typical case definition for suspected COVID-19. There is significant community spread in Ghana, therefore COVID-19 should be a differential diagnosis in patients who present with hyperglycaemia and respiratory symptoms in the absence of a febrile illness. Primary care doctors must have a high index of suspicion in cases of significant hyperglycaemia and inability to maintain oxygen saturation.Patients known to have diabetes and those not known to have diabetes may develop hyperglycaemia subsequent to COVID-19. A high index of suspicion is crucial for early identification, notification for testing, isolation, treatment, contact tracing and possible referral or coordination of care with other specialists. Early identification will protect healthcare workers and patients alike from cross-infection

Quality of glycemic control in type 2 diabetes mellitus (T2DM) and its association with markers of coagulation and inhibitors of fibrinolysis: A case–control study in the upper west region, Ghana

Background and Aims: Type 2 diabetes mellitus (T2DM) individuals are at a higher risk of developing diabetes complications, with approximately 80% complication-related mortality. The increased morbidity and mortality among T2DM patients are partly due to dysregulated hemostasis. This study determined the quality of glycemic control in T2DM and its association with markers of coagulation and inhibitors of fibrinolysis. Methods: This case–control study recruited 90 participants involving: 30 T2DM patients with good glycemic control, 30 with poor glycemic control, and 30 nondiabetic subjects as controls at a Municipal Hospital in Ghana. Fasting blood glucose, glycated hemoglobin, activated partial thromboplastin time (APTT), prothrombin time (PT), calculated international normalized ratio (INR), and full blood count (FBC) were determined for each respondent. Plasma levels of plasminogen activator inhibitor-1 (PAI-1) and thrombin activatable fibrinolysis inhibitor (TAFI) were determined using the solid-phase sandwich enzyme-linked immunosorbent assay method. Data were analyzed using R language software. Results: Plasma PAI-1 antigen levels were significantly higher in the participants with poor glycemic control as compared to participants with good glycemic control (p \u3c 0.0001). There was no significant difference in plasma TAFI levels between the participants with poor glycemic control as compared to participants with good glycemic control (p = 0.900). T2DM patients had significantly shorter APTT, PT, and INR than controls (p \u3c 0.05). At a cut-off of ≥ 161.70 pg/μL, PAI was independently associated with increasing odds (adjusted odds ratio = 13.71, 95% confidence interval: 3.67–51.26, p \u3c 0.0001) of poor glycemic control and showed the best diagnostic accuracy for poor glycemic control (area under the curve = 0.85, p \u3c 0.0001). Conclusion: PAI-1 levels were significantly increased in T2DM with poor glycemic control and emerged as the best predictor for poor glycemic control. Good glycemic management to control the plasma levels of PAI-1 is required to prevent hypercoagulability and thrombotic disorders

Coagulation factors and natural anticoagulants as surrogate markers of preeclampsia and its subtypes: A case-control study in a Ghanaian population

Preeclampsia (PE) is associated with endothelial injury and hemostatic abnormalities. However, the diagnostic role of coagulation parameters and natural anticoagulants in predicting PE has not been explored in Ghana. This study assessed plasma levels of these factors as surrogate markers of PE and its subtypes. This case-control study included 90 women with PE (cases) and 90 normotensive pregnant women (controls). Blood samples were drawn for the estimation of complete blood count and coagulation tests. The prothrombin time (PT), activated partial thromboplastin time (APTT), and the calculation of the international normalized ratio (INR) were determined by an ACL elite coagulometer while the levels of protein C (PC), protein S (PS), antithrombin III (ATIII), and D-dimers were also measured using the solid-phase sandwich enzyme-linked immunosorbent assay (ELISA) method. All statistical analyses were performed using the R Language for Statistical Computing. Results showed significantly (p \u3c .05) shortened APTT (28.25 s) and higher D-dimer levels (1219.00 ng/mL) among PE women, as well as low levels of PC (1.02 g/mL), PS (6.58 g/mL), and ATIII (3.99 ng/mL). No significant difference was found in terms of PT and INR. From the receiver operating characteristic analysis, PC, PS, and ATIII could significantly predict PE and its subtypes at certain cutoffs with high accuracies (area under the curve [AUC] ≥ 0.70). Most women with PE are in a hypercoagulable state with lower natural anticoagulants. PC, PS, and ATIII are good predictive and diagnostic markers of PE and its subtypes (early-onset PE [EO-PE] and late-onset PE [LO-PE]) and should be explored in future studies

Eco-Friendly Yield and Greenhouse Gas Emissions as Affected by Fertilization Type in a Tropical Smallholder Rice System, Ghana

