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

Healthcare provider perspectives on HIV cure research in Ghana

INTRODUCTION: Antiretroviral therapy (ART) has reduced mortality and improved life expectancy among HIV patients but does not provide a cure. Patients must remain on lifelong medications and deal with drug resistance and side effects. This underscores the need for HIV cure research. However, participation in HIV cure research has risks without guaranteed benefits. We determined what HIV healthcare providers know about HIV cure research trials, the risks involved, and what kind of cure interventions they are likely to recommend for their patients. METHODS: We conducted in-depth qualitative interviews with 39 HIV care providers consisting of 12 physicians, 8 counsellors, 14 nurses, 2 pharmacists, 2 laboratory scientists, and 1 community advocate from three hospitals. Interviews were transcribed verbatim and coded, and thematic analysis was performed independently by two investigators. RESULTS: Participants were happy about the success of current treatments and hopeful that an HIV cure will be found in the near future, just as ART was discovered through research. They described cure as total eradication of the virus from the body and inability to test positive for HIV or transmit the virus. In terms of risk tolerance, respondents would recommend to their patients\u27 studies with mild to moderate risks like what patients on antiretroviral therapy experience. Participants were reluctant to recommend treatment interruption to patients as part of a cure study and wished trials could be performed without stopping treatment. Healthcare providers categorically rejected death or permanent disability as an acceptable risk. The possibility of finding a cure that will benefit the individual or future generations was strong motivations for providers to recommend cure trials to their patients, as was transparency and adequate information on proposed trials. Overall, the participants were not actively seeking knowledge on cure research and lacked information on the various cure modalities under investigation. CONCLUSION: While hopeful for an HIV cure, healthcare providers in Ghana expect a cure to be definitive and pose minimal risk to their patients

Clinical features of COVID-19 in Ghana: symptomatology, illness severity and comorbid non-communicable diseases

Objective: This analysis described the clinical features of COVID-19 in the early phase of the pandemic in Ghana.Methods: Data were extracted from two national COVID-19 treatment centers in Ghana for over 11 weeks(from March to May 2020). Descriptive and inferential statistics were performed. Modified Ordered Logistic and Negative Binomial Regression analysis were applied to establish factors associated with illness severity and Non-communicable Disease (NCDs) counts respectively. All analysis was conducted at the 95% confidence level (p-value ≤ 0.05) using Stata 16.Results: Among the 275 patients, the average age was 40.7±16.4, with a preponderance of males (54.5%). The three commonest symptoms presented were cough (21.3%), headache (15.7%), and sore throat (11.7%). Only 7.6% of the patients had a history of fever. Most patients were asymptomatic (51.65). Approximately 38.9% have an underlying co-morbid NCDs, with Hypertension (32.1%), Diabetes (9.9%), and Asthma (5.2%) being the three commonest. The odds of Moderate/severe (MoS) was significantly higher for those with unknown exposures to similar illness [aOR(95%CI) = 4.27(1.12-10.2)] compared with non-exposure to similar illness. An increased unit of NCD’s count significantly increased the odds of COVID-19 MoS illness by 26%[cOR(95%CI) =1.26(1.09-1.84)] and 67% (adjusting for age) [aOR(95%CI)=1.67(1.13-2.49)].Conclusion: The presence of cardiovascular co-morbidities dictated the frequency of reported symptoms and severity of COVID-19 infection in this sample of Ghanaians. Physicians should be aware of the presence of co-morbid NCDs and prepare to manage effectively among COVID-19 patients

Sociodemographic and clinical characteristics of the first cohort of COVID-19 recoveries at two national treatment centres in Accra, Ghana

Introduction COVID-19 is a new disease, knowledge on the mode of transmission and clinical features are still evolving, new tests are being developed with inherent challenges regarding interpretation of tests results. There is generally, a gap in knowledge on the virus globally as the pandemic evolves and in Ghana, there is dearth of information and documentation on the clinical characteristics of the virus. With these in mind, we set out to profile the initial cohort of COVID-19 patients who recovered in Ghana. Methods: We reviewed clinical records of all confirmed cases of COVID-19 who had recovered from the two main treatment centres in Accra, Ghana. Descriptive data analysis was employed and presented in simple and relational tables. Independent t-test and ANOVA were used to determine differences in the mean age of the sexes and the number of days taken for the first and second retesting to be done per selected patient characteristics. Results: Of the 146 records reviewed, 54% were male; mean age of patients was 41.9 ± 17.5 years, nearly half were asymptomatic, with 9% being severely ill. The commonest presenting symptoms were cough (22.6%), headache (13%) and sore throat (11%) while the commonest co-morbidities were hypertension (25.3%), diabetes mellitus (14%) and heart disease (3.4%). Conclusion: COVID-19 affected more males than females; nearly half of those infected were asymptomatic. Cough, headache and sore throat were the commonest symptoms and mean duration from case confirmation to full recovery was 19 days. Further research is required as pandemic evolve

Prevalence of pneumonia by chest x-ray, associated demographic characteristics and health risk factors among COVID-19 patients in Ghana