Data on greenhouse gas emission levels associated with fertilization applied in smallholder paddy rice farms in Ghana are scanty. The current study investigated fertilization types to determine their eco-friendliness on yield, Global Warming Potential (GWP) and Greenhouse Gas Intensity (GHGI) in a major rice season in the forest zone of Ghana. In total, five treatments were studied viz Farmer Practice (BAU); Biochar + Farmer Practice (BAU + BIO); Poultry Manure + Farmer Practice (BAU + M); Biochar + Poultry Manure + Farmer Practice (BAU + BIO + M); and Control (CT). Fluxes of methane (CH4) and nitrous oxide (N2O) were measured using a static chamber-gas chromatography method. N2O emissions at the end of the growing season were significantly different across treatments. BAU + BIO + M had highest N2O flux mean of 0.38 kgNha−1day−1 (±0.18). BAU + M had the second highest N2O flux of 0.27 kgNha−1day−1 (±0.08), but was not significantly different from BAU at p > 0.05. BAU+BIO recorded 0.20 kgNha−1day−1 (±0.12), lower and significantly different from BAU, BAU + M and BAU + BIO + M. CH4 emissions across treatments were not significantly different. However, highest CH4 flux was recorded in BAU+BIO at 4.76 kgCH4ha−1day−1 (±4.87). GWP based on seasonal cumulative GHG emissions among treatments ranged from 5099.16 (±6878.43) to 20894.58 (±19645.04) for CH4 and 756.28 (±763.44) to 27201.54 (±9223.51) kgCO2eqha−1Season−1 for N2O. The treatment with significantly higher yield and low emissions was BAU + M with a GHGI of 4.38 (±1.90) kgCO2eqkg−1

The role of car tyres in the ecology of Aedes aegypti mosquitoes in Ghana

Aedes aegypti is an important vector of arboviral diseases including dengue and yellow fever. Despite the wide distribution of this mosquito species, there are limited data on the ecology of Ae. aegypti in Ghana. In this study, we report on the oviposition preference and the larval life tables of Ae. aegypti mosquitoes in Accra, Ghana. The oviposition preference of the mosquitoes to three habitat types (car tyres, drums and bowls) was measured by setting up ovitraps. We recorded the presence and abundance of larvae every 3 days. Two-hour-old Ae. aegypti larvae were introduced and raised in three habitat types to undertake larval life tables. The number of surviving larvae at each developmental stage was recorded daily until they emerged as adults. Car tyres showed a higher abundance of Ae. aegypti larvae (52.3%) than drums (32.5%) and bowls (15.1%) (ANOVA, F(2,159) = 18.79, P < 0.001). The mean development time of Ae. aegypti larvae was significantly lower in car tyres (7 ± 1 days) compared to that of bowls (9 ± 0.0 days) and drums (12.6 ± 1.5 days) (P = 0.024). The differences in pupation rates and emergence rates were not significant across the habitat types; however, the highest pupation rate was observed in bowls (0.92 ± 0.17) and the emergence rate was highest in tyres (0.84 ± 0.10). The proportion of first-instar larvae that survived to emergence was significantly higher in car tyres (0.84 ± 0.10) compared to that of bowls (0.72 ± 0.20) and drums (0.62 ± 0.20) (P = 0.009). No mortalities were observed after 9 days in car tyres, 10 days in bowls and 15 days in drums. The results confirm that discarded car tyres were the preferred habitat choice for the oviposition of gravid female Ae. aegypti mosquitoes and provide the best habitat conditions for larval development and survival. These findings are necessary for understanding the ecology of Ae. aegypti to develop appropriate strategies for their control in Ghana

Comparison of Doxycycline, Minocycline, Doxycycline plus Albendazole and Albendazole Alone in Their Efficacy against Onchocerciasis in a Randomized, Open-Label, Pilot Trial

The search for new macrofilaricidal drugs against onchocerciasis that can be administered in shorter regimens than required for doxycycline (DOX, 200mg/d given for 4–6 weeks), identified minocycline (MIN) with superior efficacy to DOX. Further reduction in the treatment regimen may be achieved with co-administration with standard anti-filarial drugs. Therefore a randomized, open-label, pilot trial was carried out in an area in Ghana endemic for onchocerciasis, comprising 5 different regimens: the standard regimen DOX 200mg/d for 4 weeks (DOX 4w, N = 33), the experimental regimens MIN 200mg/d for 3 weeks (MIN 3w; N = 30), DOX 200mg/d for 3 weeks plus albendazole (ALB) 800mg/d for 3 days (DOX 3w + ALB 3d, N = 32), DOX 200mg/d for 3 weeks (DOX 3w, N = 31) and ALB 800mg for 3 days (ALB 3d, N = 30). Out of 158 randomized participants, 116 (74.4%) were present for the follow-up at 6 months of whom 99 participants (63.5%) followed the treatment per protocol and underwent surgery. Histological analysis of the adult worms in the extirpated nodules revealed absence of Wolbachia in 98.8% (DOX 4w), 81.4% (DOX 3w + ALB 3d), 72.7% (MIN 3w), 64.1% (DOX 3w) and 35.2% (ALB 3d) of the female worms. All 4 treatment regimens showed superiority to ALB 3d (p < 0.001, p < 0.001, p = 0.002, p = 0.008, respectively), which was confirmed by real-time PCR. Additionally, DOX 4w showed superiority to all other treatment arms. Furthermore DOX 4w and DOX 3w + ALB 3d showed a higher amount of female worms with degenerated embryogenesis compared to ALB 3d (p = 0.028, p = 0.042, respectively). These results confirm earlier studies that DOX 4w is sufficient for Wolbachia depletion and the desired parasitological effects. The data further suggest that there is an additive effect of ALB (3 days) on top of that of DOX alone, and that MIN shows a trend for stronger potency than DOX. These latter two results are preliminary and need confirmation in a fully randomized controlled phase 2 trial