Objective: The study was conducted to determine the prevalence of radiologically diagnosed pneumonia among COVID-19 patients and associated factors.Design, setting, and participants: A retrospective manual data extraction of 275 medical records of COVID-19 patients was conducted at two COVID-19 national treatment centres in Accra from March to May 2020. All patients had a chest x-ray done.Main outcome and analysis: The main outcome was the presence of pneumonia. Descriptive statistics and Chi-square test of independence were employed to determine the associations between independent variables and the presence of pneumonia. All analysis was performed using Stata 16, and a p-value ≤ 0.05 was deemed significantResults: The prevalence of pneumonia was 44%(95%CI) =38.2-50.0). Chi-square independent test indicated that pneumonia in the COVID-19 patients was associated with educational level, history of domestic and international travel, mass gathering in the past 14 days before diagnosis, and discharge plan (p-value< 0.05). Patients classified as secondary cases (61.5%) and those discharged as fully recovered from the health facility (61.2%) had a higher prevalence of pneumonia. In addition, COVID-19 patients with hypertension (32.1%) and asthma (5.2%) had a significantly higher prevalence of pneumonia.Conclusion: Overall, the prevalence of pneumonia was 44% and was associated with the demographic and personal characteristics of the patients. Early detection through contact tracing and community surveillance should be intensified to pick up more asymptomatic cases. The role of the chest x-ray for triaging patients and for clinical management of symptomatic patients remains key

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Invasive disease and paediatric carriage of Streptococcus pneumoniae in Ghana.

This study was carried out primarily to evaluate the public health burden related to Streptococcus pneumoniae in Ghana and to provide related preliminary molecular epidemiological data on the organism. Invasive and nasopharyngeal specimens were screened for S. pneumoniae, and isolates were subjected to serotyping, multilocus sequence typing (MLST) and antibiotic susceptibility testing. Overall, the prevalence of S. pneumoniae in cerebrospinal fluid (CSF) was 1.7%, in blood was 0.2%, and in nasopharyngeal specimens was 15.3%. The prevalence of multiple drug resistance among the isolates was 48.6%, while the percentage resistance to various drugs was in the range of 11.1-84.0%. Serotyping of the S. pneumoniae isolates showed 7 different serotypes (3, 6B, 9, 10, 14, 16 and 23F). The extent of coverage of serotypes by the 7-valent pneumococcal conjugate vaccine was 57.1%, for the 10-valent vaccine was 57.1%, and for the 13-valent vaccine was 71.4%. MLST of 7 housekeeping genes of the organism showed a high level of genetic diversity among the isolates. S. pneumoniae appears to be an important organism in invasive infections in Ghana, being the most prevalent organism in CSF in this study. The high multiple drug resistance of the organism observed heightens the public health burden, which may be controlled by pneumococcal conjugate vaccines to a large extent

Interindividual variability in pharmacokinetics of generic nucleoside reverse transcriptase inhibitors in TB/HIV-coinfected Ghanaian patients: UGT2B71c is associated with faster zidovudine clearance and glucuronidation

There are limited data on the pharmacokinetics of generic nucleoside reverse transcriptase inhibitors (NRTIs) in native African populations, in whom they are commonly used. The authors characterized the pharmacokinetics of lamivudine (n = 27), zidovudine (n = 16), and stavudine (n = 11) in human immunodeficiency virus (HIV)/tuberculosis (TB)-coinfected Ghanaians and evaluated associations between zidovudine metabolism and UDP-glucuronosyltransferase (UGT) 2B7 polymorphisms. Lamivudine, zidovudine, and stavudine apparent oral clearance (CL/F) values (mean +/- SD [% coefficient of variation [CV]) were 7.3 +/- 2.8 (39%), 31.9 +/- 33.6 (106%), and 16.4 +/- 5.8 (35%) mL/min/kg, respectively, whereas half-life values were 4.2 +/- 1.9 (46%), 8.1 +/- 7.9 (98%), and 1.5 +/- 1.0 (65%) hours, respectively. Zidovudine CL/F was 196% higher (P = .004) in UGT2B7*1c (c.735A>G) carriers versus noncarriers. This was confirmed using human liver bank samples (n = 52), which showed 48% higher (P = .020) zidovudine glucuronidation and 33% higher (P = .015) UGT2B7 protein in UGT2B7*1c carriers versus noncarriers. In conclusion, generic NRTI pharmacokinetics in HIV/TB-coinfected Ghanaians are similar to other populations, whereas the UGT2B7*1c polymorphism may explain in part relatively high interindividual variability in zidovudine clearance

Pharmacokinetics of Efavirenz when Co-administered with Rifampin in TB/HIV Co-infected Patients: Pharmacogenetic Effect of CYP2B6 Variation

The goal of this study was to determine the effect of CYP2B6 genetic variation on the steady-state pharmacokinetics of efavirenz (600 mg/day) in TB/HIV co-infected patients receiving concomitant rifampin, a potent CYP inducer. In the 26 patients studied, CYP2B6 c.516GG, GT and TT genotype frequencies were 0.27, 0.50 and 0.23, respectively. Mean plasma efavirenz area-under-the-curve was significantly higher in patients with CYP2B6 c.516TT than in those with GT (107 vs. 27.6 μg.h/mL, P < 0.0001), or GG genotype (107 vs. 23.0 μg.h/mL, P < 0.0001). Apparent oral clearance (CL/F) was significantly lower in patients with CYP2B6 c.516TT than in those with GT genotype (2.1 vs. 8.4 mL/min/kg, P < 0.0001), and GG genotype (2.1 vs. 9.9 mL/min/kg, P < 0.0001). No differences in efavirenz exposure or CL/F existed between patients with CYP2B6 c.516GT and GG genotypes. Our results indicate that CYP2B6 c.516TT genotype can be used to identify efavirenz poor metabolizers in patients co-treated with rifampin